Immigrants and Reproductive Justice

1. Immigrants and Reproductive Justice Lillian M. Hewko Law Students for Reproductive Justice Fellow, NHWN

2. 30 Regional Coordinators (RC’s) in 26 states and District of Columbia • National policy analysis, regulatory comments and advocacy, develop and share model state marketplace policies.

3. We will cover: • Intros • Reproductive (In)justice (activity) • Immigrants and Health Coverage • Barriers to Immigrant Women’s Health • RJ Responses

4. Intro Question: Where are your ancestors from?

5. Intro Activity Values Activity-3 min Pair share-2 minutes each

6. Immigration Values Activity People should be able to move across borders in order to live or work without limitations. The government should provide public benefits, such as basic health care coverage to all people within its borders who do not have the ability to pay for such coverage, regardless of citizenship or residency. Criminalizing individuals will help deter them from coming to the United States. Immigrants come to the US because they would rather live in the United States. The U.S. should be able to rely on immigrants to sustain the labor needs of our nation’s economy. Values Activity-3 min: Strongly Agree (SA), Agree (A), Disagree (D), Strongly Disagree (SD)

7. Immigrants in the U.S. • 40.3 million foreign born (13% of total population) • 18.1 are naturalized citizens (45% of immigrants) • comprise about 17% of labor force • 24.3% of children and 30.5% of low-income children have an immigrant parent • 87% of children of immigrants are US Citizens

8. Immigrants & Health Care Needs • More Likely to Be Uninsured • 46% of non-citizens are uninsured, compared to 15% or U.S. Born citizens • 45-55% of low-income immigrant children in the US are uninsured (but citizens make up bulk of the uninsured) • Use Less Health Care • Immigrants use less health care • Per capita, immigrant use of health services costs less than half the cost for average citizen

9. Who’s Eligible for Care? Naturalized Citizens and “Qualified Immigrants” • Includes LPRs, refugees, asylees, parolees, Cuban/Haitian entrants, certain domestic violence and trafficking survivors • If entered after 1996, must have held “qualified” status for 5 years +

10. Additional Coverage for Immigrant Women & Children 30+ states provide health coverage to additional immigrants through federal option (CHIPRA) to cover Lawfully residing children and pregnant women regardless of entry, or prenatal care to women regardless of status using CHIP funds 15 states use state money to cover gaps for lawfully residing immigrants

11. Health Coverage for Immigrant Children | January 2014 ME WA VT ND MT NH MI MA NY OR MN RI WI CT MI SD ID NJ PA WY OH IA DE WV VA NE MD DC IL IN NV UT CO KY CA CA KS MO NC TN SC OK AR AZ NM GA AL MS TX LA Alaska FL Hawaii

12. Health Coverage for Pregnant Women • 14 states provide Medicaid for pregnant lawfully residing immigrants regardless of entry • 18 provide prenatal care to women regardless of status using chip funds • Only 5 provide for children regardless of immigration status

13. Health Coverage for Pregnant Women | February 2014 ME WA VT ND MT NH MI MA NY OR MN RI WI CT MI SD ID NJ PA WY OH IA DE WV VA NE MD DC IL IN NV UT CO KY CA CA KS MO NC TN SC OK AR AZ NM GA AL MS TX LA Alaska FL Hawaii

14. Barriers to Immigrant Women’s Health Care

15. Locked Out: No Access • Undocumented Immigrants, temporary visa holders, DACA youth are: • Restricted from buying health insurance on the marketplace • Not eligible for tax subsidies • Few exceptions for emergencies (e.g. pregnancy)

16. Fenced In & Locked Out: Restrictions on Low-Income Lawfully Present Immigrants • 5 year Bar: lawfully present immigrants who entered the US after 1995 must have held “qualified” status for at least 5 years before they can receive Medicaid and CHIP • Limited Federal Coverage:can purchase via Exchange, eligible for tax credits & cost-sharing subsidies

17. Contradiction: Keep Out but Help Wanted • Immigrants work hard, pay taxes and contribute to our communities and the U.S. economy • Historical Shifts • 1993 Border Security • 1994 North American Free Trade Agreement

18. Immigrant Women & 1996 Welfare “Reform”

19. Immigrants and U.S. Economy

20. Reproductive Injustice • Separation of families • Lack of access to sexual, reproductive and maternal services • Exposure and lack of resources for physical and sexual violence

21. Perfect Recipe for Reproductive Injustice: Crystal’s Story

22. No Public Funding for Abortion Services Abortion Access • Some states allow Medicaid eligible women access to state dollars for to obtain abortion services • Citizenship requirements means no state abortion funding for undocumented or individual under 5 year bar

23. Repro Justice Legislative Responses

24. Federal Responses Health Equity & Access under the Law (HEAL) for Immigrant Women & Families Act of 2014 (H.R. 4240) Sponsored by Representative Lujan Grisham (NM-01) Seeks to remove harmful restrictions for lawfully present immigrants Restores access to coverage and allows lawfully present immigrants to receive health care

25. HEAL Act Section by Section Unique Repro Rights and Immigration Bill • Section 3—Removes Barriers to Health Coverage for Lawfully Present individuals • Removes outdated and restrictive list of “qualified immigrants” • These individuals would be able to access coverage through Medicaid or CHIP • Section 4—Removes Barriers to Health Coverage for Individuals Granted Deferred Action for Childhood Arrivals (DACA) program • These individuals would be able to access coverage through Medicaid or CHIP • Can also purchase on their own coverage the exchange, and get tax subsidy and cost-sharing benefits

26. State Responses to Attacks on Immigrant Health Coverage Lifting Restrictions on ALL Immigrant Access to Health Care • CA Health Care for All Act (SB 1005) • Will expand health coverage to individuals who are currently excluded through Medi-Cal if meet income requirements • Can also purchase on Exchange program

27. Take Action Contact Your Legislator and Ask them to Co-Sponsor!

28. Thank You! Contact Info: Lillian Hewko lhewko@nwhn.org