Effective Messaging on Immigrants and Health Care Sonal Ambegaokar Health Policy Attorney National Immigration Law Center Health Action 2009 January 29,

Effective Messaging on Immigrants and Health Care

Sonal AmbegaokarHealth Policy Attorney

National Immigration Law Center

Health Action 2009January 29, 2009

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National Immigration Law Center Non-profit, non-partisan legal advocacy

organization

Policy analysis and advocacy; impact litigation; trainings; technical assistance; publications

Issue Areas: immigration policy; workers’ rights; access to health care and other safety-net benefits for low-income immigrants

www.nilc.org

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Goals on Health Care Ensure public and private health coverage expansions in

state and/or federal health reform and children’s coverage includes access for low-income immigrants, regardless of immigration status

• Incremental step: remove 5 year waiting period for lawfully residing immigrants in Medicaid/SCHIP (Immigrant Children’s Health Improvement Act (ICHIA))

• Reduce/eliminate barriers to meaningful access to health care services for immigrants (e.g., health disparities, language access)

Prevent immigrants from being used as a scapegoat in promoting health reform and other domestic policies

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Challenges General misinformation about immigrants and

health care Among advocates and policymakers Among liberal/progressives as well as conservatives

Media coverage (mainstream and Web 2.0): currently one-sided

Need for but uncertainty around comprehensive immigration reform

Current climate makes immigrants fearful of accessing health care

Political will

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Changing the Debate Educating policymakers, the media, and the

public regarding the facts about immigrants and health care

Developing champions and spokespeople

But, facts alone not enough

With support from The David & Lucile Packard Foundation, invested in communication research/planning

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Communication GoalsFinding effective messages to:

Promote INCLUSION of all immigrants in health reform and children’s coverage expansions Through the voices of all progressive allies Activate progressive/moderate voters to engage on this

issue

Counter immigration attacks with messages that are not harmful to immigrants and do not simply exclude immigrants

Prevent immigrants from being used as a scapegoat or immigration as a wedge issue Having unified voice on the ultimate goal

Findings from NILC Focus Group Research

8BELDEN RUSSONELLO & STEWART R E S E A R C H A N D C O M M U N I C A T I O N S 8

Methods Fourteen focus groups:

– Six in April 2008• Denver, Encino (N. Los Angeles), Pittsburgh• Moderate-liberal White and Hispanic voters

– Eight in July 2008• Denver, Columbus• 4 among liberal-leaning, 4 among conservative-leaning

White voters

– Exclude those with extreme anti-immigrant views

9BELDEN RUSSONELLO & STEWART R E S E A R C H A N D C O M M U N I C A T I O N S

Context on Immigration Issues Overall

Immigration “illegal;” legal immigrants viewed differently

Concerns – not paying taxes, taking from social services, not learning English – are symbolic for violations of key values:

Law and Order, Fairness, Patriotism, Responsibility

Broad support for providing some way to legalize those already here

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Immigrants and Health Care

Attitudes motivated by similar values:– Compassion– Law-and-Order– Fairness and Responsibility

Apply differently to different groups of immigrants

BELDEN RUSSONELLO & STEWART R E S E A R C H A N D C O M M U N I C A T I O N S 10


Legal Immigrants and Health Care

Little persuasion needed

Legal adults should be eligible for government health care programs because they follow rules and pay taxes.

5 year waiting period for children is wrong because 5 years is too long to make a child wait, and their parents follow the rules.

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Quotes: Legal immigrant children

“The five-year plan could be a lot longer of a wait than the course of a disease that this immigrant could get. So they could be dead before they got any benefits out of this.” – Liberal man, Denver (phase 2)

“Because if they’re legal and they’re contributing, their parents are contributing to this society and everything, then I don’t think there should be a five year waiting period for that any more than there would be for legal US citizens born and raised here who chose not to be employed and their children take advantage of the preschool stuff.” – Conservative woman, Denver (phase 2)

“And that’s what I wonder why there’s a five year waiting period…if it’s because they’re making sure they don’t come here for medical [care], but I think 5 years is way too long, especially for children.” – Conservative woman, Denver (phase 2)



Undocumented Adults and Health Care

Impact of values:– A few see health care as a need and

inclusion as the “right thing to do” (compassion)

– Many see inclusion as “rewarding illegal behavior” (law and order)

– Another large group focuses on “contributing” (responsibility and fairness)


Undocumented Adults and Health Care

Most successful message theme

combines values & practicality:

Society will be better off if we find a way for

undocumented immigrants to contribute to

costs and get the care they need to stay

healthy

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Undocumented Children and Health Care

Many, especially in liberal and moderate groups support including children:– Children are “innocent” – Practical reasons support inclusion– Give children opportunity

Most in conservative discussions oppose inclusion:– Children’s care is parents’ responsibility– Including children will attract more undocumented

immigrants

Pre-natal care is not helpful for persuasion


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Quotes: Undocumented Children

