New Society for Medical Anthropology “Takes a Stand” Statement on Health Insurance Reform

The Critical Anthropology for Global Health interest group within the Society for Medical Anthropology (SMA) regularly asks its members to “take a stand” on a contemporary health issue. In 2008/2009, this initiative focused on Unauthorized Im/migration and Health, which led to the development of the AccessDenied blog and related publications.

The current working group on Global Health Insurance Reform has announced that a preliminary SMA “Takes a Stand” statement on health insurance reform is now publicly available for comment on the SMA website. The statement’s primary goal is to analyze health insurance reform in the U.S. through the lessons learned from transformations of health care systems worldwide. This analysis is situated within the context of broader theoretical questions about recent neoliberal changes in both health care and the state, and about the social contract in general. In the spirit of making this initiative a true dialogue, the statement was built upon many of the points made in mini-statements contributed over the last several months by medical anthropologists with regional and topical expertise. Direct links to these mini-statements are included in the document.

This is just the first step of the process. All are invited to read the statement and leave comments by clicking on the “Leave Comments/Feedback” link in the upper left-hand corner of the webpage to share your comments, ideas, and suggestions.

Benefits vs. Ethics? Re-Assessing Healthcare Access for the Undocumented in France – Stéphanie Larchanché

Stéphanie Larchanché
IRIS-EHESS and Centre Françoise Minkowska, Paris

In March 2010, the French National Assembly voted to further limit healthcare access to the undocumented. Since 2001, State Medical Aid (AME) has provided undocumented immigrants living in France with free healthcare coverage. To be eligible for AME, one must provide proof of residence in France for a minimum of three months and evidence of limited monthly income (below 634 euros). Soon after this arrangement was created, however, additional restrictions were added as requirements for access to AME including presentation of a valid government-issued ID, presentation of a housing certificate – which can only be received via specific state-mandated social services – and a mandatory minimum service fee for health services. On March 2nd, 2010, following discussions on budget restrictions, center-right Assembly representative Dominique Tian proposed still more limitations on AME, including the addition of a 30 euro application fee and additional restrictions on covered healthcare services. According to Tian, «If one is willing to pay several thousands of euros to come to France, I doubt that a 30 euro application fee will prevent one from accessing care.»

Access Not Denied? The Role Localities Can Play – Helen B. Marrow

Helen B. Marrow
Universities of California at Berkeley and San Francisco

Mounting evidence shows that rather than overusing healthcare services, as both the American public and its elected officials frequently allege, unauthorized immigrants actually suffer from serious healthcare disparities.[i] A few localities around the United States have implemented noteworthy measures to improve unauthorized immigrants’ healthcare access and reduce these disparities.  My research from San Francisco demonstrates how, and why, such measures work.

Unauthorized immigrants have long been deemed “undeserving” of most forms of health care in the United States, especially since the mid-1970s, when the first legal status restrictions on a variety of government programs, including Medicare and Medicaid, were enacted (Fox 2009). 

News Round-Up (12/23/09) – Unspeakable Exclusion: Immigration and the Politics of U.S. Health Care Reform

Sarah S. Willen (SMU) & Nolan Kline (University of South Florida)

Although politicians on both the right and the left have expressed their reservations, the legislative push to pass health care reform before Christmas eve appears to be moving forward at full steam – importantly, without any substantive discussion of whether excluding unauthorized migrants and immigrants makes sense.

However the chips fall, we are left with one key take-home lesson from this lengthy, dramatic legislative saga: Americans of all stripes are, and remain, woefully ignorant about the scale and scope of unauthorized migrants’ and immigrants’ health needs; about the interconnectedness among im/migrants’ health concerns and those of citizens and authorized residents; and about the reasons – practical, financial, legal, and ethical – why helping im/migrants obtain health care might be in the collective best interest.

During the most recent debate, a few rare voices have bucked this trend. In a New York Times op-ed titled “Coverage Without Borders”, for instance, Cardinal Roger Mahony, Archbishop of Los Angeles, argues that,

Medical Deportation: Outsourcing “Removal” to Private Hospitals – Luis F.B. Plascencia

Luis F.B. Plascencia
Arizona State University

Since at least 2001, an important phenomenon has emerged that has drawn some attention from the media but remains to be more fully examined by anthropologists and other social scientists: the actions of local private hospitals to remove/deport “undocumented” migrants from U.S. territory without interference from federal agencies. These actions appear to have involved primarily migrants from Central American and Mexico.

