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tv   Urban Institute Discussion on Assistance for Immigrant Families  CSPAN  April 1, 2021 7:16pm-8:02pm EDT

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discussion about providing support for immigrant families. the panel discussed how covid-19 highlighted disparities within immigrant communities and ways to address inequities through federal legislation. this discussion is 45 minutes. ms. wartell: good afternoon, everyone. and thank you so much for joining us. i am sarah rosen wartell. first, a few housekeeping rules. today's event is being recorded. the recording will be posted online after the event. all participants are automatically muted, but we do have close captioning turned on. if you would like to adjust your setting, can click the live transcription button at the bottom if it is distracting to your peer -- distracting to you. type your questions or comments into the question box at any time. even if we don't answer them
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all, it is helpful to us to know what you're thinking about. please join the conversation on twitter, use the hashtag live at urban. today is a serious of discussions in the long overdue with our nations ongoing structural brief to them. they have encountered a safety net that can be very helpful to navigate, with eligibility and access varying with language barriers and fears about the effects of participation. since 1982, our immigration laws have included the concept of public charge. deciding whether to grant some applicants a green card or visa, an officer has to decide whether they will become dependent on
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certain government programs in the future which would make them a public charge. however, the circumstances were relatively narrow when construed. the trump administration first proposed and then sought to implement a final revised public charge rule asked -- which expanded the circumstances in which applicants might be given admission to the united states. long before the rule was in place, many immigrants became far more fearful about receiving any more public benefits that might help them and their children to thrive, even those who were clearly qualified for care of immigration. while litigation ensued, the pandemic hit, hitting especially hard many immigrant communities. yet these populations were further disconnected from the u.s. safety net than they ever had been before. and the initial relief packages further excluded immigrants from receiving further funding. the biden administration recently withdrew the appeal of
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the court decision which had struck down the public charge rule. so it is effectively no longer in effect. the trump era public charge rule is no more. the two most recent relief bills have expended eligibility for some aid, including more opportunity for some immigrants to receive financial support. yet, immigrant families continue to face many barriers, both formal and informal in accessing the safety net. confusion still reigns from the earlier era, and all the complications still remain. these barriers in many cases decreased both the well-being of families and the economic success of their communities. to discuss this challenge we have two conversations. in the first part i am pleased to be joined by representative judy chu, who represent california's 27th district in the l.a. area and has been organizing colleagues in
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congress in an effort to include immigrants in covid-19 relief. after that, i wll chat with two other experts to talk more about the rules and regulations. so thank you congresswoman for joining us today. i hope you are well. rep. chu: nice to see you. ms. wartell: i do want to take a moment to express on behalf of the institute committee our support for all those who are facing the rising wave of anti- asian hate and violence and especially those triggered by the recent events in atlanta. we stand strongly with you and your constituents. thank you for being here. representative chu, nearly 40% of your l.a. area district is foreign-board. how has the pandemic affected the immigrant community and
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their family members? rep. chu: first, let me say thank you urban institute, because you have laid the groundwork for us to fight the anti-immigrant federal policies that haven't put on us over the last four years. with your data, with your research -- and believe me, it is a powerful tool that i have relied on time and time again when i am speaking to people on capitol hill, when i am at the hearings. so it's incredible what you are able to do. this pandemic of course has exposed deep inequalities in our health care system. each of us are equally susceptible to the virus, but not all of us are equally impacted by it. communities of color and especially immigrant communities have had some of the worst
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experiences battle in this pandemic. for instance, most frontline workers, whether they are nurses, teachers, tend to come from immigrant communities, which means they are putting themselves at risk for our sake. and yet these communities have less access to quality health care, which is why you are seeing higher infection and mortality rates in these populations. and it is your research that documents that anti-immigrant federal policies such as the public charge rule have deterred immigrant families from seeking health care, food, and economic assistance, even as the pandemic health and pandemic burden is falling most heavily on them. that is why we work so hard to ensure we blocked any efforts to restrict coverage of testing, treatment, or vaccinations