“Well, I think it goes back to – we are talking [about] innocent children who, most of them, cannot help the fact that their parents are here illegally. It is not their fault that they are here illegally. I don’t feel they should be punished not receiving medical care and being sick and then expecting everybody else because they are sick yet they don’t qualify for health care because their parents are here illegally. A part of me says no, shouldn’t provide it for them because we need to teach their parents that it is not okay to be here illegally. The other part of me says, but they are kids. They can’t help it, and there is nothing they can do about it.” – Conservative woman, Columbus (phase 2)

“Children didn’t ask to be born. They get stuck with where they get stuck. They get in the situation they are in and they deserve to be healthy and strong. If they are not getting healthcare, they are not going to be healthy and they are not going to be strong. They are going to be throwaway kids.” – Liberal woman, Columbus (phase 2)


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Answering Pushback on Immigration in Health Care

The special interests who do not want the health care system to befixed are using these arguments about immigrants to block changesthat could help make health care affordable for everyone. Immigrantsaren’t stopping us from fixing health care – it’s insurance companiesand pharmaceuticals and other people who are making lots of money by keeping things the way they are. We do need to address immigration in this country, but until we fix it,we can’t let the immigration issue divert us from making sure thatyou, your neighbors, and everyone else gets quality, affordablehealth care. Everyone in America – including immigrants – should

pay an amount they can afford for health care.


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Recommendations – Overall

1) Focus on health care – specifically “affordable health care for everyone”

2) Connect with personal feelings and experiences – “no one should have to live in fear”


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Recommendations – Overall

3) Address practical concerns – preventive care and everyone contributing

4) Assert that leaving people out will hurt all of us.


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Message: All Immigrants Affordable health care for everyone in the U.S. is a necessity. This should includepreventive care, because it will help people stay healthy and save us money down theroad. We need a health care system where everyone contributes to the cost of medicalcare, and no one has to fear that one accident or illness will leave themunable to care for themselves or their families.

In this system, everyone contributes, and everyone is secure in knowing that they canget health care; this needs to include all immigrants, legal or not. If we leave out millionsof people living in our communities the system will not work and will affect all of us.

We have to find a practical solution to our immigration system, but it is not realistic todeport the 12 million immigrants without legal status who are living and working in thiscountry. Instead of excluding them, we will be better off if we make sure that they arecontributing to the health care system. Everyone in the U.S., including all immigrants,should pay what they can afford and get the health care they need.


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Recommendations - Children

1) Start with “all children”

2) Add information about children who are not covered

3) To persuade on undocumented immigrants, remind audience that children are in a situation they did not cause


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Recommendations - Children

4) Emphasize the benefit of preventive care, including vaccinations

5) Focus on providing an “opportunity”


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Messages - Children

No child should be denied health care in the U.S. But right now, children who

were brought here legally face a five-year waiting period before they are

eligible for government health care programs [and children who were brought

here as illegal immigrants are denied coverage]. Preventing children from

getting the care they need is punishing them for a situation they didn’t cause.

All children should be able to get health care, so they have the opportunity to

grow into healthy, productive citizens.

Helping more children get health insurance will be better for all of us in many

ways. Insured children are more likely to get preventive care such as

vaccinations that can keep them healthy and give them the opportunity to

grow into productive adults. All children should be able to get the care they

need, and we should make that happen by [INSERT ASK].


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Immigrant Health MessagingOverall Messages

Do Don’t Start and end with the goal of health care for all people (or all children, etc).

Start the conversation on immigrants’ need for health care.

Emphasize that preventive care is cost-effective and helps people stay healthy.

Claim that preventive care is “cheap” or will “make” people healthy.

Answer attacks on immigration with practicality and values, and then return to health care for all.

Return to health care without any real answer to attacks on immigration.

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Immigrant Health Messaging Adults

Do Don’tFocus on affordable care. Suggest “free” or

“government-provided” health care.

Emphasize that people using care will contribute.

Focus on what’s better for America – encouraging contribution and participation rather than division, isolation and impractical attempts at deportation.

Make the conversation about what’s best for undocumented immigrants.

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Immigrant Health Messaging Children

Do Don’tInform about five-year waiting period. “We shouldn’t ask children to wait for health care” and “five years is a lifetime for a child.”

Expect any knowledge on this topic.

Remind that children should not be held responsible for a situation they did not cause. They were “brought here.”

Defend or blame their parents’ actions.

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Sonal Ambegaokar

NILC Health Policy Attorney

[email protected]

www.nilc.org

Effective Messaging on Immigrants and Health Care Sonal Ambegaokar Health Policy Attorney National Immigration Law Center Health Action 2009 January 29,

Documents

n d c o

t i o n s context

health care services

health care attitudes

health care political

health disparities

health care impact of

lowincome immigrants