For Immigrant Families, Mix Of Status And Low Income Makes Staying Healthy A Struggle

Jul 9, 2016

Some days, in the busy East Baltimore insurance agency where she works, saleswoman Nathaly Uribe takes nonstop calls from members of the city’s Latino community, looking to buy home and car protection plans. It’s an unspoken irony that the women in her office, who spend eight hours a day insuring others, don’t have health insurance themselves.

While Latinos are the fastest-growing group nationwide in Obamacare’s health exchanges, most of the country’s 11 million undocumented immigrants are barred by law from buying coverage.

 Nathaly came to the US when she was one, from Chile; her family came on a tourist visa and stayed. They found work, learned English, Nathaly’s sister was born, and they lived a pretty typical American life – except in one way.

Sixteen years ago, Nathaly’s mom, Marlene, developed epilepsy.

"At first they were very calm seizures, just a quick kind of shaking of the body and you kind of lose sensation in parts of your face, but she would just sleep it off and she’d be fine," Nathaly remembers.

Because she was undocumented, she couldn’t qualify for Medicaid. And because she was only making $300 a week as a nanny, she couldn’t afford to buy her own health insurance. So her health care was spotty; she made do with emergency room visits, charity clinics, a revolving cast of doctors, and an ever-changing array of medicines. And she got worse.

"We would have to take her to the hospital. They were very serious grand mal seizures, she wouldn’t faint, she wouldn’t stop," Nathaly says. "And then she had a T.I.A., so a mini stroke."

Meantime, Nathaly’s sister, a US citizen, was growing up with typical American medical care – a pediatrician, vaccinations.

Nathaly, one of the millions of young people brought to the US as kids who are now known as DREAMers, didn’t have that. Instead, as Nathaly’s English surpassed her parents’, she became the family interpreter and medical advocate.

"When it comes down to your mother’s health or school, y’know, Mom obviously is more important than missing math class that day," she says. "Which the schools don’t understand."

That’s a role Nathaly still plays. It can be a painful dynamic for both of them.

"She always be there for me for giving support. I try to give some support to her, but I feel like she giving more support to me," Marlene says, tearfully. "And I’m supposed to be the mother."

But without Nathaly’s advocacy, Marlene says, she wouldn’t have reached her 40th birthday. She recalls a time a doctor prescribed her a powerful a new drug, one that made her feel "barely there."

Because she had no opportunity to follow up and adjust the dosage, things got scary. She’d be driving her daughters someplace and suddenly have no idea where she was. Once, her husband caught her flipping a frying steak with her bare hands.

"It’s like, I can’t work, I can’t drive, I not remember everything," Marlene says. "Sometimes it’s hard to say: ‘Because it’s the medicine.’”

After that scare, Marlene went off medication.

At 13, Nathaly researched online, and read that medical marijuana had worked to control epilepsy symptoms in some patients. So for the past eight years, with doctors’ tacit approval, her mom has relied on that, and the family says it’s cut her seizures dramatically.

"So now she, thanks to the medical marijuana and everything, she’s kind of gotten her life back," says Nathaly.

But at the moment, Marlene’s health doesn’t depend on her daughter’s Google skills. Last year, she and her husband were accepted into CHAP, or the Community Health Access Program, a new charity program through Kaiser Permanente that doesn’t ask about immigration status.

One of the early enrollment events at Baltimore’s public library made a big impression on program director Kimberly Fox.

"I got there early, and when I got into the auditorium it was completely filled with families and individuals needing and seeking to be screened for charitable care and coverage – that were in need," she says. "It was all word of mouth."

Thirteen hundred people in Baltimore got two years of free insurance and subsidized care through the program. In February, Nathaly was added to her parents’ plan.

All these years that she’s been taking care of her family, Nathaly herself has struggled with obesity. Now, at 21, she’s talking with a doctor about it for the first time.

"She said to me: 'What’s your main health issue or concern?'" Nathaly recalls. "And I said, 'Well, you’re looking at it.'"

Her doctor tells Nathaly she’s a great candidate for a gastric bypass, but she’s racing the clock to fit in all the prerequisites.

When the Kaiser program ends in December, current members can reapply for two more years, but nothing’s for sure. So now Nathaly is packing in follow-ups, trying to get as healthy as she can before she’s on her own again.

This story is part of a reporting partnership with Kaiser Health News, which is not affiliated with Kaiser Permanente.