Improving population health depends on including undocumented immigrants in health care reform, concludes Hastings Center advisory group
With comprehensive immigration reform a priority for President Obama and gaining bipartisan and public support, there is a need and an opportunity to consider how the millions of undocumented immigrants should be integrated into our health care system, concludes a new report from The Hastings Center.
The report is the executive summary of the findings of a Hastings Center project that explored ethical, legal, and policymaking challenges that arise when undocumented immigrants living in the United States need medical care. It can be found on the project Web site, http://www.undocumentedpatients.org/executive-summary. Nancy Berlinger and Michael Gusmano, research scholars at The Hastings Center, are co-directors of the project, which was funded by the Human Rights program of the Overbrook Foundation.
Most of the 11 million undocumented immigrants do not have health insurance and are ineligible for most federally funded health insurance programs. Their lack of health insurance undermines population health, the report concludes, especially that of children and Hispanics, who make up 80 percent of the undocumented population. Some 4 million U.S.-born children have undocumented parents, and these citizen children lag both in health insurance enrollment and in access to health care despite their eligibility for the Child Health Insurance Program (CHIP).
The executive summary, Undocumented Patients: Undocumented Immigrants & Access to Health Care, outlines the recommendations of the project advisory group, which, in addition to Berlinger and Gusmano, consists of physicians, health care administrators, and experts in health policy.
Policymakers and other stakeholders in immigration reform should explicitly address access to health care for low-income immigrants, who may include undocumented immigrants, guest workers, permanent legal residents, refugees, and newly naturalized citizens, in the details of reform proposals.
The Health and Human Services Secretary should direct safety net funding to states with large informal labor markets, where undocumented immigrants and other low-income immigrants are likely to live and seek health care, to mitigate known uncompensated-care problems.
State policymakers should, similarly, support safety net funding for organizations serving undocumented immigrants, other low income immigrants, and mixed-status families, in which at least one parent is undocumented and one child is a U.S. citizen.
Health policy analysts should study and share findings on local level innovations, such as union-sponsored low cost health insurance, aimed at improving the health, welfare, and safety of undocumented immigrants and their integration into mainstream society.
"Immigration reform and health care reform are related," says Berlinger. "Our nation is taking up immigration reform at the same time as we are implementing the Affordable Care Act, which aims to increase access to health care. As we consider how to create a path to citizenship for millions of undocumented immigrants, how can we ensure that the benefits of the ACA also reach them, in a fair and timely way?"