My work at the county health department and as a volunteer at a local soup kitchen exposes me to a wide variety of people, some of whom happen to be illegal immigrants.

One day, a woman brought her 72-year-old Spanish-speaking father to the health-check clinic I provide in a corner of the soup kitchen. Juan Rodriguez* was suffering from a variety of ailments, including congestive heart failure, diabetes, and hypertension. His daughter told me that she had taken him to the hospital emergency department (ED) the previous day because he was having breathing difficulties and that he’d been told to follow up with his primary-care provider (PCP).

Unfortunately, Mr. Rodriguez doesn’t have a PCP. Although he has lived in the United States for more than 30 years, worked at a factory, and pays all his taxes, Mr. Rodriguez’s legal status makes him ineligible for Medicare, Medicaid, and the community’s uninsured clinic. His daughter said she takes him to the ED when he needs care, but she knows her father can’t go there unless he is “really sick.”

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Mr. Rodriguez is one of the thousands of people who flood hospital EDs because they’re denied basic health care that could be provided at open-service community clinics.

This is just plain wrong.

For one thing, everyone deserves health care. Most illegal immigrants are diligent workers, concerned parents, and good neighbors. They also take jobs many other people won’t, performing the hardest work for the lowest wages.

Promoting the welfare of all people is the goal and rationale for health care—it’s not optional. We’re all part of a larger community—our state, our country, and our planet. The view that anyone in this community deserves less than having his or her basic needs met is unethical and immoral.

In addition to being wrong, current policy is fiscally irresponsible. That is because the system wastes millions of dollars every year. Based on the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, most illegal immigrants are ineligible for government-subsidized health-care coverage.

However, the Emergency Medical Treatment and Active Labor Act of 1985 mandates treatment for anyone entering an ED. Because they have no other source of care, illegal immigrants must turn to EDs, where they run up an unpaid tab of some $250 million annually in unreimbursed costs.1

It’s not that they’re asking for a free ride. Some 8 million undocumented residents in the United States file personal income taxes and pay Social Security and Medicare taxes. Between 1996 and 2003, these taxes totaled nearly $50 billion. Properly utilized, that money could easily fund a system of community health clinics. The outcome might well be a decrease in overall health-care spending because prevention and early intervention cost far less than secondary or tertiary care.

As for Juan Rodriguez, I examined him as thoroughly as I could at the soup kitchen and gave his daughter some instructions for his care. The following week, she told me that her father had gone to live with one of her siblings and that he was not doing well. I have neither seen nor heard from either of them since.



1. Duke University Center for Health Policy, Law, and Management (2002). Health problems facing illegal immigrants. Available at Accessed June 1, 2007.

Diane L. Klutz, APRN, CNS, CFNP, is a nursing doctoral candidate at Texas Woman’s University, Denton, Tex.