Health care and immigration are two important issues, each fraught with challenges. The U.S. Congress is currently struggling with whether and how it should combine these issues. There are an estimated 11 million undocumented immigrants who interact with their communities where they live, work and play. However, this population lacks adequate health care due to their immigration status. Few undocumented immigrants have insurance through employer-sponsored programs and even fewer are covered by privately purchased insurance. Language, cultural barriers and limited financial resources also deter them from receiving early treatment and care. As a result, undocumented immigrants’ access to health care is generally limited to emergency rooms or community health clinics.
Inadequate access to health care and treatment can lead to the spread of disease and stymie disease control efforts. In November of 2012, immigration authorities detained a Nepalese man who had extensively drug-resistant tuberculosis, or XDR-TB. This is the first XDR-TB case that Immigration and Customs Enforcement encountered, but health officials aren’t confident it will be the last. The Centers for Disease Control and Prevention report the TB rate among foreign-born persons in the U.S. in 2012 was 11.5 times higher than among U.S.-born persons. States with large immigrant populations, such as California, Texas, Florida and New York, represented almost half of all TB cases reported in 2012.
Proposed immigration reform focuses on providing this population a path to citizenship by granting a registered provisional status. In general, this status allows undocumented immigrants to legally work in the U.S. but denies them public benefits. Undocumented immigrants are currently excluded from the Affordable Care Act (ACA). For example, they aren’t covered under the individual mandate provision, entitled to any government subsidies, and are banned from purchasing insurance through insurance exchanges. Undocumented immigrants remain ineligible for Medicaid, making them prone to rely on safety-net providers (providers that offer health services to uninsured or other vulnerable patients). Under the current immigration reform bill these ACA provisions will continue to apply. Provisions that exclude undocumented immigrants from the U.S. health care system have implications that impact public health.
There is no guarantee that undocumented immigrants have been inoculated for the same diseases the U.S. seeks to control within its borders. Immigration law requires those seeking to immigrate, or change their status to permanent resident, provide proof of vaccination against vaccine-preventable diseases, but this does not apply to undocumented immigrants. The failure to address immigrant health care means there are few options available to adequately and quickly address preventable disease and illness. Because this population tends to live in the shadows of society, tracking and preventing disease in immigrant communities poses numerous difficulties. Undocumented immigrants may avoid agencies that require self-identification, and fear visiting a health clinic will draw the attention of immigration officials. There is greater risk of exposure to contagious disease when access to health care is limited.
As drug-resistant diseases become more prevalent around the world, the U.S. can protect itself by providing undocumented immigrants with access to health care. As immigration reform is being considered, Congress has a second opportunity (the first was during the debate on the ACA) to have a robust debate on the public health benefits of insuring undocumented immigrants and enabling them to obtain better access to health care. Providing such benefits will widen the pool of insured persons and offer the potential to decrease the spread of disease and per capita cost. There is also significant potential to cut costs by lowering the use of emergency care. And most importantly, immigration health reform can prevent disease and illness in undocumented immigrants, thereby protecting the health of the entire U.S. population.
This blog post was prepared by Song Choi Betzler, J.D., M.P.H., Legal Fellow at the Network for Public Health Law — Mid-States Region at the University of Michigan School of Public Health.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this post do not represent those of the Robert Wood Johnson Foundation.