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against covid-19 in ways that would have left the immigrant communities behind. we simply cannot afford to leave an entire population out of our relief effort. which is what republicans unfortunately were trying to do over and over again. nonetheless, we still have work to do. for instance, i tried to get those who are the ichin recipients to be able to get the economic relief check, but we were unable to do that. so, clearly, there is so much more relief that we need for our immigrant communities. but i must tell you these problems expend -- extend to the business community as well, which is why we debated relief legislation over the past year. and when we did that i pushed for the small business administration to translate their materials into other languages so that
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non-english-speaking business owners have a chance at this economic relief. these businesses were hit just as hard by the pandemic as their english-speaking neighbors. they are certainly deserving of just as much relief. and i do have to tell you that at the beginning, there was a huge problem where the big banks were the ones who gave most of the big loans to their ongoing loan customers. and so it shut out the truly small businesses who did not know how to get through. so we did a $60 billion set aside to make sure it was the community banks, and the community develop corporations that really served the underserved communities that would be able to get the funds to get those ppp loans out to the immigrant communities that we intended it for. ms. wartell: well, you touched
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on a whole bunch of things i want to come back to. but i wanted to start with a question about day one of the new administration. when president biden issued what was a very powerful executive order, it directed every federal agency to take into consideration the implication of policy choices on equity gaps. so weighing whether a new piece of legislation would widen our close gaps in access to opportunity and wealth, or whatever the issue may be, for a particular population. the executive order focused particularly on race and ethnicity and other aspects of identity, but it does not speak to immigration status. i am curious of your reaction to that choice. rep. chu: well, there is so much overlap between underserved communities and immigrant communities. so even though he did not specify immigrant communities, i think they will absolutely
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benefit from this order. that is why i worked so hard to push for fda and other aid to target underserved communities as well, and pushed so hard to make sure they translated the materials into other language so that non-english-speaking can benefit. and that is why in the american rescue plan, we actually have set aside for community navigators who would actually help the smallest of businesses to be able to figure out how to go through the bureaucratic system that will give them the forgivable loan that they need. now, i will give you an example from the aap i community. even before the pandemic, aapi had a hard time accessing due to language and geographic areas. -- barriers. and we did not even understand how much that was happening because there was a lack of disaggregated data that limited our understanding of the needs of our diverse aapi communities.
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whereas we do know that certain subsets of communities like the native hawaiian pacific islanders are suffering so much more. now, a year into the pandemic, the inequalities are only getting worse. and other factors are keeping us from responding appropriately. one third are limited english proficient. but information about the pandemic is still not really available in all the aapi languages. these trends are especially distressing because of the disparate impact covid-19 has had on the aapi community and other communities of color. for us in the first year the pandemic, it was a 35% increase in the mortality rate of asian americans compared to the average of the five previous years. from december to january there was a twofold increase in deaths for asian americans.
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we know that other immigrant communities are similarly suffering. in addition to translating more materials for non-english speakers and targeting more aid to these neighborhoods, there is also more we must do directly for immigrants. like i said, the survival checks were not sent to undocumented workers that used i-10 numbers for filing. and that is so unfair, since these workers pay taxes and are a part of our community. they deserve to have the same help as everyone else. at least we were able to make sure that in the american rescue plan that we passed last month that mixed status families could be included and that those with social security numbers would be able to get the checks they so deserved. where in previous iterations, they were not able to. ms. wartell: congresswoman, as you know well, better than most,
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so many of the deeper and -- of the different programs have their own eligibility criteria. even with the passage of the recent law, would you like to see further work done on eligibility to help expand access for immigrant populations? if so, what are the priority areas you are thinking about? rep. chu: well, i feel there is a lot of work that has to be done. and that's why i introduced the coronavirus immigrant families protection act early on in the program, in the course of the covid-19. in short, any benefit received during the pandemic does not count as a negative factor in future immigrant status determinations, and prohibits discrimination based on immigrant status. any funding for -- it makes emergency medicaid
