In the previous sections, I have shown that mothers state that undocumented children do
not have access to preventive healthcare and mostly rely on free or FQHC, emergency room
visits or the generosity of local doctors and providers. The following sections detail the impacts
of the lack of insurance on the children’s lives.
5.6.1 The consequences of delayed care
While the interviewed mothers were hesitant to elaborate on the consequences of home
remedies and self-medication, providers, on the other hand, were more forthcoming in explaining
the negative outcomes of delayed care. They shared stories that illustrate how the parental
decision to defer consultation with doctors about minor ailments could potentially lead to a more
complicated and expensive medical situation later on:
[T]uvimos el caso de un muchacho, un niño que no tenía seguro, dos casos (…) donde comenzaron a presentar síntomas de apendicitis con dolor abdominal con fiebre, que demoraron ir al médico, demoraron ir al médico, demoraron ir al médico, y en uno de ellos la condición que desarrolló fue peritonitis. Y eso significó una hospitalización de siete días con operación abierta, con una cantidad de antibióticos, y los costos elevadísimos. (Provider 4)
We had a case in which a kid did not have insurance… two cases actually where they started showing appendicitis symptoms, with abdominal pain, fever and they delayed going to the doctor, they delayed and delayed and in one of the cases the kid developed peritonitis. That meant a seven day hospital stay, with an open surgery, with a lot of antibiotics and very expensive costs.
All providers interviewed for this study agreed that the deterioration of a health problem and
expensive treatment are the two major implications of delayed care. As Graciela, Irene and
Carola said during the interviews, large medical bills are a huge financial burden for immigrant
Latino families. Even if the cost for a child’s treatment is eventually compensated by EMA, it
represents a drain on public funds, one that could have been avoided with timely primary care.
Provider 6 gave a couple of examples of the practical benefits of preventive medicine:
So, if you leave a child who has an ear infection that goes untreated and let’s say it ruptures and then the infection spreads to the brain. Now you are looking at someone hospitalized with very expensive costs that could have been prevented. So, very simple treatments upfront can prevent a lot of problems down the road. And the same things goes with immunizations so as long as these children are getting immunizations along the way, you are preventing a big problem down the road. You give them a flu shot now, it will prevent all the problems they would have gotten later.
According to providers, the exclusion of preventive care for uninsured children under the current
MA and SCHIP eligibility criteria has created a public health conundrum.
5.6.2 Persistent Chronic Conditions
Children with chronic conditions were especially at risk in the absence of health
insurance, as they were unable to receive regular medical attention and medication to keep their
symptoms under control. Provider 5 described two instances: one child who suffered from
repeated and severe tonsil infections and needed a tonsillectomy, and the other involved a girl
Irene, one of the mothers, shared that she had an uninsured son who diagnosed with
Attention Deficit Hyperactivity Disorder (ADHD). The monthly therapy sessions and daily
medications needed to treat this condition were expensive, but the lack of insurance meant that
Irene had to bear the expenses. Given the financial insecurity of most undocumented immigrant
families, Irene said she dreaded the moment she might not have enough money for the therapy
sessions or medications.
5.6.3 Early detection of health problems
Irene’s child could be considered fortunate as he was at least diagnosed with ADHD.
According to the health providers, uninsured children with access only to free or low-cost PHC
centers do not get to consult specialists or receive certain kind of tests. This often results in the
delay in detecting some types of developmental or speech deficiencies and, later, to receive
therapies to address those issues. Conditions such as autism are also difficult to diagnose if the
child is uninsured. According to the providers, these developmental conditions are likely to
become worse or harder to treat if left untreated for a long time.
5.6.4 Restrictions on school activities
The interviews with the providers and mothers revealed that uninsured children are
restricted from certain activities and denied some benefits at their schools. Graciela, one of the
mothers, was informed by her son’s school that it requires the students to have health insurance
before they are allowed to participate in any kinds of sports. Provider 5 recounted hearing a
mom “No, we cannot have your child play sports because she does not have health insurance.”
Graciela said she was once made to buy short-term insurance by the school so that her son could
participate in a school camping trip.
Besides the social isolation and reduced physical activity resulting from restricted
participation in sports and camping trips, limited access to dental and eye care also affects the
academic progress of uninsured children. Having toothaches can limit a child’s ability to
concentrate and eye problems can also affect them:
[Imagine not] being able to see the chalkboard (…) If you can’t afford to get glasses then you can’t see the board and that’s affecting your learning. And I think that, not being able to see a doctor that can help you may be with your diet or informing you about the benefits of exercise, and the importance of that might affect the eating habits of the family which in turn will come back to their health (Provider 3).