Essential hospitals face barriers in providing care to immigrant populations. They must find unique ways to address the complexity surrounding immigration status for their patients. Our friends at the National Immigration Law Center agree – Health Policy Attorney Gabrielle Lessard shares her thoughts.
A recent Commonwealth fund survey shows that 9.5 million previously uninsured people got coverage under the Affordable Care Act (ACA). While this is good news, many more members of our communities remain without insurance.
A substantial majority of these remaining uninsured live in low- and moderate-income households. They include families whose income falls below the tax filing threshold, and those without an affordable offer of coverage. They also include people excluded from the ACA because of their immigration status, both undocumented immigrants and recipients of deferred action for childhood arrivals.
Immigrant populations and others without health insurance are less able to manage chronic conditions and more likely to be diagnosed with a disease after it has progressed. They often forgo needed care, or delay seeking care until their symptoms become intolerable. When they receive treatment they frequently have poorer outcomes.
When uninsured patients avoid medical treatment until confronted with an emergency, hospitals expend resources treating conditions that could have been prevented or treated in less costly settings. As we face a decline in resources for the essential hospitals that care for our most vulnerable, it becomes important for hospitals to increase their focus on promoting and maintaining wellness within their service areas.
Moving Beyond the Hospital Walls
Hospitals should engage community-based health educators, and strive for increased integration with other community resources, such as community and school-based health centers. This is particularly important for reaching immigrants, who face significant language and other socioeconomic barriers to accessing health care by traditional paths. Non-profit hospitals could use their Community Health Needs Assessment processes to map community resources and develop plans for strategic alliances. These alliances could, in turn, be supported by community benefits funds.
In states pursuing Section 1115 Medicaid waivers, hospitals should advocate for delivery system reforms, such as the establishment of accountable care organizations that promote integration across the health care system and provide incentives for improving population health outcomes.
Essential hospitals can reduce unnecessary emergency services by diverting non-urgent patients to primary care, and reduce readmissions by coordinating discharge plans with primary care providers. Many details will need to be worked out, but hospitals can lead their communities in developing more integrated care that promotes the efficient use of limited safety net resources, improves community wellness, and reaches immigrants and other disadvantaged people.
Join the Conversation
Immigrants face complex challenges to accessing care and staying well, including language, cultural, and other sociodemographic barriers. America’s Essential Hospitals has established an online forum on immigrant health issues – join me and your colleagues in the group!