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services available to all immigrants. and the disaster program would be extended to allow individuals of families impacted by the pandemic toof course, it would e problem. the individual tax identification number so they can get the checks that they deserve and would also make sure there is translation. federal agencies would be able to translate the relief efforts into the most frequently encountered languages and have community-based organizations have culturally linguistic appropriate materials. finally, it would modify immigration policies that would deter immigrants from seeking health services for the duration of the covid-19 emergency. by suspending in person ice
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checks and make sure that they feel safe. i feel that our efforts need to be updated and that they need to be more sensitive to immigrants. i also believe that we can do so much more in terms of the underlying system of our safety net. that is why i support congress member jayapal heel for immigrant families act that would move on necessary barriers to health care access for immigrant families. it would provide access to affordable health care coverage for daca recipients, provide access to medicaid or the children's health insurance program without the five-year waiting. . and allow undocumented immigrants to purchase health insurance through the affordable
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care act marketplace. so that they could get the health care they need. the safety net has to be there on an ongoing basis for all immigrants. ms. wartell: i want to close with this question. the last couple years even before the pandemic was a period in which there was a great deal of anxiety and confusion across the immigrant communities about immigration enforcement and how the public charge will affect people and their families. the fact that the rule is no longer in effect does not necessarily remedy overnight the challenge of confusion. how and what can we be doing as a country to try to provide more information, more clarity to people and try to overcome some
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of the barriers to participation in programs people are completely eligible to participate in that may be harming their ability to support their families and become resilient to make a better future? rep. chu: the public charge role has caused so much confusion across the united states and i had nonprofits that serve the community that saw an immediate drop in those who would normally use their services because people were so afraid of the consequences. it had its intended effect by the trump administration. it was an intentionally cruel rule meant to punish immigrants who took advantage of services they were legally entitled to like health care. so many immigrants went without seeing a doctor because they were afraid it would impact their immigration status.
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this is especially cruel since it was during the pandemic when it was more important than ever we have access to health care especially since many of these workers were in frontline jobs. that is why i am so thankful president biden directed agencies to review the public charge role and rescinded the memorandum and that it is no longer in effect, but i would say there is still confusion. i do not know if immigrants really know it is not in fact. probably not. that is not enough. that is why the american rescue plan includes something i'm very proud of as having pushed, which is a billion-dollar for a pandemic emergency assistant funds to enable states, tribes and territories to help families with the lowest of low incomes to cover additional pandemic driven expenses and avert eviction and other real hardship
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. we were able to successfully push back against efforts that would have restricted these funds and made it more difficult for immigrant families to adjust their status as legal permanent residents or u.s. citizens if they used these assistance funds to pay rent or buy food or cover their basic necessities. this was important because excluding from -- excluding immigrants from covid relief benefits is incredible detrimental. this pandemic emergency assistance fund allows those that are administering it to be able to provide those services regardless of background. ms. wartell: thank you very much for coming and sharing these thoughts with us. our thoughts are with you and your constituents and the aapi community around the country. we are grateful to you and your
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partnership and working on these issues. thanks so much for being here. now i am going to be joined by the principal research associate at the urban institute and a former staff attorney for the northwest health law associates and she has been working to help expand access to immigrant communities to health care benefits. thank you so much for being with us. i'm going to ask you to step back and lay a little bit more of the groundwork about -- we heard representative chu talk about the limitations of pandemic relief for immigrants. can we dashcam explain what were the rules of access? how did they change and where they stand now? >> no problem. that is a tough question to
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start off on because it is really complex. it is hard because there is variation across states and there is variation across immigration status is. -- immigration statuses. in general, undocumented immigrant are not eligible for federal benefits. there are some exceptions for things like emergency medicaid, immunizations, school meals and a few other supports. many immigrants with lawful statuses are awful -- also not eligible. immigrants with a green card, permanent resident are not eligible for benefits for the first five years with that status. other exception groups are not subject to the five-year bar.
