Title: How Welfare Reform Act Affects Elderly Immigrants' Health and Healthcare Service Utilization: Comparisons Before and After Welfare Reform
Abstract: Background: The intended result of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193: PRWORA) was to conserve public funds while addressing welfare deficits. To achieve this end, the PRWORA (1) requires immigrants who came to the United States after the law took effect to show proof of U.S. citizenship to be eligible for federally funded public benefits, including Medicaid, unless the states where they lived provide state-funded benefits; (2) reinforced the `public charge law,' indicating that once the Immigration and Nationalization Service deems a post-welfare reform immigrant a public charge, this could result in the denial of a green card, denial of readmission to the United States after a trip abroad, or in deportation (Buff, 2008; Kandula et al., 2004); and (3) deems the income and resources of the sponsors of immigrants to judge the immigrant's eligibility for public assistance including Medicaid, which is considered `a unique obstacle' to immigrants to be judged as being poor (Dordeski & Steffens, 2010). As a result, to be eligible for public assistance `Public Law 104-193' and `Affidavit of Support Under Section 213A of I-864' require elderly immigrants (a) becoming U.S. citizens or (b) completing 40 quarters (i.e., 10 years' worth) of work requirement unless they live in a state which provides state-funded assistance. On the other hand, some factors related to elderly immigrants raise some concerns about elderly immigrants' health. The factors may include that (1) most commonly, elderly immigrants enter the United States at 60-79 years of age through the family reunification program at the invitation of their naturalized adult children, implying that these immigrants have little or no U.S. work history and that they are more likely than their U.S.-born counterparts to live in poverty (Leach, 2009); (2) elderly immigrants, in particular, those from non-English speaking countries, are limited in learning a second language at their later age to pass the citizenship test which asks their listening, writing, and speaking ability in English: in 2006 almost 71 percent of newly arrived elderly immigrants had little or no English proficiency (Leach, 2009) and among the total elderly immigrants, as much as 56 percent reported limited command of English in 2010 (Batalova, 2012); and (3) they are more likely than their U.S.-born counterparts to rely on Medicaid due to (a) their socioeconomic status (Batalova, 2012; Leach, 2009), (b) limitation in their access to Medicare due to their lack of the required work history (Quadagno, 2005; Nam, 2011), (c) limitation in their access to employment-based private health insurance due to age-based discrimination in the labor market (Quadagno 2005; Nam, 2011), (d) limitation in working adults' access to direct-purchase health plans covering their older adults without Medicare coverage (Yelowitz, 2000; Choi, 2009), and (e) partly, little market for that age group due to the almost universal Medicare coverage among older adults…
Publication Year: 2013
Publication Date: 2013-01-01
Language: en
Type: article
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