Work in Progress: Immigrant Health Care from the Vantage of Cancer Testing and Screening
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LETTER TO THE EDITOR
Work in Progress: Immigrant Health Care from the Vantage of Cancer Testing and Screening Stephen M. Modell1 · Paul J. Fleming2 · William D. Lopez2 · Heather Honore’ Goltz3 Accepted: 17 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This letter offers a perspective from cancer testing and screening on the improvements in immigrant insurance coverage and care charted in Bustamante et al.’s April 2019 article in JOIH on “Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act.” Supportive evidence for their data may be found in complementary literature drawing from both the National Health Interview Survey the authors use and the Medical Expenditure Panel Survey, while post-ACA surveys and state level information suggest disparities remain for lawfully present and undocumented immigrants ineligible for Medicaid and unable to secure insurance to pay medical costs. Existent options for cancer services are discussed. Further relevant reform depends on voter awareness and collaborative efforts between consumer advocates and legislators. Keywords Cancer screening · Genetic testing · Breast cancer · Colorectal cancer · African · Hispanic · Immigrant · Patient Protection and Affordable Care Act Bustamante et al.’s article “Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act” (JOIH Apr 2019) suggests future directions for reform from the perspective of cancer testing and screening [1]. While charting marginal improvements from 2011–2013 to 2014–2016 for several immigrant categories, the most pronounced salutary shifts in insurance coverage, * Stephen M. Modell [email protected] Paul J. Fleming [email protected] William D. Lopez [email protected] Heather Honore’ Goltz [email protected] 1
Department of Epidemiology, Center for Public Health and Community Genomics, University of Michigan School of Public Health, M5049 SPH II, 1415 Washington Hts., Ann Arbor, MI 48109‑2029, USA
2
Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
3
Social Work Program, College of Public Service, University of Houston-Downtown, Houston, TX, USA
delayed care, and forgone care were in those with 5 years or less of U.S. residence. The authors’ Table 1, depicting odds ratios for lack of insurance and care compared to U.S.-born citizens, indicates additional room for improvement; the Affordable Care Act (ACA) instituted a work in progress. The authors’ findings confirm those of Sharif et al., who also analyzed 2011–2016 data from the National Health Interview Survey, while Bustamante et al. further break the NHIS data down into number of years of residency [1, 2]. The consistency of findings within and between studies suggests the positive impact of the ACA on immigrant health care coverage and utilization, bearing in mind that the ACA’s individual mandate penalty was lifted 3 years after this wave of data. These general fi
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