Why don’t immigrants understand healthcare coverage?

healthcare coverage

Language is not the only barrier that Arabs, Latinos, Asians, and other immigrant populations in the United States have to face when it comes to navigating the healthcare insurance maze. The culture and societal customs of their countries of origin also add to the Babel-like confusion. The Affordable Care Act requires all immigrants except illegal aliens -who probably have bigger problems anyway- to get insurance. In fact, that may be one of the reasons that many of them come to the U.S. in the first place, and one would think they’d be happy to be treated like most American citizens who are also required by law to buy health insurance.

Getting them to enroll is not even the problem. The cultural shock actually comes when immigrants are asked to pay out-of-pocket to see a doctor or for a laboratory test, to which they may reply that they have already paid their monthly insurance premium. The healthcare lingo is filled with terms as those, as well as others like copayment or deductible, which often have definitions but seldom meanings, even for Anglophones but especially for non-English speakers. Attempting to translate these concepts is sort of like Willard Van Orman Quine’s example of trying to translate the phrase “neutrinos lack mass” into a New Guinea highlands language. “This whole concept of insurance doesn’t exist in the Eastern world,” public health manager for the Arab Community Center for Economic & Social Services (ACCESS) Madiha Tariq explained to PBS. “People are always confused about the health care system when they come to this country.” ACCESS is a not-for-profit agency that caters to Yemeni, Lebanese, Iraqi, Bangladeshi and Syrian immigrants.

It’s bad enough that immigrants don’t understand, but it’s worse when they misunderstand. “They call us and say, ‘it’s a scam’,” insurance navigator for ACCESS Rawha Abouarabi says. Then again, they may think that the entire notion of healthcare coverage is a scam regardless. “Iraqis don’t believe in insurance,” ACCESS case manager and refugee from Iraq Hasanain Al Ani says. He adds that Iraqi people are used to government-sponsored healthcare where, for instance, “I only have to pay $15 and do not have to wait as long,” according to an uninsured anonymous refugee from Bagdad quoted by PBS. Waiting times in Iraq are based on socioeconomic status. This person couldn’t afford to pay $70 for the same service in Dearborn, Michigan and didn’t qualify for Medicaid because she hasn’t been in the U.S. for a minimum of five years. As a result, she had to wait her sore throat out.

The issue is compounded when it comes to people who need regular care to treat chronic conditions. ACCESS provides cancer screenings among other services, but “we have ladies who have never had a mammogram,” bemoans Tariq. “Cancer is stigmatized in the Arab culture. (Women) were scared no one would marry their daughters if others found out they were diagnosed.” In order to address this concern, ACCESS has an unmarked door through which women can sneak undetected into the screening area and get a mammogram. Additionally, the agency distributes a brochure among Arab American women stressing the importance of cancer prevention and how to screen themselves, and helps women diagnosed with cancer with survivors, so that the latter can assist and support the former.

Legal immigrants have the same rights and obligations as American citizens as far as healthcare insurance goes. They can use the ACA’s online exchanges to enroll and check whether they qualify for federal subsidies, and may be penalized if they fail to get coverage. Nevertheless, non-citizens are thrice as likely to be uninsured as citizens. Fortunately, there are success stories too. Forty-eight year old diabetic Najwa Dahdah cancelled her insurance policy when her monthly premium increased by $500 dollars when she was diagnosed with diabetes at the same time as she became pregnant with her third child. She was in dire straits managing her condition, but after signing up under Obamacare she and her husband get a $430 subsidy, and their children are eligible for Medicaid.

Related Read: Get Insurance in the U.S., see a doctor in Mexico