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Why as a nation are we so uncaring about the needs of all of America's children, especially the ones coming across the southern border seeking a better life?
I ask that question as a pediatrician, who has spent my professional career focused on the health and well-being of children. As such, I am deeply concerned that amid all the noise and hand-wringing about border crossings, we hear little or nothing about how we as a nation are going to meet the health care and other developmental needs of newly arriving immigrant children, as well as the cost to America from inaction.
Another reason I am so disturbed by this silence and lack of progress is because I am an immigrant myself. At age 7, I came to America from Cuba, via Nicaragua. As a doctor and immigrant, it's hard to be anything but extremely sensitive to the toll falling on children crossing the southern border, most escaping extreme poverty, persecution, violent neighborhoods, political strife, or a combination of all.
Their journey to the United States has likely been an arduous one, often across several countries and through rugged and dangerous lands. And their traverse comes on the heels of having already experienced stress and trauma no child should have to deal with during their formative years. Once here with their families or on their own, hoping to begin a new life, and one filled with promise, these children instead find themselves trapped in limbo, often for years, and forced to suffer more. Vulnerable psyches are further damaged from downright xenophobic comments and actions taken by the very U.S. agencies, both public and private, that purport to take a proper and humane process for determining residency status. This trauma, layered upon pre-existing hardships, results in life-long physical, emotional, and social ills.
It doesn't have to be this way. As a pediatrician, I know that when children receive comprehensive health care—medical, dental, mental, and social services—they stand the best chance to thrive and succeed. Access to that kind of care and support is out of reach for most immigrant children because of our current state and federal laws and regulations. Children without documentation are more likely than non-immigrant children to lack insurance and therefore forgo well-care visits.
In the pediatric field, well-care visits are specifically designed as opportunities for preventing disease from occurring, or once it has taken place, from getting worse. Lack of access to health care also comes with an economic price. It is far less expensive to provide preventive services than management and treatment of disease, particularly in emergency rooms—often the only health care available to children without legal documentation—where it is estimated that care can cost as much as 12 times more than a visit to a doctor's office.
Providing immigrant children access to comprehensive health care as soon as they enter our country will reduce unnecessary and costly emergency room visits and hospitalizations, improve health, and lower costs.
Our great and mighty nation—the United States of America—should want to make a discernible difference in the lives of every child who steps foot on our soil. We should want to ensure that all children, regardless of birthplace, have access to proper nutrition, shelter, emotional support, and access to comprehensive health care. We should be willing to make some necessary changes in current laws and policies. Otherwise, we must ask ourselves, what do we truly value as a nation?
The announcement from the Biden administration in mid-April that it plans to expand health care coverage to all Deferred Action for Childhood Arrivals (DACA) participants in the United States is a monumental step forward. But we can and must do more.
The recommended and fuller policy prescription from the organization I head, Children's Health Fund, is a fair one and easily administered. Outlined in detail on the Fund's website, here are the four main actions being advocated:
—Remove waiting periods that bar children who recently immigrated from immediately accessing Medicaid and CHIP.
—Provide more funding for Federally Qualified Health Centers.
—Use state funds to increase access to care for children without documentation in more states throughout the country.
—Develop inclusive plans to ensure that immigrant children have access to social programs that are vital to their health and well-being.
As the World Health Organization and other international and domestic bodies have previously stated, health is a basic human right and the United States, like other nations, has a "legal obligation to ensure access to timely, acceptable, and affordable health care." I interpret "acceptable" to mean quality health care, or that which we would want and expect for our own children.
While I know there may be challenges to enacting these changes, I fully believe that whatever it takes to get it done is the right thing to do.
Arturo Brito, MD, MPH, is president and CEO of Children's Health Fund.
The views expressed in this article are the writer's own.