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a lot of complexity. there is a lot of differences at the state level since the 1996 immigration and welfare reforms led to what is referred to as a patchwork of policies. some states filled in the gaps for portions of the nonqualified groups. many states limited the five-year bar for medicaid. these groups who are not eligible for federal programs may be eligible for state or local programs. pending other eligibility criteria. some states have led the way on expanding access. we will talk more about that. all of these basics on paper did not change during the trump administration. a combination of immigration and enforcement policies including an expansion of the public charge rule really led to a trend of chilling effects where we know immigrant families and
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groups were more reluctant to produce a pay in these programs -- to participate in these programs. the changes that were proposed and put in place in the previous administration did not change immigrant eligibility rules for these programs. they attacked -- they attached immigration consequences. for non-cash programs like medicaid or food stamps or housing assistance. that is the basics. ms. wartell: it is not of the public charge rule is gone. it is that we are back to the pre-trump era public charge rule where those programs in which participation was thought to make you likely to become a public charge is much more narrowly construed but there are still consequences for participation in some of those programs. that is a great transition for you.
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why was it so hard to access benefits before the expanded public charge rule? you tacos through the typical experience of an immigrant family seeking care and how to these experiences vary across the different statuses? >> thank you for having me today. i appreciate all the work urban institute is doing. there are multiple factors that make it challenging for immigrants to access needed support. there are eligibility restrictions for certain programs based on immigration status. that means your immigration status impacts of the services and supports you can access and determines whether you can actually access food, housing, health care that you need particularly now during the covid pandemic. if you are a citizen or have temporary protected status or
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undocumented or have permanent resident status and whether or not you have met the five-year bar has a permanent resident, impacts what type of public benefits you are eligible for. there are other considerations such as whether folks are aware the programs exist, whether they know that they are eligible based on income, resources as well as immigration status eligibility criteria. and other things like whether the application process is welcoming. is it understandable and available in the language accessible to the community? these eligibility restrictions play out in the health coverage context. your immigration status determines what health coverage programs you may be eligible for and compared to the insured
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population, those who are uninsured are less likely to have a regular doctor or get timely and routine care and are more likely to be hospitalized for preventable conditions. to give some context, among the non-elderly population, 23% of lawfully present immigrant and 45% of undocumented immigrants were uninsured in 2018 compared to 9% of citizens. among citizen children, those with at least one noncitizen parent are more likely to be uninsured compared to those with both parents being citizens . these rates of uninsurance among immigrants makes sense when you consider the eligibility restrictions tied to the different health coverage programs based on immigration status. u.s. citizens including naturalized citizens are eligible for all publicly funded
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health coverage programs which includes medicaid, the children's health insurance program, the affordable care act qualified health programs and medicare if they meet the other criteria. for people with lawful permanent resident status as we discussed, if they met the five-year bar, they could be eligible for medicaid or medicare. if they have not met the five-year bar, they could be eligible to purchase qualified health plans on the exchange. their other lawfully present immigration categories, any of which are eligible to -- many of which are eligible to purchase plans. affordability remains a barrier. many people have access to qualified health plans still have to pay out-of-pocket costs. unlike medicaid, which in most circumstances, there are no out-of-pocket costs, qualified health lands do include out-of-pocket costs and that
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serves as a barrier for lower income folks for accessing the services they need. there is data that shows out-of-pocket costs as little as one to three dollars prevents people from accessing services they need including things like prescription medication. dinh-zarr undocumented folks who have the leak -- then there are undocumented folks who have the least available. they are not eligible for medicaid, qualified health programs and medicare. folks who have not met the five-year bar are also eligible for this emergency medicaid. states have flexibility in how the emergency medicaid program is implemented. specific service coverage varies from state to state. there is the emergency medical treatment and labor that requires anyone who goes to an emergency department to be
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stabilized and treated without regard to their insurance status or ability to pay. and it has been an unfunded -- and there are these charity mandates both federal and state that help meet some of this but it varies from state to state and hospital to hospital. some are much more generous than others. in washington state, this state law is for folks up to 100% of poverty, hospital-based care should be written off. there are hospital policies that go beyond that and are writing off out-of-pocket costs for up to 400%. that varies. there are federally qualified health centers and rural health clinics. those include sliding fee schedules. some cost sharing is required of patients. recently, the washington immigrant solidarity network conducted a statewide survey of over 5700 undocumented immigrant
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-- undocumented individuals were people of mixed status households and found that 87% of respondents lack health insurance and the majority cited immigration restrictions or costs as key barriers to obtaining coverage. 66% of respondents identified lack of health insurance as a barrier to accessing health care services and another 59% identified cost of care as a barrier. despite the f q hc and will health clinic availability, respondents reported inability to access health care services including things like primary and preventive care, vision, dental and behavior health care among others. ms. wartell: it is a lot. i think you made the point. the dizzying array of complexities a family faces when trying to determine whether or
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not they and their families should and can get access to health care let alone what consequences it might have for the immigration status is very difficult and daunting. i'm going to ask us to step back for a moment and each of you and the congresswoman have been working to expand access. the less the administration had an argument i would like to ask each of you briefly to join with one or two points. they argued the access to the safety nets should be restricted to those who have had been in the unit and states -- the united states and immigration status should be resected to those who are not likely to take advantage of the social safety net. clearly, i think there is a different point of view reflected by the advocates trying to gain access to these services.
