Bar to a Healthy Future: Stories of Immigrant Children Left Behind

Resource: An excerpt from Bar to a Healthy Future: Stories of Immigrant Children Left Behind
by Julie Chinitz & Gerald Smith, Health Rights Organizing Project (June 2007)

Available at:

Access to quality health insurance makes a big difference in children’s lives. Before 1996, all children residing lawfully in the U.S. qualifi ed on equal terms for Medicaid, the country’s major health coverage program. That year, however, Congress established a host of restrictions on immigrants’ enrollment in federal programs, including Medicaid. One of the Medicaid restrictions is a “five-year bar” on eligibility. In 1997, Congress passed the State Children’s Health Insurance Program (SCHIP) – taking a major step toward eliminating uninsurance among children – but the bar remains in place. Ten years later, SCHIP is up for reauthorization, and Congress has a unique opportunity to restore health coverage through Medicaid and SCHIP to the children left behind in 1996.

All children should have a chance at a healthy future.

Health care is an essential part of all childrenʼs future. Without it, they don’t grow and develop to their full potential. Denying children their health closes the doors to opportunity, bestowing on them a harmful lifelong legacy.

Insurance plays a critical role in health. According to the Institute of Medicine, lack of continuous health coverage results in “lost health and longevity, including health defi cits leading to developmental and educational losses for children.”

Recent statistics reveal shocking discrepancies in the quality of care children receive when they have no health coverage. Uninsured children hospitalized for injuries are twice as likely to die in the hospital as are insured children. When taken in with a traumatic brain injury, their length of stay is three days shorter. They are five times more likely to have a delayed or unmet health care need.

Children of color deserve healthy futures, too.

Ensuring a healthy future for every child requires reversal of a troubling trend: the shocking scarcity of insurance for children of color. Of the nine million uninsured children in the United States, over half are either Latino or African American.

Although lack of quality, affordable coverage remains a threat for all low-income children, the racial disparities are alarming. Overall, the uninsured rate for Latino children is almost three times that for white children. African American children are almost twice as likely – and Asian children more than one and half times as likely – to lack coverage. Children of color constitute about 42 percent of all children, but 62 percent of all uninsured children.

The failure to ensure access to health insurance for all our children contributes to persistent racial and economic inequities. Often, the only jobs available for parents of color pay low wages and offer no benefits. Placing quality coverage disproportionately out of reach for children of color only compounds these inequities.

Public health coverage programs make a difference in childrenʼs lives. The number of children without insurance would be almost four times greater if not for the country’s public investment in health coverage. Through Medicaid and SCHIP, the federal government provides matching funds that allow states to provide coverage to children. Approximately 34 million now have insurance as a result. These children receive well-child checkups, treatment for illnesses and injuries, eyeglasses, braces, and other care they otherwise would have to go without. Medicaid and SCHIP have made a difference in their lives. Many others, however, are still being denied the opportunity to enjoy the benefits of these programs.

Children’s health insurance is in Congress’ hands.

In 1996, Congress closed the door to coverage for many immigrant children. Before 1996, noncitizen children and pregnant women lawfully living in the U.S. qualified for Medicaid on equal footing with their citizen counterparts. That year, however, Congress passed immigration and welfare laws that severely restricted immigrants’ eligibility for public health coverage.

Among these restrictions is the “five-year” bar. The bar prevents states from offering Medicaid and SCHIP to most immigrants, including children and pregnant women, who have had their lawful permanent residence (“green card”) or other specified statuses for less than five years.

These restrictions are so complex that many people are excluded from the programs even when they are eligible. Workers at government agencies often do not understand the rules. As a result, they reject immigrant applicants who should be able to receive coverage. In other cases, eligible immigrants believe they don’t qualify and never apply.

Due to the bar, many immigrant children and pregnant women – no matter their family income – are shut out of the health coverage that would make a critical difference for their futures. By recent estimate, roughly 400,000 to 600,000 low-income children would be able to enroll in Medicaid and SCHIP if not for the five-year bar and related restrictions.

In 1997, Congress spurred real progress toward insuring all children.
Congress established SCHIP in 1997, recognizing the lifelong importance of health insurance. The program received strong bipartisan support, and once it was enacted each state took advantage of the opportunity to expand children’s coverage. The support for SCHIP among lawmakers has been echoed by the public in general. Overwhelmingly, Americans believe the investment in children’s coverage has been a wise one.

In just 10 years, SCHIP, along with its larger companion program Medicaid, has achieved remarkable successes. Between 1997 and 2005, the uninsured rate among lowincome children dropped by a third, from over 22 percent to 15 percent. During this same period, as employer-sponsored coverage declined, uninsured rates among adults – who often cannot qualify for publicly-funded coverage – increased. If not for the improvements in public health coverage through SCHIP and Medicaid, children too would have joined the ranks of the uninsured. Instead, the nation made steady progress covering children.

But the law still leaves immigrant children behind. Despite these advances, the inequities of the 1996 immigration-related restrictions remain in place. These hurdles remain intact for immigrant families. As a result, at a time when Medicaid and SCHIP helped the country make signifi cant strides in reducing children’s uninsured rates, immigrant kids fell even farther behind.

Between 1995 and 2005, the proportion of low-income, non-citizen children without any health insurance grew by nine percent. Now, almost half are uninsured. Meanwhile, the uninsured rate for low-income children from U.S.-born families is 15 percent – still too high, but much lower than among those children’s non-citizen counterparts.

SCHIP reauthorization creates the opportunity to address this disparity. Our government should ensure access to health care for all our children.

Some states have filled in the gap, but most have not. Closing the door to coverage based on citizenship status leads to devastating results and contributes to alarming racial and ethnic disparities. Indeed, children of immigrant parents are over twice as likely as other children to be in reported fair or poor health.

Rather than allowing the five-year bar exclude their children and pregnant women from coverage, a number of states have filled in the gap left by the federal government. They are using their own funds to provide insurance to immigrant children. One state, New York, has recognized this as an obligation under its constitution.

Lacking federal matching funds, though, most states are not covering those left behind by the federal government. Children in these states are going without health care during the most critical developmental years of their lives.

An opportunity exists to renew and expand our investment in health. Congress is now drafting legislation to reauthorize SCHIP, which must be renewed by September 2007. The national conversation over the future of SCHIP provides a unique opportunity to advance a commitment to the future of all our children.

Congress can take an important step in this direction by lifting the five-year bar and eliminating other restrictions that close the clinic doors for so many children. Federal lawmakers should follow the lead of states that have chosen to cover kids despite the 1996 restrictions, understanding that all our children deserve a chance at healthy lives. Meanwhile, states should take advantage of all available options to cover their kids.

Telling the stories of the children left behind.

This publication describes the experiences of just a few of the children who are left behind by the 1996 (pre-SCHIP) immigration-related restrictions. It also tells the stories of not-so-different children who have benefi ted from the wise investment in health insurance that should be available to all our young people.