February 15, 2019 seemed like quite the average Friday for our country; however, in the eyes of our President, we were in a State of National Emergency. The Trump administration’s persistent desire to build a wall on the Mexican border and immigration advocates’ goal of increased rights for immigrants are only two positions on the wide spectrum of current opinions on immigration to the United States. Those in favor of a border wall hold that view because they see undocumented immigrants as “lawless individuals” – a source of unemployment, crime, prostitution, and drugs.
Regardless of one’s opinion on undocumented immigration, we cannot ignore the undocumented immigrants already living in America. The Migration Policy Institute’s 2017 population data analysis estimated that among the 44.5 million immigrants currently residing in the US, 11.3 million are undocumented. Furthermore, 4.5 million children either are undocumented themselves, or have parents with “illegal” status. These populations predominantly reside in coastal metropolitan areas, such as New York, California, and Texas.
Progressive immigration policies have reflected the notion that all humans have inalienable rights. For example, education for children of illegal immigrants has received widespread attention with the Dream Act and DACA. Less discussed, however, is the undocumented person’s right to healthcare. In a country dependent on privatized health insurance, the United States seems to have difficulty accepting the idea of universal healthcare for all citizens; thus, the idea of allocating taxpayer money for undocumented immigrants’ healthcare may seem unlikely in our current policy landscape.
From a public health standpoint, the inequity of health access among undocumented immigrants is simply unacceptable. Studies have shown intersectional ties between immigrant status and decreased health outcomes. This connection stems from barriers to access, including fear of deportation, stigma, lack of financial resources, language barriers, and inability to provide necessary documentation, like a social security number or vaccination record. A 2013 Migration Policy Institute report estimates that as many as 71% of undocumented immigrants lack health insurance. These inequities are further exacerbated by limited employment opportunities with health benefits. As a result, these individuals are often denied insurance and discouraged from seeking treatment. The issue is further exacerbated by socioeconomic status (SES), as there is a correlation between undocumented status and lower SES. Often, those in poverty experience less desirable health outcomes due to second stress, lack of time, and decreased exposure to resources.
The effect of lack of access among illegal immigrants can be felt by everyone in the communities where they reside. According to the American Medical Association, with these barriers, illegal immigrants wait until it is too late to seek care, adding to crowded and strained emergency rooms in city hospitals. With impacts on both individual and societal levels, we must acknowledge the policy changes that must be done to mitigate this inequity.
Legal Changes
The Affordable Care Act has set a great precedent to expanding coverage, regardless of immigration status. In the future, we hope to see policy, such as California’s “My Health LA,” and “Healthy San Francisco,” that give full rights of health care to undocumented immigrants and alleviate costs. Most recently in New York City, Mayor Bill de Blasio released a plan to increase health care coverage.
Education and Community Outreach
Even with progressive policies, there needs to be a way to connect immigrants to their options. Medical-Legal Partnerships (MLPs) are attorneys that “resolve legal barriers to health care access through a team approach by contributing expert knowledge of relevant law.” They act as an educational resource for health professionals and immigrants. Another approach is to expand the number of local community health clinics in areas of high need, which put health providers, social workers, and cultural liaisons altogether. Considering many undocumented immigrants are also Limited English Proficient (LEP) patients, these clinics ensure that language barriers are reduced.
Training Providers
There needs to be a focus on cultural competency in the health care setting to reduce stigma and shame. Currently, The American Medical Association has a Code of Ethics that outlines ethical expectations for Physicians and their undocumented patients, based on the four principal tenets of medical ethics: autonomy, beneficence, non-maleficence, and justice. As it is a health care provider’s responsibility to act in a patient’s best interest, do no harm, and to treat patients similarly, there is an emphasis on the universal right to health care, regardless of immigration status.
AMA Policies | |
Opinion 11.1.1 | Defining Health Care – Health care is a “fundamental human good” and health as a necessary component of a full life |
Opinion 11.1.4 | “The medical profession must work to ensure that societal decisions about the distribution of health resources safeguard the interests of all patients and promote access to health services” |
Policy D65.992 | Medical Needs of Unaccompanied, Undocumented Immigrant Children – Physicians should assess how immigration status can affect a child’s physiological and mental health |
Policy H-160.917 | Federation Payment for Emergency Services for Undocumented Immigrants – Expand legislation that provides federal funding to states for emergency services for undocumented immigrants |
Policy H-440.876 | Opposition to Criminalization of Medical Care Provided to Undocumented Immigrant Patients – Physicians are not criminals for providing care to undocumented immigrants. |
Table 2 made from information provided by the AMA Code.
Ultimately, an aggregation of these three spheres of policy change will help to mitigate the inequalities in health care access to undocumented immigrants. Hopefully, these groups will feel less pressured to delay seeking medical attention from fear of deportation.