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i just want to ask, can you join that question -- that argument and why do you think that is either the right way to go or the wrong way to go? >> sure. covid has really shown how interconnected we are as a society and the health and safety has been tied to our community regardless of immigration status. our front-line workers are is representative to -- overrepresented by immigrants and they do not have access to the safety net and the supports they need so that they can continue filling those roles. when people are provided with the supports they need such as nutrition, housing, health care, whatever it is, the entire nation's benefits because people
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are more likely to succeed and be productive members of society. you cannot expect a child who is hungry to be able to focus in school and meet their full potential. it is not a realistic expectation. as representative chu discussed, in order to maintain those vital roles in the community and keep those filled, they need the supports just like citizen counterparts. one thing we do not talk about as much but representative chu did mention is acknowledging the contributions of immigrants to funding these social supports they are systemically excluded from. 44 point 4 million immigrants in the u.s. make up 13.6% of the population. they have paid over 400 billion in taxes in 2017. they are excluded from the safety net. it does not make sense.
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ms. wartell: urban and many others in the field have been studying how immigrant families have fared over the last few years, particularly how successfully or not they have been able to accept the safety net. can you talk about what we know? >> sure. so immigrant family participation in safety net programs dropped significantly and dropped more than for nonimmigrant families. the administrative data, the most recent community survey data and the interview data, we at urban and others have collected over the last several years. we have built up a strong evidence base these chilling effects took place. our most recent survey data we collected in december 2020, that showed one in six adults and immigrant families reported
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avoiding public programs or other help because of immigration concerns, and a brief we are working on now will show it is one in four when you look at low income families. consistently, over the three years we have collected this data, this avoidance was the most common in families where there were individuals without a green card. even in families where people born outside the u.s. were naturalized or had green cards, we saw the chilling effects. they were also higher in families with children, closer to one in five adults in families with children reported those effects. the drop started in the context of discussions about the new rule, which had several years of buildup from drafting the public eye to the rulemaking process in 20 and then implementation in february 2020, just before the covid crisis hit.
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this was an issue being covered in the media, tons of litigation, twists and turns, and widespread worries and -- worries in immigrant communities across the country about participating in these programs for themselves or their children could have immigration consequences. there was a lot of confusion about what the rule said. with a couple types of spillover effects of sorts. one to nine test programs that would not be considered. the final rule specified participation in nonemergency medicaid, food stamps, federal housing assistance would be considered in a green card application but it did not include programs like free or low-cost health care, private support, and we see evidence that immigrants were avoiding those supports as well.
