Response to President Trump’s Comment on Healthcare for Undocumented immigrants: Why are we still leaving people behind?

In 2002, President Bush signed the “No Child Left Behind Act” into law, a landmark educational reform program, aimed at closing the achievement gap between disadvantaged (K –12) students and their more advantaged counterparts [1]. History shows that we were able to achieve this kind of inclusive educational reform. However, healthcare reform is still proving to be an unattainable feat.

Inception of the ACA

The year 2010 was marked with sweeping healthcare legislation: the advent of the Patient Protection and Affordable Care Act (Obamacare/ACA). The ACA was touted as the largest and most comprehensive piece of health care legislation since Medicare and Medicaid in the 1960s [2]. 

Shortfalls of the ACA

While the ACA has seemingly changed the landscape of healthcare in the U.S. (ending discriminative practices due to preexisting conditions, extension of coverage for young adults and Medicaid expansion [3]), a critical group has been excluded from its provisions: undocumented immigrants.

Trump’s position on this group has always been to protect our borders and keep them out.

2020 State of the Union Address 

It is 2020, a brand new decade. Let’s see what’s in the pipeline here. 

In his 2020 State of the Union Address, President Trump once again expressed his disdain for undocumented immigrants, asserting the need to pass legislation “to prohibit free government healthcare for undocumented immigrants.” Really Trump? This is problematic for several reasons, and is really the wrong approach to addressing the health care crisis in the U.S. 

Why is this concerning?

– Lack of health care access in undocumented immigrants lends itself to a multitude of problems. This results in millions of people without coverage, which translates to poor health outcomes. Individuals without access to care tend to delay basic and necessary medical services such as preventative care.

– When they do get healthcare, it is often too late. The result is that acute conditions have worsened into chronic conditions, which ultimately overburdens safety net services such as emergency room systems. (Consider the cost-factor here: public hospitals are typically funded by tax-payers’ dollars, so in one way or the other, the health care of undocumented immigrants must be paid for. But, why do we wait until it is too late?).  

– Undocumented immigrants contribute to the national burden of disease. If they are not receiving proper healthcare, this will exacerbate the spread of infectious diseases and worsen the disease state in the U.S. on a broader scale. 

– Additionally, immigrants in general bring unique environmental exposures when they come to the U.S. Some of these exposures can be either risk or protective factors for disease. The presence of unique risk factors may increase the propensity for certain health outcomes. Thus, not having access to care is detrimental to this population. 

The sum of all these factors is an increased burden and cost of healthcare to the U.S. on a whole.  

How can we mitigate this? 

If we truly care about the health and well-being of everyone in the U.S., healthcare provisions for undocumented immigrants should be made on a national level. These include:  

-Amending the ACA to provide health insurance subsidies through the state/federal marketplace to everyone who permanently reside in the U.S. (regardless of immigration status).

-Ensuring subsidies and tax breaks for private health insurance carriers so they can provide affordable health insurance for all. 

Signs of Hope: NYC Care

Special shout out to Mayor DeBlasio on his implementation of the NYC Care program. While not health insurance, it is a health care access program that guarantees care within the NYC Health + Hospitals system to New Yorkers regardless of their immigration status or ability to pay.

This is a step in the right direction and could serve as a model for other areas until true health care reform has been passed on the federal level. 

How Ironic

I find it ironic that President Trump commented on his efforts to address the coronavirus outbreak, a now global epidemic that originated China, yet the health care crises that are the reality for millions of people here go ignored.

And using said coronavirus as an example, should an undocumented immigrant without health care become infected, there’s a heightened risk of spreading that pathogen to others, since it is highly probable that that person is without health care, and may be reluctant to seek medical services due to cost or other barriers to care.

The danger that lies herein cannot be overstated. Extending access to care to undocumented immigrants is essentially accounting for the safety and well-being of every American.  

As a society, we have agreed that it is not acceptable to leave children behind—alas, they all deserve an equal chance at an education. Unfortunately, we still cannot agree on ensuring health care access for all: many undocumented immigrants still lack access, and we have no problem leaving them behind, although they comprise a significant part of the U.S. population – approximately 12 million [4].

Indeed, without further health care reform, we cannot truly say that we’ve made any progress. It is 2020, let us live like we’re really in a new decade and not in primitive times.  

You can read more about the uninsured population here.

References:

1. Education Week. (2015, April). No Child Left Behind: An Overview. Retrieved from edweek.org/ew/section/multimedia/no-child-left-behind-overview-definition-summary.html
2. Adkinson, J. M., & Chung, K. C. (2014). The patient protection and affordable care act: A primer for hand surgeons. Hand Clinics, 30(3), 345–vii. http://doi.org/10.1016/j.hcl.2014.05.002
3. Kaiser Family Foundation. (2013, April). Summary of the Affordable Care Act. Retrieved from https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/
4. Brookings. (2019, November). How many undocumented immigrants are in the United States and who are they? Retrieved from https://www.brookings.edu/policy2020/votervital/how-many-undocumented-immigrants-are-in-the-united-states-and-who-are-they/

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