By Gerardo Sauceda Espinoza
“Anyone who has ever struggled with poverty,” noted author James Baldwin in 1960, “knows how extremely expensive it is to be poor.” That succinct sentiment could have come out of Fresno, where the concentrated poverty rate in certain areas is higher than anywhere else in the country according to a 2018 USA Today study.
A major fraction of that growing number is the local community of Hispanic immigrants who are finding it increasingly difficult to navigate out of the high costs of living in poverty. Access to quality, affordable healthcare is just one of many social and economic barriers they’re confronted with, but it is one with the gravest of consequences.
There are an estimated 1.8 million immigrants who are uninsured in California, and it’s important to remember that this is not just a number of individuals separate from all else. These are not static newcomers, but instead entire communities of families that are a foundational part of our cities. In Fresno County, 200,000 immigrants currently form more than 20% of the population, according to a recent study out of USC Dornsife.
The Central Valley is a region that will always attract immigrants given the low cost of housing coupled with a high demand for agricultural workers. This explains why Fresno is home to deeply rooted immigrant families contrary to the common misconception that most immigrants have just entered the United States.
Take, for example, some of the most disadvantaged areas in Fresno County: On average, unauthorized immigrants in central, southeast and southwest Fresno have been living there for nearly a decade. One out of every five children in these specific areas of Fresno have at least one undocumented parent.
Moreover, after comparing poverty rates between the native born and the unauthorized, Dornsife found the gap to be at 20 percentage points, whereas at the county level the gap is much wider at 33 percentage points. Recent national reports and studies, such as last year’s USA Today study, have shown that poverty rates in Fresno are increasing among all residents—not just the undocumented.
Access to healthcare is not the only economic barrier that immigrants face, however, it is one of the most detrimental. It is no secret that many immigrants in Fresno County form a large part of the working poor, and they pay a price with their health for the long hours they work.
The majority of people in Fresno, both unauthorized and native born, struggle against heavy pollution, low wages and sparse economic mobility. As an unauthorized immigrant without healthcare coverage, one accident or unexpected health issue could leave an already struggling family with health costs that would be insurmountable for even native-born Fresnans.
In fact, a 2013 poll showed that 79% of undocumented immigrants were motivated to get healthcare because they fear financial hardship brought on by paying out of pocket. Fear also plays a role in accessing healthcare, which the undocumented and their citizen children might qualify for.
“Though the citizen children of undocumented parents are not excluded from the ACA’s [Affordable Care Act] programs,” a 2014 San Diego University report explains that “their rates of coverage and access to medical services fall behind their peers. Undocumented parents are less likely to access programs where they fear their legal status will be exposed.”
The ramifications of these fears extend beyond those who are unauthorized given that their household structure is not exclusively immigrant and usually always includes citizens. Unauthorized immigrants are integrated enough to affect the economic trajectory of the city yet not integrated in ways that let them share in what little hope Fresno offers for moving out of poverty.
Employer-based health insurance covers only about 14% of all unauthorized immigrants in Fresno County, and bleak economic mobility prospects tell us that looking to employer-based coverage as a solution is unrealistic for communities that largely depend on low-wage seasonal work. Moreover, employer-based health insurance and the Affordable Care Act don’t go far enough in providing suitable coverage for citizens and immigrants fare much worse.
The onus of integration cannot solely be placed on immigrants by way of emphasizing personal improvement such as learning English. However fundamental, these personal requests reduce socioeconomic barriers to something that could be overcome with education and self-improvement alone.
Education and self-improvement are a crucial part of the answer, however, sociologists such as Manuel Pastor believe the real answer is addressing systemic barriers such as access to healthcare in ways that “will result in economic stability by preventing personal financial catastrophe” while also strengthening the state insurance exchange and ultimately every household in Fresno County.
Gerardo Sauceda Espinoza is a local student and freelance journalist interested in politics and the lives of everyday people. Contact him at firstname.lastname@example.org