Health Disparities Among Uninsured LGBTQ and Undocumented Communities in Fresno

Health Disparities Among Uninsured LGBTQ and Undocumented Communities in Fresno
Image by Flickr user throgers

By Oday Guerrero

Although the expansion of the Affordable Care Act (ACA) and Medi-Cal have increased the level of coverage for those living in California and most of the United States, there are many folks who continue to be excluded from receiving access to affordable healthcare, especially in Fresno County. Because the existing health laws discriminate against people based on their socioeconomic status, gender identity and immigration status, among others, some of those communities who still lack affordable health insurance are those within the lesbian/gay/bisexual/trans/queer (LGBTQ) community and the undocumented community.

To make matters worse, a battle has occurred between the Fresno County Board of Supervisors and community advocates as to whether the Medical Indigent Service Program (MISP) should continue to cover the undocumented community of Fresno. The community residents of Fresno need to take a stance in support of health coverage for all, so that everyone including the LGBTQ and undocumented communities, can access health programs without racist and homophobic/transphobic barriers.

Many within the LGBTQ community face multiple obstacles that block them from receiving health coverage; those obstacles include higher poverty rates, discrimination based on gender identity and higher levels of depression and chronic illnesses compared to the heterosexual community. In a recent Pew Research poll, it was estimated that 4 in 10 individuals who identified as LGBTQ earned $30,000 or less in a year compared to 28% of the U.S. population overall, and earnings are even lower for LGBTQ people of color.

LGBTQ individuals continue to receive unequal treatment from healthcare providers and insurance companies as well, especially low-income transgender people. A 17-year-old transgender youth living in Fresno who wanted to be identified as TRGirl explained that it is difficult for her to get the coverage she needs “in order to have a healthy mental health.” During one visit to the doctor, she was asked to pay $450 for blood tests, which she could not afford to pay. She pointed out that insurance companies see her medical needs as “cosmetic” and not important.

“Transgender health including facial feminization surgeries and other surgeries are necessary because we go suicidal because we can’t be who we truly are at heart, and insurance companies need to see that,” TRGirl boldly states.

Another group that has been explicitly excluded from fair health coverage is the undocumented community, which is completely obstructed from the ACA and full-scope Medi-Cal and can only seek emergency services through the state. By being rejected from preventive and specialty care, undocumented people do not have access to resources necessary to treat chronic illnesses.

The MISP, currently managed by the Community Regional Medical Center, is the only way undocumented residents in Fresno County have been able to obtain specialty care for many years, but the future of the MISP now falls into the hands of the Fresno County Board of Supervisors, which wanted to eliminate the program secretly during New Year’s Eve.

Clinica Sierra Vista, which in 1984 won an injunction that requires the county to provide services for the medically indigent, agreed to file a lawsuit against the county to save the MISP. Since then, Judge Donald S. Black ruled on April 21, 2014, that the county would be required to provide services for those who are uninsured and lawfully present but would no longer be required to cover those who are undocumented.

The only hope for the undocumented community is a bill offered by Assembly Member Henry T. Perea (D–Fresno) in which the state of California would waive Fresno County’s
$5.5 million debt from transportation funds as long as the Board of Supervisors decides to provide the MISP for undocumented individuals. This deal is crucial for the future of the MISP and its undocumented patients who are in serious need of continuous medical treatment.

Nineteen-year-old Jonatan Ramirez is an undocumented gay youth whose family is directly affected by the need for healthcare coverage. By being involved in organizations such as the Gay Straight Alliance Network, he has done intersectional work with LGBTQ and undocumented communities, and among both groups he sees the personal need for healthcare. His undocumented grandmother uses the MISP to help pay for her diabetes medication. She barely has enough money for her co-pay, which then the rest of the family pays.

Ramirez feels the frustration of “being alienated from this society” because officials like the Board of Supervisors have not taken a public stance showing support to immigrant families, “People are basically telling me that I can’t get sick. We as undocumented people do the labor that people don’t want to do, we are the backbone of the country…and [we’re] treated like animals.” The Board of Supervisors should accept the
$5.5 million deal so that all Fresnans can truly be healthy.


Oday Guerrero is an immigrant womyn activist and founder of Fresno Immigrant Youth in Action (FIYA). To contact and to receive more information about local immigrant youth organizing, e-mail


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    The Community Alliance is a monthly newspaper that has been published in Fresno, California, since 1996. The purpose of the newspaper is to help build a progressive movement for social and economic justice.

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