A Portrait of Immigration

Part 1:  Undocumented and Uninsured – A Health Care Challenge

[Editor’s Note: Click this link for an overview of the series and an interview with the author.]

Tammy Worth — Special correspondent to The Hale Center for Journalism

In 1990, there were only five Hispanic people living in Milan, Mo. – one family living on a farm on the outskirts of the small, rural town in north central Missouri. Today, 45 percent of Milan’s 1,909 residents are Hispanic. Missouri, on the whole, is less than 4 percent Hispanic.

During this time, Milan has slowly morphed into an unusual amalgamation of Mayberry and Guadalajara. The streets are lined with older homes and the town square is befitting slightly run-down Norman Rockwell painting. Amongst a city hall, lawyer’s office and police station is a small bakery with Spanish-speaking proprietors. There is a general store with Hispanic workers out front smoking cigarettes. Around the corner is a fitness center with signage reading, “Gymnasio Abierto Las 24 Horas.”

The unusual landscape is due to an influx of immigrants in Milan after the opening of the Premium Standard Farms pork processing plant in 1994. Now a Farmland Foods plant, owned by Smithfield Foods, Inc., it is one of the community’s largest employers. It has a workforce of about 1,200, half of whom are Hispanic, according to a written statement by the organization.

These scenes have become more common in a handful of rural Midwestern towns like Garden City, Kan., and Crete, Neb. Immigrants are coming, or being brought, to these towns en masse to work at meatpacking plants – taking low-paying, arduous jobs that local residents aren’t willing to fill.

Much like the cleaning crew labors in the dark of night, the immigrants settle in quietly, below the radar in these communities. They navigate their children through the school systems and work modest jobs. They rent homes or reside in rundown mobile home parks like the one on the outskirts of Milan. They live amidst the communities, but apart. They are here quietly creating a new generation of American families.

No interpreter available 

When I first met Maria, she had three children and was nearing the end of her fourth pregnancy. She and her husband are from Guatemala, and he works on the cleaning crew at the Farmland in Milan. She was currently not working because of the pregnancy.

The couple moved to the United States in 2003, settling in Atlanta. They worked at a poultry plant there for a couple of years, and then moved to St. Joseph to work at the Triumph Foods plant. Triumph began laying off employees, and Mary and her husband heard there were opportunities with Mossberg Sanitation, the group that cleans the plant in Milan, so they moved east in 2008.

Within a year of moving to Milan, Maria became pregnant. After about five months, she was diagnosed with gestational diabetes and spent much of the rest of the pregnancy ill. Neither she nor her husband had health insurance.

During her difficult third pregnancy, she decided to have a tubal ligation, surgery that would tie or cut her fallopian tubes, providing permanent birth control. When she went into labor, the hospital told her they had lost the paperwork. There was no interpreter available during her delivery, and the tubal ligation wasn’t performed.

“I don’t know why that happened,” she said. “I don’t know if it is because they knew we didn’t have insurance or that we didn’t have any money. I think that’s why they didn’t treat me.”

Maria was pregnant again shortly after she had her third child. This time, she was able to have the tubal ligation after delivery. One week after her baby was delivered, she received a call from her obstetrician’s office saying they weren’t sure the procedure had taken.

They found scar tissue on the left side of her uterus during the surgery that might have complicated the procedure. They recommended she get an ultrasound that would cost $1,300. The hospital offered to split it into weekly payments of $400 with the first required immediately – payments she couldn’t afford. At her one-month checkup, her doctor recommended she take birth control pills to avoid getting pregnant again and get an ultrasound when she could afford it.

“At this point I don’t know who I am, what they did and what I’m going through … and they don’t know either,” she said. “I ask, ‘Why are they putting me on birth control?’ We could try to put the money together (for the ultrasound), but I can’t just pay for nothing. They need to do everything that needs to be done. I want to get sterilized.”

Reinterpreting the American Dream

Undocumented immigrants are not very different from U.S. citizens: They, too, are trying to live the American Dream, which has become more elusive for most everyone in recent years.

Though it is difficult to tease out exact numbers and demographics of undocumented immigrants, many groups have estimated who they are and how they live. These statistics paint a detailed picture of people immigrating to the United States.

There are an estimated 11.9 million undocumented immigrants in the United States and about three-quarters are Hispanic. They are typically low-income, working adults with families.

According to a study by the Urban Institute looking at data from 2009, 51 percent of undocumented immigrants who have lived in the United States for more than five years live in mixed-status houses with citizens. The Pew study found that almost half of households with an undocumented individual are comprised of a couple with children, double the percentage of U.S.-resident households.

Just more than half of adult undocumented immigrants have a high school education as opposed to 92 percent of U.S. residents. They are also poorer: the median income for undocumented immigrants is $36,000 as opposed to $50,000 for U.S residents.

Immigrants also have low rates of being insured. In spite of similar employment rates, only about 35 percent of immigrants receive insurance coverage from an employer as opposed to 65 percent of citizens, according to the Urban Institute report. It found that more than half of nonelderly immigrants are uninsured compared to 17 percent for citizens. Approximately 40 percent of immigrant children are uninsured as opposed to 7 percent of U.S.-born children.

When Maria talks about Milan, I hear her repeatedly use the word “triste.” I speak almost no Spanish, but understand she is calling it sad. When asked why she and her husband moved to the United States, she is quickly and markedly upset.

Her father passed away when she was 7 years old, and she lived with her mother and eight siblings in one room. They slept on the floor and collected pine leaves for a bed. She didn’t have shoes and owned only two outfits.

She wipes tears from her eyes when she said that food was scarce. When there was something to eat, it was often tortillas filled with herbs. She wanted to go to school, but there was no money for food, much less education. She wasn’t looking for a husband, but married at the age of 16 because she had no other choice. She and her husband (who has 14 siblings) moved to the states in 2003 searching for a better life.

“I came here because we always heard the life here was better, and we could work and live better,” she said. “My mom was pregnant when my father passed away. She got mad when I used to ask for food. But I know now that she really didn’t have any way to get food to us.”

I ask if she considers her life here in the United States better than what she had. She thinks for a moment and shakes her head yes.

“Here there is food,” she said. “And we can afford clothing. Here there are jobs, and at least you can do something.”

Worth reported this special series during a year-long Association of Health Care Journalists Reporting Fellowship on Health Care Performance supported by The Commonwealth Fund.

Major Funding for Health coverage on KCPT provided by Assurant Employee Benefits and the Health Care Foundation of Greater Kansas City.