May 14, 2013 The Honorable Patrick Leahy Chairman Senate Judiciary Committee 437 Russell Senate Office

Building Washington, DC 20510 Dear Sirs: We write to you today on behalf of Physicians for Reproductive Health, a doctor-led national advocacy organization that uses evidence-based medicine to promote sound reproductive health policies. We commend Senate consideration of comprehensive immigration reform. However, we have concerns about provisions in the Border Security, Economic Opportunity, and Immigration Modernization Act that would be deleterious to the health of women and their families. We urge the Senate Judiciary Committee to lift prohibitions on access to health coverage in the bill and affirm equitable access to health care for all. All women, including immigrant women, need access to reproductive and sexual health care services. As currently written, immigrant women and families on the roadmap to citizenship must wait up to 15 years before they can access a full range of affordable health care options like Medicaid; 15 years is too long to wait to see a doctor. Health coverage is needed for a range of care including prenatal visits, sexually transmitted infection screenings, breast feeding support, and contraceptives. The decision to exclude immigrant women and families from these programs threatens their health. Lack of health insurance can lead to delay of diagnoses and ultimately increase medical costs when care is finally accessed. Barriers to heath care take a toll on the health of immigrant women and widen health disparities. For example, while cervical cancer has been on the decline for U.S.-born women, research indicates that the disease, which can be prevented through routine gynecological care and is highly treatable when caught early, has been on the rise for immigrant women.1 And studies point to lack of health insurance as a significant barrier for immigrant women in accessing the routine gynecological care necessary to prevent cervical cancer.2 We take care of immigrant women and families every day. We ask that you oppose any amendments or provisions in the immigration bill that would create barriers to women accessing comprehensive health care, including abortion, and instead advocate for policies that are responsive and supportive of immigrant womens health. Sincerely, Nancy Stanwood, MD, MPH, Board Chair-elect, Physicians for Reproductive Health Alabama Pippa Coulter Abston, MD, PhD Marsha Sturdevant, MD, MSS (Signatures continue on next page)
1

The Honorable Charles Grassley Ranking Member Senate Judiciary Committee 135 Hart Senate Office Building Washington, DC 20510

American Congress of Obstetricians and Gynecologists. Health Care for Undocumented Women. January 2009. Available at http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Wom en/Health_Care_for_Undocumented_Immigrants . Accessed on May 14, 2013 2 Rodriguez MA, Ward LM, Perez-Stable EJ. Breast and Cervical Cancer Screening: Impact of Health Insurance Status, Ethnicity, And Nativity of Latinas. 2005. Annals of Family Medicine. 3:235-241.

Arizona Janet Shalwitz, MD Eve Shapiro, MD, MPH Andrew Terranella, MD, MPH Barbara H. Warren, MD, MPH California Andrea Angelucci, DO Betsy S. Aubrey, RNP Susie Baldwin, MD, MPH Nicole M. Bender, MD, MSc Claudia Borzutzky, MD Claire D. Brindis, DrPH Judith Broder, MD Catherine Cansino, MD, MPH Angela Chen, MD, MPH Margaret T. Chen, MD Marsha Epstein, MD Richard L. Fischer, MD Arthur A. Fleisher II, MD, FACOG Micaela Godzich, MD Pratima Gupta, MD, MPH Jennifer Hastings, MD Paula J Adams Hillard, MD Jerome Hoffman, MD Andrea Jackson, MD Ronna Jurow, MD, MS Barry Kaminsky, MD Sarah Kennedy, MD, MPH Jen Kerns, MD, MPH Caron Kim, MD, MSc Lynette Leighton, MD, MS Lisa Lestishock, MSN, CPNP E. Steve Lichtenberg, MD, MPH Erin Lunde, MD, MPH Heather R. Macdonald, MD, FACOG Jane B. Marmor, MD Aisha Mays, MD Sarah McNeil, MD Karen Meckstroth, MD, MPH Marilyn Milkman, MD Joann Moschella, DO, FAAFP Scott Nass, MD, MPA Miriam Parsa, MD, MPH Susan C. Robinson, MD Lynne Rosen, MD Jennefer Russo, MD, MPH Nicholas Sasson, MD Naomi A. Schapiro, RN, PhD, CPNP

Tania Serna, MD, MPH Kate Shaw, MD Joan Smith-Maclean, MD Aparna Sridhar, MD Bruce S Steir, MD, MPH Alice Stek, MD Rebecca Trotzky-Sirr, DO Amy Voedisch, MD, MPH Curren Warf, MD, MSEd Tracey Wilkinson, MD, MPH Sophia Yen, MD, MPH Clinton Young, MD Natalie Young, MD Connecticut Aileen Gariepy, MD, MPH Georgia Nicholas Fogelson, MD Hawaii Bliss Kaneshiro, MD, MPH Illinois Cheryl Chastine, MD Catharine Crockett, MD Lori Gawron, MD, MPH Cassing Hammond, MD Gary Strokosch, MD Carole Warshaw, MD Elisabeth Woodhams, MD Sloane York, MD Iowa Mona Dalal, MD Jill Meadows, MD Jennifer R. Niebyl, MD Minnesota Diane J. Horvath-Cosper, MD Erika Johnson, MD Adrienne Richardson, MD Nebraska Amy E. Lacroix, MD New Jersey Noa'a Shimoni, MD, MPH

New York Gail Bauchman, MD David L. Bell, MD, MPH Nerys Benfield, MD, MPH Jocelyn Bitterman, MD, FAAP, FSAHM Laura S. Boylan, MD Joan Budd, MD Wendy Chavkin MD, MPH Byrd Cleveland, MD Deborah Coady, MD Robert L. Cohen, MD Anne Davis, MD, MPH Stacy De-Lin, MD Angela Diaz, MD, MPH Philip L. Ferro, MD Erin Gertz, MD Leslie Goldberg, MD Steven R. Goldstein, MD Emily Greenspan, MD Lois Anne Katz, MD Aileen Langston, MD, MPH Jenny Libien, MD, PhD Cathleen London, MD Sarah Miller, MD, MPH Kathleen Morrell, MD Jean Marie Naples, MD, PhD Siripanth Nippita, MD Lydia Pecker, MD Sharon Phillips, MD, MPH Daniel Pomerantz, MD, MPH, FACP Susan Rubin, MD, MPH Laura Schiller, MD Gail Shust, MD Zehra Siddiqui, DO Jonathan M. Vapnek, MD Lin-Fan Wang, MD Mary White, MD Pennsylvania Nadia Dowshen, MD Loreta Matheo, MD Elizabeth Miller, MD, PhD Pamela J Murray, MD, MPH Rhode Island Andrew Blazar, MD Gretchen Paranya, MD Pablo Rodriguez, MD

South Carolina Angela Dempsey, MD, MPH Texas Anitra Beasley, MD, MPH Paul Fine, MD Bhavik Kumar, MD Judy Levison, MD, MPH Ann Schutt-Aine, MD Scott J. Spear, MD Robin Wallace, MD, MAS Junda Woo, MD Utah Kamilee Christenson, MD Amna Dermish, MD Leah Torres, MD Vermont Kym Boyman, MD, FACOG Cheryl A. Gibson MD Washington Andrea Hoopes, MD

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