By Dennis Cooley, MD, FAAP
KAAP Immediate Past President
One of the great things about being on the AAP’s Committee on Federal Government Affairs is that you get a better understanding of the broad issues facing our profession. Immigration is one such issue. I am sure many of you wonder why the AAP is expending time and effort on the problem of immigration. This is a divisive issue in our state with some groups such as agriculture and business advocating for more liberalized policies on immigration and others including our Secretary of State pushing for more restrictive laws. Why are we even getting involved in this?
First, let’s look at some of the facts. Immigrant children, defined as either foreign born or having at least one parent who is foreign born, represent the fastest growing segment of the U.S. population. One in every four children in our country is now living in an immigrant family. The majority of these children (89%) are indeed citizens. Immigrant children will be staying in this country and will be making up a large portion of our future workforce and adequate health care is vital in order for them to be successful and thrive. This is not just something happening in states surrounding our nation’s border. Kansas has large populations of various immigrant groups. For example, Kansas City is home to large numbers of Somali and Burmese immigrants as well as Hispanics. Immigrant populations are living in rural settings as well as urban centers. In some communities in the western part of the state, nearly 50% of their inhabitants are immigrants.
Immigrants and their children need access to affordable health care. Uninsured immigrant children are more likely to get their primary care from emergency rooms which are more costly and inefficient for these services. They are less likely to receive preventative services. It is in the interest of this country that we care for these children. As a result, the AAP has come out with a policy statement in the June issue of Pediatrics. It can be summed up as follows:
All children regardless of immigrant status should have access to comprehensive, coordinated, culturally and linguistically responsive and continuous health services provided in a quality medical home.
What are the challenges facings pediatricians as we provide this care? One is payment. While most of these children are Medicaid eligible for various reasons they are not enrolled. The result is poor or no payment for our services. If they go to the ERs then the hospitals have to adsorb the costs and as we all know these are eventually paid by all of us through cost shifting.
Another challenge is the language barriers. The cost of having interpreters is prohibitive to private practitioners. In many cases, the cost of the interpreters far exceeds the payments we receive. Finding trained medical interpreters is another problem.
Finally, helping families navigate the system in order to receive services many times falls on pediatricians and their staff. We are assuming the extra duties of being the social worker but we certainly are not getting paid for it.
Also attending the COFGA meeting was Dr. Pam Shaw. Dr. Shaw is a fellow Kansas Chapter Past President, current AAP District VI Chair and an AAP board member. She attends the COFGA meetings as the liaison from the board to our committee. Being from Kansas, she joins me in on visits to the staffs of our congressional contingent. Be assured at our visits these concerns and how they are affecting our state were among the many things we talked about. (For more about other topics we discussed see the legislative update in this newsletter). I must say, I was pleasantly surprised by the response we received from the congressional staffs on this issue. We actually met with not only staffers involved with health issues, but those who are focusing on immigration. Having these additional staff members come to meet with us says volumes about how important this issue has become. I also was pleased that they seemed to “get it” that these children need to be cared for. They also were attentive to the problems facing our members.
Will we get a new immigration law? The answer is yes. When it will happen is still up in the air. But there is a sense of urgency now on the hill about immigration reform. This is in no small part due to election results of 2012. If I would have addressed this topic at the offices of our elected officials before the 2012 elections, I can say for a fact our reception would have been drastically different. It is the Academy’s concern that in the process of immigration reform, children will be forgotten. It would do Congress and our nation well to follow the words of the AAP:
“The health, well-being and safety of children should be prioritized in all immigration proceedings.”