About 11 million unauthorized immigrants are residing in the U.S. today (The Hastings Center, 2017). Most immigrants come to the U.S. with the hopes of living the American Dream and are often younger and healthier when contrasted with their counterparts who are born in the U.S. This disparity is mainly associated with limited access to healthcare that results in poorer health outcomes for undocumented immigrants. Several barriers impede this population from accessing quality healthcare, and they include communication difficulties, lack of support from the federal government about medical coverage, and limited access to job offerings, among others (Hacker, Anies, Folb, & Zallman, 2015).
Since time immemorial, discrimination toward the immigrant population has been present as healthcare in the U.S. is regarded as a scarce resource; thus, immigrants are perceived to drain the fund (Think Cultural Health, 2013). This form of the stigma associated with their immigration status contributes to the vulnerability of this population (Shi, 2014). Nevertheless, taking into consideration that undocumented immigrants are also human, the U.S. health system needs to consider providing health services to undocumented immigrants. The accessibility and quality of such services should be similar to that of both legal immigrants and U.S. citizens.
Considerations for Policies Focused on Care
This section will constitute a discussion of both individual policies for and against the provision of healthcare to undocumented immigrants, to allow for discussion of both sides of the issue.
Legal Considerations
The U.S. healthcare system has been long governed by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PWORA) that excluded unauthorized immigrants from all federal-funded insurance programs, such as the Children’s Health Insurance Program, Medicare, and Medicaid. Later on, in 2010, the Affordable Care Act (ACA) was formed. Even though the U.S. lacks a constitutional right to health, ACA instituted a ‘statutory right’ to health directing that citizens and legal residents obtain private and public insurance, including the low-income earners (Berlinger, Guidry-Grimes, & Hulkower, 2017). Moreover, similar to PWORA, ACA prohibited undocumented immigrants from accessing federal insurance plans. The only difference is that the ACA permitted undocumented immigrants to access care in the case of emergency services freely. However, non-emergency services tend to be more costly than emergency services (The Hastings Center, 2017). The ACA also guaranteed the provision of language assistance services to vulnerable populations (HHS Office of Minority Health, 2016).
Contrarily, there are some laws and statutes that advocate for access to health services irrespective of citizenship status. Under the Emergency Medical Treatment and Active Labor Act of 1986, EMTALA, emergency services are to be provided to all individuals irrespective of their immigration status (Berlinger et al., 2017). Furthermore, other policy options, which are mostly under the state and local levels, have expanded coverage and improved healthcare access to unauthorized residents (The Hastings Center, 2017). In addition to the state legislature, is the Civil Rights Act of 1964, which illustrates that federally funded medical facilities have to serve all patients of all backgrounds.
Ethical Considerations
The American Medical Association (AMA) opinions and policies emphasize the provision of sanctuary doctoring by attending to the social and medical needs of unauthorized immigrants. The AMA Code of Medical Ethics delineates the essentiality of good health and summons medical practitioners to provide care to all patients and be blind to other medically irrelevant details. Opinion 11.1.1 outlines the responsibility of society to ascertain that all people have access to an adequate quality of care, irrespective of their capability to finance such services (Harbut, 2019). Opinion 11.1.4 further builds on this concept by expounding on the specific ways through which medical practitioners can ensure care for all by acting as advocates for the vulnerable patient population (Harbut, 2019). Another ethical conviction that guides physicians are the Hippocratic Oath. The oath does not condone physicians refuting care to patients simply because of their citizenship status. Lastly, the American Nursing Association (ANA) ethical guidelines affirm that healthcare is a fundamental human right; thus, all individuals living in the U.S. should be granted access, including undocumented immigrants (American Nurses Association, 2015). It is essential to note that all ethical policies mandate equal care.
Financial Considerations
Most undocumented immigrants are uninsured as they have low-paying jobs; hence, they cannot afford out-of-pocket medical expenses or private insurance. Most U.S. citizens perceive that illegal immigrants are a liability to the nation’s healthcare system, with some thinking that unauthorized immigrants should be prohibited from accessing social services provided by the federal and state governments (Flavin, Zallman, McCormick, & Boyd, 2018). This perception is also reflected in the ACA which has restricted the availability and accessibility of health insurance to U.S. citizens and legal immigrants.
However, research shows that irrespective of the immigration status, presence or absence of insurance, and the age group, immigrants consume half to two-thirds of that spent by the U.S.-born population (Flavin et al., 2018). Moreover, unauthorized immigrants do not financially burden taxpayers as they generate tax revenue through filing federal and state tax returns, sales taxes, payroll taxes, and ad valorem taxes imposed on rent or home-ownership. According to Gee, Gardner, Hill, and Wiehe (2017), the total amount of state and local taxes collected annually from undocumented immigrants is approximately $11.74 billion. Under Medicaid, unauthorized immigrants are only eligible for discrete programs; for instance, emergency services. Furthermore, children born in the U.S. from undocumented parents are granted U.S. citizenship; hence, they are eligible for Medicaid or the CHIP program (Flavin et al., 2018). The federal government also allocates funds to various states in the form of disproportionate share hospital (DSH) payments, and upper-payment limit (UPL) supplemental payments. States often target UPL payments to safety-net hospitals and community health centers, which are often frequented by undocumented immigrants (Berlinger et al., 2017). Collectively, these federal financing programs help to support the care of unauthorized immigrants and reduce the burden on the local taxpayer.
Public Health Considerations
By default, immigrants arriving in the U.S. are often healthier than their U.S.-born counterparts. Therefore, they need fewer public health services in their initial periods of stay. However, the “healthier” concept deteriorates over time. The state and local governments have established community health centers and safety-net hospitals through which they can access health care. Moreover, there are federal programs that fund the healthcare of undocumented pregnant women and their children. Some local governments, such as Montgomery County, created the “Montgomery Cares” program have collaborated with local health centers to provide specialty treatment plans and medication for anxiety disorders, diabetes, and orthopedic injuries, among others. This is considered a substitute health plan for undocumented immigrants who are prohibited from accessing Medicaid or subsidized private insurance.
Conclusion
From the above analysis, it is seen that undocumented immigrants have earned their equal rights to receive quality healthcare similar to that provided to U.S. citizens. The provision of healthcare services has to be centered on the patient’s medical needs rather than that of other unrelated factors, such as nationality. A healthcare facility is not a place for negotiating nor enforcing immigration policies. Therefore, since immigrants, including their undocumented counterparts, are law-abiding citizens in almost all aspects, and generate tax; hence, they must be given medical attention similar to that of native-born Americans. The federal government should seek new ways of improving coverage and access to healthcare to undocumented immigrants, for instance, by making medical coverage part of the social contract between this vulnerable population and their employers.
References
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Flavin, L., Zallman, L., McCormick, D., & Boyd, J. (2018). Medical expenditures on and by immigrant populations in the United States: A systematic review. International Journal of Health Services, 48(4), 601-621. Web.
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Think Cultural Health. (2013). National Standards for Culturally and Linguistically Appropriate Services (CLAS) in health and health care. Web.