Ensuring access to reproductive health care for both immigrants and low-income American citizens should be a priority in the renewed public debate around comprehensive immigration reform. Previous attempts to curtail immigrants’ access to health care had damaging—and largely unintended—effects, including a steep decline in Medicaid enrollment among eligible legal residents following welfare reform in 1996, and new barriers that also affected American citizens resulting from Medicaid’s new proof-of-citizenship requirement, according to “The Impact of Anti-Immigrant Policy on Publicly Subsidized Reproductive Health Care,” by Adam Sonfield, published in the Winter 2007 issue of the Guttmacher Policy Review.

“Our analysis suggests that policymakers must be mindful of two problems that surfaced during previous attempts to curb immigrants’ access to health care services,” says Adam Sonfield, senior public policy associate with the Guttmacher Institute. “First, these laws tend to inflict considerable collateral damage beyond the targeted groups of immigrants. And second, even if these policies work as planned, the wisdom of denying anyone—even illegal immigrants—critical health services, especially reproductive health care, is questionable given the severe repercussions for women, children, families and society.”

In the 1996 welfare reform legislation, Congress mandated that legal immigrants must live in the United States for at least five years before they are eligible for federally funded services under Medicaid, including family planning services and pregnancy-related care. Not surprisingly, Medicaid enrollment fell among the targeted group of recent immigrants. However, it also dropped substantially among eligible long-standing residents, who are now only half as likely as U.S.-born citizens to have Medicaid coverage and 70% more likely to be uninsured.

On top of previous restrictions, a 2006 law requires states to ensure that Medicaid enrollees who claim to be citizens provide documentary proof. “Millions of low-income American citizens now find themselves ensnared in the bureaucratic red tape of anti-immigration laws,” Mr. Sonfield notes. “Delays caused by the time, difficulty and expense of obtaining a passport or other required documentation are especially problematic for pregnant women who need prenatal and other time-sensitive care.”

The analysis concludes that although anti-immigration sentiment remains strong among many policymakers and constituents, Congress should resist the temptation to cater to this viewpoint and, instead, reassess the wisdom of denying immigrants access to critical health services. “Ultimately, is it really in the national interest to deny prenatal care to immigrant women whose babies will be U.S. citizens?,” asks Sonfield. “Who benefits from withholding contraception or services for communicable diseases such as HIV from immigrants?”

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The many benefits of expanding Medicaid coverage for family planning services.

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