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Health Care Reform Toolkit



Messages on Immigrant Inclusion in Health Care Reform

Results from Recent Communications Research

By Adam Gurvitch, NILC Consultant


This document includes newly tested messages about immigrants and health reform. It presents messages and message elements that were tested in focus groups and polling in 2009 by Lake Research and American Environics, on behalf of Health Care for America Now (HCAN), the National Immigration Law Center (NILC), Asian American Justice Center (AAJC) and other groups. The message elements were reviewed by immigrant rights organizations such as NILC and National Council of La Raza (NCLR), as well as groups working on health reform such as HCAN, the Herndon Alliance, and Center for Community Change. 

The messages invoke core American values such as fairness, responsibility, and opportunity, and represent immigrants in a way that aligns with the cause of immigration reform.  Many of the message elements are repeated, and are offered here in various combinations.

Messages about immigrant inclusion in health reform, addressed to legislators, policymakers, and voters:

  1. LEGAL IMMIGRANTS. It’s important that Congress not be divided by distractions. Many immigrants pay the exact same taxes as U.S. citizens, but most legal immigrants are forbidden by Congress from using the Medicaid and Medicare programs paid for by these taxes. Health reform must be inclusive, and must end the unfair treatment of immigrants.

  2. LEGAL IMMIGRANTS II. Legal immigrants pay the same taxes as citizens, and should have affordable health insurance and Medicaid without any waiting periods, just like other Americans.  It would be unacceptable to invite people to come to this country as lawful permanent residents, collect their taxes, and then refuse to let them buy affordable health insurance.

  3. FAIRNESS. Americans value fairness, and expect our legislators to do the right thing by reforming health care so that everyone who wants to have insurance can buy it at a reasonable cost.  Americans deserve a system where workers are treated equally, and everyone — including immigrants — pays their fair share of the cost and has access to affordable health care.

  4. COMMITMENT.  All Americans deserve health care they can afford. We simply cannot afford half-measures and unfair exclusions in health reform that leave out millions of people who want to pay their share. Anyone who is working and is committed to this country should be allowed to pay for affordable health insurance for themselves and their families. If we let immigrants contribute and buy affordable insurance premiums, hospitals and clinics will see fewer uninsured patients.

  5. KIDS. All kids deserve health care, and health reform should allow affordable coverage for all children in America, including immigrant kids.

  6. KIDS II. America is not the kind of country that says some kids deserve health care and some don’t. Reforming health care means that all children will have access to affordable, quality health care. If we deny health care to any child, including immigrant children, all our children will suffer. Kids go to school with other kids and they need to go healthy.  Making sure all children have access to coverage will benefit our entire community and the future of our country.

  7. FAIR SHARE. If health reform requires immigrants to purchase affordable health insurance, it will mean immigrants will pay their fair share of the cost of health care, like everyone else.

  8. FAIR SHARE II. Immigrants, including immigrants who lack legal status, should be required to have health insurance just like all Americans, and to pay their fair share for it. If everyone is required to pay something for health insurance, and immigrants are paying for health insurance like everyone else, they should have the same access to affordable health care.

  9. TAXPAYER SAVINGS. Taxpayers will save if immigrants are required to pay their fair share for health insurance. Requiring immigrants to pay into the system will allow for the necessary expansion of services for everyone who has trouble paying for health care.

  10. FOCUS ON HEALTH. Health reform should require that everyone pay a fair share for health care they can afford, and immigrants should have the opportunity to pay for health care like everyone else. The immigration system is broken and there are a lot of questions about the best way to fix it. But health care is also a problem, and needs to be addressed right now. It would be a shame if we let our disagreements on immigration get in the way of tackling the health care crisis.

  11. FOCUS ON HEALTH II. Immigration is an important issue and there are a lot of questions about the best way to approach it. But health care is a big problem for us now. We can’t let the immigration issue divert us. We need to make sure you and I are getting quality, affordable health care.

  12. PUBLIC HEALTH. Covering all the members of our communities, including immigrants, is a public health decision that is important for all of us. Our personal health and the health of our families can't be separated from the health of the entire community. If we allow everyone to pay into the system and get the health care they need we will all benefit from a healthier community.

  13. CONTRIBUTIONS. In America, when people work hard they should see the fruits of their labor. Letting new immigrants pay into the health care system will help bring down the costs for everyone. Why make us all pay higher health care premiums by telling immigrants they can’t contribute and be part of our health care system?  It’s not fair and it hurts everyone.

  14. COMMON SENSE. Including immigrants in health coverage for all is just common sense. It’s important that everyone receive basic health care to prevent disease and suffering. With or without coverage, everyone needs care and our doctors and nurses aren’t going to let people die. By having everyone in our communities buy health insurance they can afford, we ensure a healthier society overall.

  15. EVERYONE. In this system, everyone should pay in, and everyone should be secure in knowing that they can get health care; this needs to include all immigrants, legal or not. If we leave out millions of people living in our communities the system will not work and will affect all of us.

NOTES:  Messages 1, 8, and 15 are slight variations of the versions tested in focus groups. Message 8 substitutes “immigrants who lack legal status” for “illegal immigrants,” which was the term tested. Messages 2, 4, and 5 are preferred messages that are awaiting testing.

Health Reform Messaging Do’s & Don’ts


  • Speak about immigrants positively embracing America and American identity. Emphasize immigrant faith in the American Dream.

  • Talk about making health care affordable for immigrants who are committed to becoming Americans and contributing to the nation.

  • Always note that immigrants “pay their taxes” and stress that immigrants will have to pay for their health care “just like every other American.”


  • Speak about immigrants fleeing desperate economic circumstances in their native lands.

  • Tell voters that immigrants are here to stay and they need to accept it. Doing so reinforces concerns that the problem is out of control.

  • Imply that immigrants are carriers of disease.

  • Argue that immigrants pay more in taxes than they receive in benefits. Voters don’t believe it, and it triggers skepticism about immigrant motives.

Sonal Ambegaokar, Health Policy Attorney  |  |  213-639-3900 x. 114