2008-09 AMSA Legislative Agenda

1. Congress must fund title VII and VIII of the US Public Health Service Act, and ensure equity in access to quality, affordable health care for communities of color and underserved populations.

Immigrant Health Background

A) As of 2005, nearly one-third of the U.S. population identified themselves as a member of a racial or ethnic minority group; by 2050, this share is expected to increase to nearly half 1.

Most immigrants come to the U.S. for access to employment, not health care. Legal and undocumented non-citizens accounted for 22% of nonelderly uninsured in 2006, and are proportionally more likely to be uninsured than citizens, but they are not the primary factor driving the nation’s uninsured problem: citizens make up 78% of the uninsured. Due in large part to higher rates of uninsurance, non-citizens receive significantly less health care than citizens. Since 1996, Federal law has generally prohibited undocumented immigrants as well as legal immigrants from receiving non-emergent Medicaid and SCHIP coverage for the first five years they reside in the U.S.

Even though non-citizens have poorer access to care and receive less primary care than citizens, they are significantly less likely to use the emergency room than citizens: as of 2008, some 13% of adult non-citizens report an emergency room visit in the past year compared to 20% of citizens 2.

AMSA believes it is time to move beyond merely chronicling health disparities, to working to address health equity. For too long the burdens of poor health have been distributed along racial, social and economic lines. Health disparities are a symptom of the underlying problems of prejudice and injustice that continue to persist in our society. By focusing on an ethics-based approach to eliminating health disparities at their roots, we can achieve health care for all in America.

Migrant. Broad term defining most people who move to a foreign country for a certain period usually over a year long (not tourists or business travelers), for a variety of reasons, commonly economic 3.

Immigrant. Someone who moves to a foreign country permanently 4.

AMSA Immigrant Health Position

A) Congress must pass the Legal Immigrant Children’s Health Improvement Act. AMSA believes that ensuring the quality and affordability of health care for migrants and immigrants is an integral part of our work to achieve quality, affordable health care for everyone.

Congress must amend title XIX (Medicaid) and XXI (Children’s health insurance) to allow states the authority to provide health care through these programs for eligible pregnant women and child resident aliens.

The Legal Immigrant Children’s Health Improvement Act of 2007 [H.R.1308] and [S.764] will accomplish this aim.

Workforce Diversity Background

B) Title VII and VIII programs focus on systemic problems with primary care, diversity, and workforce that AMSA members work passionately to improve.

In 1998, half of internal medicine residents chose primary care; currently, about 80 percent become subspecialists or hospitalists 5.

Since fiscal year (FY) 2006, the Title VII programs have struggled to recover from a 51.5 percent funding cut.

AMSA Workforce Diversity Position

B) Congress must pass the Health Equity and Accountability Act of 2007 [H.R. 3014] [no Senate companion due to weaker Kennedy/Frist bill]. This bill will strengthen health services and resources for community and rural health centers, enhance diversity in the healthcare workforce, promote cultural and linguistic competency, re-establish the Indian Health Service, and implement other initiatives to eliminate health disparities.  It is essential that we ensure these programs have sufficient resources to continue fulfilling their mission of educating and training a health care workforce that meets the needs of our complex society.

1 Kaiser Family Foundation. Update of Key Facts: Race, Ethnicity and Medical Care. January 2007. http://www.kff.org/minorityhealth/upload/6069-02.pdf
2 Kaiser Commission on Medicaid and the Uninsured: Key Facts. March 2008. http://www.kff.org/medicaid/upload/7761.pdf
3 UNHCR “Protecting Refugees” 2007-‐08
4 Ibid.
5 From the American Academy of Family Physicians, based on data from the National Resident Matching Program: The impending collapse of primary care medicine and its implications for the state of the nation’s health care. Washington, D.C.: American College of Physicians, January 30, 2006. (Accessed August 10, 2006, at http://www.acponline.org/hpp/statehc06_1.pdf)