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									Integration or Isolation:
 Access to Services for

     EARN Conference
       Las Vegas, NV
       December 2008

        Tanya Broder
     A Historic Moment
Changing demographics and growing
 political participation visible across
Enforcement efforts increased, without a
 new pathway to lawful status.
Restrictions on services proposed, and
 in some states, implemented.
Immigration less successful as political
 wedge, but may still be used to derail
 debates on economic and social issues.
Integration strategies gaining ground.
 State and Local Choices
  In the absence of (or while waiting for)
  federal reform, will states invest in or
  impose restrictions on services for
  immigrants and their family members?

 Promote access to preventive care and
  other critical services, and immigrant
  integration or . . .
 Take steps to isolate and make life more
  difficult for immigrant families?
States and Counties Provide
  Services to Immigrants
 Almost all states take advantage of federal
  funds available to serve immigrants
 Half of the states provide services to at least
  some immigrants ineligible for federal
  Medicaid, SCHIP, TANF, Food Stamps or SSI.
 Many states and counties invest in preventive
  care for children, prenatal care, naturalization
  services, or other efforts to integrate
 But significant gaps remain.
 State Proposals to Restrict
     Access to Benefits
Hundreds of state bills proposed to restrict
 access to services for immigrants in 05-08.
The vast majority failed to pass, but the
 number of copycats grew each year.
The enacted laws had minimal legal effect,
 but imposed practical barriers.
Even where rules didn’t change, the debate
 generated fear and confusion that prevents
 eligible immigrants and citizen family
 members from securing critical services
     Enacted State Laws
 Arizona Prop. 200 (2004)
 Virginia (2005)
 Arizona, Colorado, Georgia (2006)
 Idaho, Oklahoma (2007)
 Utah, Missouri, South Carolina (2008)

 Eligibility generally not altered, but verification
  requirements imposed, with exceptions.
 Restrictive document lists harm US citizens
  and lawfully present immigrants; costly for
  agencies to administer.
      Local Measures
   Targeting Immigrants
Over 100 localities considered restrictions
 on private housing, services, employment,
 English only, police/ICE cooperation;
Legal challenges to landlord/tenant
 provisions successful to date;
Harm and costs of measures documented,
 rationales debunked; local governments
 began to reconsider
Climate profoundly affected,residents left,
 political and economic fallout
    Access to Education
Enrollment in post-secondary schools
 threatened in a few states
In-state tuition laws defended; state
 financial aid and scholarships pursued
Raids and enforcement measures add
 to fear and confusion, affecting
 attendance at primary schools and
 Head Start, as well as parents’
 willingness to seek services
      Documented Harm
CO - $2 million spent by state agencies (no
 savings), US citizens denied services.
OK – barriers/delays for citizens, harm to
 immigrants and broader communities;
 infant death.
AZ – drop in clinic visits, WIC, school
Local ordinances - litigation costs,
 burdens for landlords, businesses, added
 discrimination, harm to local economy.
Federal DRA – $8.3 million spent by 6 states
  to find 8 ineligible immigrants in caseload of 3.6
  million; tens of thousands of eligible US citizen
  children denied Medicaid.
   ID Issues for Citizens
Brennan Center for Justice Survey:
7% of US citizens do not have ready
 access to citizenship documents
11% of US citizens (more than 21 million
 individuals) do not have government issued
 photo ID
Seniors, persons of color, low-income
 citizens disproportionately affected. ID
 often does not reflect current information,
 particularly for younger citizens.
 Alternative: Invest in
Immigrant Integration
     Affirmative Policies
Improve access to health care and critical
 services for immigrants
Promote English, vocational English, job
 training, naturalization, civic participation
Enforce labor and civil rights laws, anti-
 discrimination and anti-retaliation policies
Reinforce confidentiality and victim/witness
 protection policies
Pressure federal government to return to
 state/locals taxes paid by immigrants by
 covering immigrants in federal programs.
     Address Barriers for
      Eligible Families
Education to clarify eligibility rules and
 address immigrant-specific concerns, such
 as public charge
Outreach strategies to reach eligible but
 not enrolled families
Limiting inquiries and documents requested
 from applicants, privacy messages
Practical strategies for ensuring access for
 individuals with limited English proficiency
Document the Benefits of
   Inclusive Policies
Improved access to care, individual and
 public health outcomes, school attendance,
 fewer work absences, increased
 productivity for parents
Broader engagement in efforts to protect
 health and safety, including law
 enforcement efforts
Civic participation leading to improvements
 in neighborhoods, schools and communities
   Monitor Immigrant
Issues in Health Debates
Ensure that coverage touted as universal
 doesn’t leave out subgroups of immigrants
Remove/minimize barriers for eligible
 immigrant families (confidentiality policies,
 outreach strategies, application forms)
Improve health care system generally, by
 addressing affordability, quality of care,
 cultural competence, and reducing health
  Health Care Implications of
     Immigration Debate
  Improving Immigration Status
  Increases Access to Coverage:
Undocumented immigrants often work
 in low-wage industries without
 employer-sponsored health insurance
Even when offered, insurance premiums
 may be too high for low-wage workers
Legalized immigrants may be able to
 move to jobs that are more likely to
 provide benefits and/or higher wages,
 improving ability to pay for health care
 Immigrants More Likely to Be Offered
Private Health Insurance as Legal Status

                           % Offered Employer-
                            sponsored Health


                    Undocumented     Lawfully     Citizen
                      immigrant      Present

Based on comparisons of insurance among Latinos in California, 1999-2001.
Enrico Marcelli (Harvard Univ.) Migraciones Internacionales, 2(4):5-36, Jul-Dec.
2004. Prepared by Leighton Ku of the Center on Budget and Policy Priorities
 Legalization as an Anti-
   Poverty Strategy:
Improves economic well-being of
 immigrants and family members
Promotes economic growth, increased
 wages, taxes and spending, improved
 workplace and community conditions, with
 positive impact on broader low-income
Creates political space for health care
 reform and other anti-poverty legislation

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