As Congress debates immigration reform, policymakers should heed the strong public health and fiscal arguments for eliminating legal obstacles to affordable public and private health insurance coverage for immigrants, according to a new Guttmacher analysis. Among many other benefits, such policy changes would improve immigrant women's ability to obtain the full scope of contraceptive services and supplies, comprehensive maternity care, and a range of other preventive health services.

"For nearly two decades, numerous federal and state policies have created barriers to health insurance coverage for millions of individuals residing in the United States with varying immigration statuses," says Kinsey Hasstedt, author of the analysis. "These restrictions foster harmful—and ultimately self-defeating—disparities, including in access to sexual and reproductive health services. This in turn not only jeopardizes the health and economic well-being of immigrant women and families, but further entrenches systemic health and economic disparities for future generations of Americans."

Hasstedt tracks how rising anti-immigrant sentiment in the 1990s contributed to today's patchwork of policies under which millions of immigrant women and their families are effectively blocked from obtaining health insurance. Among women of reproductive age, 45% of the 6.6 million noncitizen immigrants are uninsured, compared with 24% of naturalized citizen immigrants and 18% of U.S.-born women. Among reproductive-age women with incomes below the federal poverty line, fully 60% of noncitizen immigrant women lack health insurance.

Lack of insurance coverage constrains immigrant women's ability to obtain preventive sexual and reproductive health care services, ultimately denying them—and their families, communities and the nation as a whole—the broader social and economic benefits associated with that care.

"In the end, it's not just public health that suffers from these misguided restrictions, but also the nation's fiscal health," says Hasstedt. "For instance, it is well documented that coverage of contraceptive services is at least cost-neutral, if not benefit-generating. And other preventive services, like prenatal care and STI prevention, can likewise reduce long-term health expenditures."

The analysis recommends that efforts to reform U.S. immigration policy frontally address the health insurance and health care needs of immigrant women and their families by:

• ensuring that the 11 million currently undocumented individuals who gain provisional status through immigration reform are considered "lawfully present" for all purposes;
• enabling all lawfully present individuals, including those with DACA status (the DREAMers) and any new status created in immigration reform, to access Medicaid and CHIP without the current "five-year ban" or any other waiting periods; and
• enabling all lawfully present individuals, again including those with DACA and provisional statuses, to obtain coverage through the Affordable Care Act's health insurance exchanges that will become operational in 2014 and receive income-based subsidies to make this coverage affordable.

"Unfortunately, the immigration reform debate—at least up until now—has largely given short shrift to the legitimate health insurance and health care needs of our nation's immigrants, including coverage and care related to sexual and reproductive health," says Hasstedt. "It would be short-sighted of policymakers to let yet another opportunity to invest in the health and economic stability of immigrant women and families, and that of our nation as a whole, slip by."

Read the full article here: "Toward Equity and Access: Removing Legal Barriers to Health Insurance Coverage for Immigrants," by Kinsey Hasstedt

Also in this issue of Guttmacher Policy Review:

"What Women Already Know: Documenting the Social and Economic Benefits of Family Planning," by Adam Sonfield;

"Besieged Family Planning Network Plays Pivotal Role," by Rachel Benson Gold;

"Medication Abortion Restrictions Burden Women and Providers—and Threaten U.S. Trend Toward Very Early Abortion," by Heather Boonstra;

"In Search of Breakthroughs: Renewing Support for Contraceptive Research and Development," by Sneha Barot