The passive role adopted by the Bush administration and now the Obama administration, and the generally unpublicized efforts by hospitals involved, mean that an unknown number of migrants have been involuntarily and “voluntarily” deported/removed despite the accepted principle of Federal preemption in the regulation of migration.

News Round-up (12/5/09)

Sarah S. Willen
SMU

As the U.S. Congress wrestles with President Barack Obama’s proposal for system-wide health care reform, “illegal” immigrants’ overwhelming lack of health insurance coverage has become a matter of heated national debate. The debate erupted full-force in September when Representative Joe Wilson’s (R-SC) interrupted President Obama’s presentation of his health care plan before a joint session of Congress. In response to Obama’s declaration that unauthorized immigrants would be excluded from the planned reform, Wilson issued his now-infamous accusation of the President: “You lie!” This highly publicized breach of Congressional etiquette, and the media frenzy that ensued, say much about how American politicians, and the American public, think about unauthorized im/migrants’ health.

Illegal Immigrants as the Last Frontier of Welfare – Didier Fassin

 

Didier Fassin
Institute for Advanced Study, Princeton

This is a note of circumstance in two ways. First, it was written as the prelude to a lecture on “Global Health” delivered at the Conference of the Society for Medical Anthropology at Yale University in September 2009; it must therefore be placed in this broader perspective. Second, it refers to a scene I found significant in the early period of the debate around health care reform in the United States. However, I do not want to be seen as following the crowd of critics of this courageous and indispensable reform always deferred. Thus this fragment must be considered simultaneously within this specific context and outside of it, since it is meant to evoke the larger question of which members a society may exclude from its solidarity (and I refer here to “members” because people who live, work and die in a given society can claim membership whatever their citizenship and status).

Health Care Reform Is Intimately Linked to Immigration Reform – Peter Guarnaccia

Peter J. Guarnaccia
Rutgers University

As a long-term advocate of universal health care, I am cautiously optimistic that current bills will make a positive difference for many. But as someone who has rapidly become more involved with transnational Mexican communities and their health issues, I am dismayed by the current refusal to include unauthorized immigrants in the health care plan.

In preparing our book, A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship (2006), Keith Wailoo, Julie Livingston and I organized two conferences to discuss issues of organ transplantation, Latinos in the U.S. health care system, and rights to medical care. I came to this project amazed that Jesica Santillan, an 18-year-old undocumented Mexican immigrant who had come to the U.S. explicitly to try to get a heart-lung transplant, had managed to receive such a procedure.

“You Lie!”: Going Beyond the Obama-Wilson Debate – Josiah Heyman

Josiah Heyman
University of Texas at El Paso

Representative Joe Wilson famously interrupted President Obama’s health care speech to Congress by shouting “you lie,” just after the President had said that proposed legislation would not provide access to health insurance for undocumented immigrants.  Factually, Wilson was wrong.  The legislation indeed restricts the undocumented from receiving its benefits.  But the central assumption of the debate itself is wrong.  Obama claimed that a rigid line had been drawn; Wilson that it was not rigid enough.  But on close examination the rigid line fades from sight.

In public health, our fates are connected.  The H1N1 flu is a mild reminder of this.  When there is a more severe pandemic, we will regret frightening off and making access hard for any of our biological neighbors.  To offer a different, but I hope even more persuasive angle: health care access is a matter of mutual moral obligations, a network of ties accumulated throughout society.  I know a 100-year-old woman, still in good health but needing a bit of attention.  She herself is an immigrant, a citizen and retiree after years of marginalization and hard labor.  Her caregiver is undocumented, undergoing the same life of sweat and stigma in the present day.  They owe each other their existence.  They depend on each other for their health.

Immigrant Health: Shamans, ‘Soul Calling’ and the Uninsured – Jennifer Hirsch & Emily Vasquez

Jennifer S. Hirsch & Emily Vasquez
Mailman School of Public Health, Columbia University

What a bitter irony to read about hospitals’ growing willingness “to consider patients’ cultural beliefs and values.”  In “A Doctor for Disease, a Shaman for the Soul” (September 19, 2009) the New York Times describes the integration of Shamans and their traditional healing practices, including “soul calling” and chanting, at a hospital in Merced, California, that serves patients from a local Hmong community. The program, meant to build understanding between the Hmong and the medical establishment, exemplifies an approach “being adopted by dozens of medical institutions and clinics across the country that cater to immigrant, refugee and ethnic-minority populations.”