Undocumented Immigrants
Galarneau, Charlene
QESTION: When does "universal" mean "all but 3.2 million"? ANSWER: When it describes the actual coverage of U.S. residents for benefits under President Clinton's health reform proposal....
...Immigrant rights advocates fear, with reason, that this Health Security Card would become, de facto, a national identification card offering anything but security for undocumented immigrants...
...Hospitals are legally bound to provide emergency care as well as labor and delivery services for pregnant women regardless of ability to pay, immigration status, etc...
...This loss of political will has quieted even those who have historically taken the lead in supporting health programs which serve all community residents...
...that germs 204 • DISSENT Health Care Reform are oblivious to immigration status and "public" health requires health care for the "public...
...The political difficulty of arguing on behalf of undocumented immigrants in today's virulent antiimmigrant atmosphere is certainly one reason for the silence of our political leaders...
...Unfortunately, the loudest voices today are found among the supporters of alternative health reform plans that generally offer less "universal" coverage than the Clinton plan...
...The concern is that in year six this designation will expire and the health centers would be essentially mainstreamed into the larger system of health alliances and plans...
...SPRING • 1994 • 205...
...Undocumented immigrants would pay taxes, and perhaps even wage-withheld premiums, to support a health care system in which they, unlike other residents, could not participate...
...In short, most undocumented immigrants depend upon their personal financial resources and a tenuous patchwork of publicly-funded services for health care...
...QESTION: When does "universal" mean "all but 3.2 million...
...All told, these programs do not come close to meeting the health care needs of the undocumented immigrant population...
...For example in the short term, the plan intends to set aside $1 billion annually for federally mandated emergency and maternity care...
...The concurrent elimination of the Medicaid eligibility system, which qualifies some people for emergency services, raises concerns about whether, they will in fact be covered...
...Given the current shape of the health reform debate, it is highly unlikely that undocumented immigrants will be included, as other residents Barry C. Hoyt...
...Medicaid covers some of them for restricted benefits, that SPRING • 1994 • 203 Health Care Reform is, for emergency care and labor/delivery services only...
...Generally speaking, "undocumented aliens" or "undocumented immigrants" are persons liv ing in the United States without the approval of the U.S...
...As the proposal now stands, only "eligible individuals," not undocumented immigrants, would be able to participate in this system...
...While the plan would significantly expand access to health care overall, the unqualified claims of "universality" that commonly are used to portray this plan mask this significant exclusion...
...ANSWER: When it describes the actual coverage of U.S...
...The language of the Health Security Act is clear: the estimated 3.2 million "undocumented aliens" currently residing in the United States are "not eligible to obtain the comprehensive benefit package through enrollment in a health plan pursuant to this Act" (Section 1005, (a), 17...
...Exemplifying an increasingly common and morally problematic mix of health and immigration policies, several members of Congress have already suggested that a national health database could serve immigration control objectives...
...Recent administration assertions that undocumented immigrants will continue to be served through hospitals and health centers, though excluded from the new managed care system, are contradicted by the short- and long-term implications of the plan itself...
...Public hospitals and community and migrant (farmworker) health centers are the principal facilities serving undocumented immigrants, with private physician practices and public health departments offering more limited preventive and primary care...
...that the government is abdicating its responsibility to help the needy, and so on...
...Until "we" pull together the political and moral will to address these deeper questions publicly, honestly, and wisely, we will continue to thwart health care reform efforts by believing, for example, that "universal" means "all but 3.2 million...
...The tension between the plan's simultaneous inclusion and exclusion of undocumented immigrants creates a number of perverse potential consequences...
...The president's health reform plan proposes a devastating scene of reduced and eliminated health care services and financing for this already underserved population...
...Immigration and Naturalization Service (INS...
...It appears that citizen children of undocumented parents would be denied the plan's comprehensive benefit package due to their parents' lack of insurance...
...Who counts as members of this community and why...
...The most serious long-term implication involves community and migrant health centers that would be designated "Essential Community Providers" and continue to receive federal grants for five years...
...Some state Medicaid programs, such as those of New York and California, extend coverage to include prenatal care services...
...Once again undocumented immigrants would be marked by the lack of a card, in this case, a Health Security Card...
...Currently insured undocumented immigrants would lose their health insurance...
...The issue of health care for undocumented immigrants reflects a set of fundamental questions about who "we" are as a political, moral and health care community...
...The criticisms of the plan's exclusion of undocumented people are substantial: that it is "penny wise and pound foolish" to focus on emergency care...
...Yet it is estimated that $1 billion would not cover these hospital costs in California and Texas alone, not to mention in all fifty states...
...Most live in a few states such as California, New York, Texas, Florida, and Illinois, settling into households, neighborhoods, and jobs among persons of like ethnicity and national origin...
...What is the nature of social justice in health care...
...residents for benefits under President Clinton's health reform proposal...
...These serious economic, public health, and moral arguments have yet to be actively addressed by the administration or Congress...
...Comprehensive, culturally competent health care is unavailable to most undocumented immigrants...
...Members of a single household or family often represent a variety of distinct immigration and citizenship statuses...
...Undocumented immigrants tend to avoid being identified as undocumented for fear of triggering INS deportation...
...Historically, community and migrant health centers have offered primary health care services to local residents, particularly medically underserved residents, without concern for "alienage...
...What benefits and responsibilities accompany membership...
...Similarly, employers would be required to pay insurance premiums for undocumented employees who could not receive benefits...
...Are these distinct communities with distinct memberships...
...that health care is a fundamental human right irrespective of citizenship...
...As a result, their interactions with official social institutions, including medical facilities, are often cautious and minimal...
...Preventive and primary health care is routinely deferred, relatively minor health problems become serious, and significant medical intervention becomes a necessity...
...Despite little evidence for claims of present or future overutilization of health care services by undocumented immigrants, this plan recommends tortuous programmatic gymnastics in order to offer a very restricted set of services to them...
...The already common perception that a card will be needed in order to receive health care services will likely inhibit cardless persons from seeking care...
...and Nancy Hari are included, in the reform package...
...that partial population coverage sabotages the new system's cost control objectives...
...Although some undocumented immigrants have private health insurance, most work in low wage jobs without health insurance benefits...
...The preservation of current services and funding, especially for such categorical programs as community and migrant health centers and hospital payments, is crucial not only for the obvious health reasons, but for keeping undocumented health care needs visible and the door open for their future full inclusion...
Vol. 41 • April 1994 • No. 2
