Ms S, a 40-year old woman, presented to urgent care in Texas with a sore throat and cough for 3 weeks. She obtained no relief of her symptoms using over-the-counter medications. She reported that she smoked one-half pack of cigarettes per day for 3 years, having quit at 31 years of age. She had been exposed to second-hand smoke her entire life. She was unable to recall her immunization status. Work-up revealed metastatic lung cancer. She did not have health insurance and earned less than the minimum wage. She was ineligible for public assistance because she is in the United States illegally.

Ms S’s case is not uncommon. Ms S and her family spent their entire modest life savings to come to the United States, where they have lived for 3 years and are now reluctant to return to Mexico.  

With soaring healthcare costs in the United States, the added burden of caring for people who do not live in the country legally can be overwhelming for healthcare providers and institutions. For undocumented immigrants, few healthcare options are available through the Affordable Care Act (ACA). Instead, this population is usually limited to using resources such as emergency services, charity care, or community health centers. Senate Republicans are working hard to repeal the ACA by revising the Senate Better Care Reconciliation Act (BCRA), which would limit eligibility for some of the benefits that undocumented immigrants have under the current law.

According to an article written in The Wall Street Journal, approximately 11 million undocumented immigrants reside in the United States; as of 2016, 5.4 million were from Mexico.1 In a recent blog posting, the author reported that 8.1 million undocumented immigrants are willing to work, and these workers make up approximately 5% of the US work force.2 Policymakers are now tasked with identifying a solution to this problem ranging from “offering such workers a path to citizenship to kicking them out of the country.”2

Coverage restrictions for immigrants will continue under healthcare reform proposals and in both the revised BCRA and the American Health Care Act (AHCA), specific changes to the language used in the ACA will limit eligibility for some of the benefits that immigrants have had under the current law (NCSL, 2017).3 Undocumented immigrants will be barred from enrolling in Medicaid or will be ineligible to purchase coverage through Marketplace exchanges.

According to an article written in the Huffington Post, the author states that “[i]n 2012, [California] spent over $600 million on emergency room and other health-related services for people living in the state illegally.”4 In 2015, a vote was passed by the California Senate to permit unauthorized immigrants to purchase health insurance on a state exchange created under the ACA. This measure would make California the first state to offer such coverage to this demographic. That same year, California became the largest state in the nation to provide healthcare to all children, regardless of their immigration status.5 Senator Ricardo Lara broadened this provision by sponsoring the Health for All Kids Act, which expanded Medi-Cal coverage to make California the state with the largest population of undocumented immigrants to implement such a policy; similar policies are in place in New York, Illinois, Washington, Massachusetts, and Washington, DC.5

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Numerous arguments have been presented to support providing insurance coverage for undocumented immigrants. One is that undocumented immigrants are willing to work at jobs that legal residents are not and therefore are a vital resource that should be protected. According to the article in The Wall Street Journal, “men in the US illegally are more likely to work than their native-born counterparts, and they’re willing to take jobs pretty much regardless of how much or little they get paid.”2 Healthcare costs for everyone can be reduced by providing preventive services such as immunizations to undocumented children and medical care to undocumented individuals who have communicable diseases.

We can close our eyes and look the other way; however, this issue is not going away — it is here to stay.

References

1. Krogstad JM, Passel JS, Cohn D. 5 facts about illegal immigration in the U.S. Pew Research Center website. Published November 28, 2018. Accessed February 21, 2019.

2. Sparshott J. Men in the U.S. illegally are more likely to work than men born here, for less. The Wall Street Journal website. https://blogs.wsj.com/economics/2016/03/22/men-in-the-u-s-illegally-are-more-likely-to-work-than-men-born-here-for-less/. Published March 22, 2016. Accessed February 21, 2019.

3. Immigrant eligibility for health care programs in the United States. National Conference of State Legislatures (NCSL) website. http://www.ncsl.org/research/immigration/immigrant-eligibility-for-health-care-programs-in-the-united-states.aspx. Accessed February 21, 2019.

4. Dobuzinski A. California Senate approves bill allowing undocumented immigrants to buy health insurance. Huffington Post website. https://www.huffingtonpost.com/2015/06/02/california-undocumented-immigrants-health-insurance_n_7496354.html. Published June 2, 2015. Accessed February 21, 2019.


5. Yee G. Bill extends Medi-Cal health coverage to California’s undocumented immigrant children. Press-Telegram website. https://www.presstelegram.com/2015/10/09/bill-extends-medi-cal-health-coverage-to-californias-undocumented-immigrant-children/. Published October 9, 2015. Accessed February 21, 2019.