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another type of spillover was it affected people who would not be subject to a future public charge test. of major concern is children and immigrant families, most of whom are u.s. citizens themselves. there is also the exception groups that would never get a test like refugees. there was a misperception that public charge considerations would impact citizenship applications, not just green card applications, so current green card felt those effects. the extent of this misunderstanding was large. in our 2019 data, we found only one in five adults in immigrant families knew that children's participation in these programs would not be considered in a public charge test and similarly, one in five new that
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it would not affect citizenship applications. so there was a lot of confusion and misperceptions about what the rule said. it played out, unfortunately, in jobs and participation and it also played out in service providers. we saw a lot of that on the ground in houston and las vegas. those service providers, health care providers, the enrollment, all the people involved in trying to get people -- get support to families had to contend with litigation outcomes. they had to follow all of that to provide accurate information to their clients and work to reassure families and correct those misperceptions about what rule might mean for them. it has been an enormous dynamic both for families and communities. ms. wartell: i want to cover two
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things quickly before we wrap up. many of the programs we are talking about, there are federal rules and policies, but as you mentioned, they are largely administered at the state and local level. given the circumstance just described, what do you see is the role of state and local governments in supporting immigrant communities and helping people to navigate to the programs that make sense for them? >> state and local governments have continued to play a key role in filling gaps in the safety net and addressing some of this confusion and ongoing fear in the community. looking in the health care context, there are states that have expanded coverage to all children regardless of immigration status, coverage for
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pregnant folks, access to family planning services, then implementing covid specific programs that touch on some of the other determinants that we had discussed previously like programs including emergency cash, rent, and utility assistance. payments to families excluded from the federal stimulus fund. but this varies from state to state. there are still states that have not taken up the option to expand medicaid or chip coverage to all children regardless of immigration status, so there is a lot of flexibility there, but it does vary based on the politics in each state and what is going on there. there are local programs as well, county-based coverage
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programs counties have implemented for low income folks regardless of their immigration status. there is a lot that can be done. ms. wartell: i want to ask each of you to briefly close with a thought about intersectionality. the country is rightly coming to understand the extent to which there is ill into our society so many systems and structures that prevent access to opportunity for folks of different ethnic and racial backgrounds among other things, and yet we are also seeing that immigrant communities for the most case, , reflect people from different racial and ethnic backgrounds as well, so you see a layering of effects. i am curious if you think about this moment and the opportunity we have to draw attention to racial and other barriers in
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society and to think about how policies could help to overcome them. how does that affect the conversation that we have been having? please be brief. >> i think improving access to the safety net and health coverage is really tied to systemic racism and how we are in the midst of a public health emergency, a global pandemic, and the communities that are disproportionately contracting, being hospitalized for and dying from covid are the ones that are most likely to be uninsured or underinsured and the ones least likely to have access to the needed supports, so it is rethinking the safety net in general, removing some of these immigration status restrictions that exist that we discussed earlier and ensuring that everyone has the support they need to thrive and be productive members of society. ms. wartell: thank you.
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>> i guess the main point is when you look at racial disparities in the data, say in covid vaccine access or any range of policy issues we care about looking at those , disparities just by race and ethnicity, it maps the immigrant part of the story. when we see disparities for latinx four aapi -- latinx or aapi or black communities, it can be instructive to point out that one third of latinx people, two thirds of aapi people and 1/10 of black people were born outside the u.s. and many more are second-generation with a parent born outside the u.s. that realization can enhance our perspective on what that disparity looks like and what policy or practice measures might be needed to make a difference and mitigate it. i think the intersection is important to think about.
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ms. wartell: we are grateful to both of you for helping us think about those questions and more. it is wonderful to have you with us. thank you for your great work. to our audience, think you for being with us, we look forward to seeing you soon. be well and be safe. >> tonight on c-span, a conversation with white house chief of staff ron klain. then, veterans affairs secretary denis mcdonough on his agency's covid-19 response. later, a hearing on access to voting rights in the united states. that is followed by a look at state election laws. >> c-span is your unfiltered view of government. funded by these television companies and more including charter communications. >> broadband is a force for impairment.
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that is why charter has invested billions filling infrastructure, upgrading technology, empowering opportunity in communities big and small. charter is connecting us. >> charter communications support c-span as a public service along with these other television providers giving you a front row seat to democracy. >> white house chief of staff ron klain spoke about president biden's agenda with politico chief washington correspondent ryan lizza. this conversation is 20 minutes. ryan: good morning, everyone. i am the co-author of political playbook and chief washington correspondent at politico. the washington administration is full ahead with the vaccination timeline, the deployment of $2 trillion in pandemic relief at a
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