In recent years, the idea of universal health care has gained global momentum, with many countries adopting this model as a national goal. Universal healthcare entails “people obtaining the health services they need without risking financial hardship from unaffordable out-of-pocket payments [1].” It also ensures “financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all [2].” Yet, this goal has been unattainable thus far in countries around the world. In the United States, as of 2020, there are over 22.1 million undocumented immigrants in the U.S. About 4 in 10 undocumented immigrants are uninsured, making undocumented immigrants the largest group of uninsured individuals in the country [3]. The lack of coverage hindering undocumented immigrants contributes to healthcare affordability and access barriers, affecting the health outcomes of the growing undocumented population. When considering universal healthcare, we must consider the large numbers of undocumented and uninsured immigrants across the United States.
Undocumented immigrants have had a pre-existing history of discrimination in different sectors of society making it unlikely and unable for them to seek help as an underrepresented group in the US. During the recent COVID-19 pandemic, many undocumented immigrants lost their jobs, resulting in the loss of employer or union-covered health insurance. Moreover, most undocumented immigrants work low-wage jobs that do not offer employer-sponsored coverage. Currently, across the United States, undocumented immigrants are ineligible for coverage through the Affordable Care Act (ACA) Marketplace, Medicare, Medicaid, as well as the Children’s Health Insurance Program (CHIP). Only six states—California, Illinois, Maine, New York, Oregon, Washington, and Washington, DC—provide CHIP to children of undocumented immigrants [4]. Although there has been controversy surrounding funds used for public benefits aiding undocumented immigrants, it fails to take into account the billions of dollars and local taxes contributed by undocumented immigrants. According to research conducted by New American Economy, undocumented immigrants contributed $20.1 billion in federal taxes and $11.8 billion in state and local taxes in 2018 [4].
There are many coverage limitations and obstacles undocumented immigrants face in searching for insurance options and affordable healthcare access. Yet, the available options do not cover visits and medications that may not be deemed “necessary.” For example, in New York and other states, one available option for undocumented immigrants is Emergency Medicaid. While Emergency Medicaid requires hospitals to treat patients during emergencies, regardless of ability to pay, this coverage only provides medical payment for emergency medical care and service. For example, heart attack, kidney dialysis, labor, and cancer treatment. However, Emergency Medicaid does not cover ongoing medical care and routine health services, preventing undocumented immigrants from accessing preventative health care [5]. Only prescription drugs associated with emergency medical care are covered. Certain prescription drugs that do not meet these standards include proton pump inhibitors for GERD, blood pressure medications, and insulin for diabetic patients.
Limited insurance coverage affects the health outcomes of undocumented and uninsured immigrants and their access to proper healthcare services. Although immigrants usually have healthier chronic disease profiles compared with the U.S. population, the risk of developing a chronic disease increases over time as mentioned by Dr. Colleen Payton [6]. Amongst immigrant populations, there is a lack of knowledge about chronic disease management and a lack of preventive care within communities. This may be a barrier to seeking care in a timely fashion contributing to an increased risk of developing chronic diseases. Immigrant populations in the U.S. are at increased risk for hypertension, diabetes mellitus, cardiovascular disease, and mental health issues. Undocumented immigrants, in particular, face structural, economic, and linguistic barriers that contribute to these adverse health outcomes [7]. This population also faces stressors related to their undocumented status including fear of deportation, discrimination, and stigma within society, which contribute to poor physical and emotional health. Especially during the Trump administration, this fear resulted in families avoiding health programs and seeking medical care. As of now, undocumented immigrants depend on Federally Qualified Health Centers (FQHCs) that provide primary health care, dental, mental health, and pharmacy services that operate on a sliding-scale basis. They also rely on free health clinics operated by volunteer medical students, physicians, and private donations, However, this preventative care is limited as patients do not have access to specialty services for specific health concerns [8].
Moving forward, policy solutions must be made to expand access to health coverage for immigrants. Additionally, policy solutions should consider rebuilding trust and reducing fear to support the well-being of immigrant families. Proposed solutions at the federal level may include expanding Emergency Medicaid coverage to cover preventative healthcare services, medications, and equipment. Recently, certain states have attempted to expand Medicaid and CHIP coverage. Advancements during the Biden Administration included Navigator programs that provided insurance enrollment assistance to individuals [9]. However, these interventions and policies must involve communities to rebuild trust and reduce fears of utilizing these services. There also is a need to promote outreach and assistance to help uninsured families be aware of their health insurance coverage options. These outreach programs should recognize the racial and ethnic compositions of uninsured demographics and focus on addressing underlying barriers including poor health literacy, unawareness of rights, and fear of stigma. While universal healthcare in the United States requires complex policy implementations and logistical barriers, we cannot define this goal as universal if undocumented immigrants are excluded.
References
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Beck, Teresa L, et al. “Medical Care for Undocumented Immigrants: National and International Issues.” NIH U.S. National Library of Medicine, 16 Nov. 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141175/.
Tsuchiya, Kazumi, and Ryan T Demmer. “Citizenship Status and Prevalence of Diagnosed and Undiagnosed Hypertension and Diabetes Among Adults in the U.S., 2011–2016.” American Diabetes Association, 20 Jan. 2021, https://diabetesjournals.org/care/article/44/3/e38/138736/Citizenship-Status-and-Prevalence-of-Diagnosed-and.
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NYC Human Resources Administration Office of Citywide Health Insurance Access. “Do I Qualify for Emergency Medicaid? - New York City.” NYC Human Resources Administration, https://www1.nyc.gov/assets/ochia/downloads/pdf/fly-957-emergency-medicaid-english.pdf.
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