HealthLawProf Blog

Editor: Katharine Van Tassel
Case Western Reserve University School of Law

Tuesday, August 14, 2012

The Intersection of Immigration Reform and Health Care Reform

On Thursday, August 9, Reuters published an article about one of the hidden effects of the Affordable Care Act on undocumented immigrants that both supporters and opponents of the ACA should think about. Undocumented immigrants are not permitted to purchase private insurance on the heatlh insurance exchanges set up by the ACA, nor are they eligible for Medicaid. Health-care providers that serve this community are concerned that as more low-income citizens and documented immigrants get insurance under the ACA, undocumented immigrants will fail to seek health care because of the fear that they will be easily identified as undocumented due to their uninsured status, and reported to the authorities. Not only will the undocumented immigrants fail to seek health care for themselves, but they may very well fail to seek health care for their U.S.-born children, for fear of being identified, deported, and separated from their children. Despite assurances from health care providers that they don't check immigration status when treating patients, and don't report immigration status to the authorities, many undocumented immigrants have been taught through long experience in their home countries (and here) not to trust any authority, even health care providers. All of this makes the case for a comprehensive review of our laws regarding immigration and the treatment of undocumented immigrants when they are in the country. Having the laws regarding health care and immigration work at cross-purposes is hardly efficient or helpful to any of us.

Comparing our Policy to North Korea and Iran

However, I have little hope that any serious reform efforts to remedy this situation will be forthcoming. I recently saw something circulating on Facebook comparing our immigration policy unfavorably to the actions of North Korea, Afghanistan, and Iran towards those who illegally cross their borders (where you would generally be shot, sentenced to hard labor, or imprisoned for a lengthy period for crossing the border), and insinuating that this is why we are "broke." The absurdity of comparing our policies to those of totalitarian regimes, where people are starving (North Korea) or lacking in freedoms that we consider fundamental to our rights as Americans (Iran), and insinuating that North Korea and Iran have it right, all in an effort to foment baseless hostility towards undocumented immigrants (who have been found to use all social services less than American citizens) as the root of our economic troubles, does not bode well for any reasoned debate about our policy towards immigrants and health care.

A Health Insurance Executive with a Heart

On a more positive note, one of the more surprising statements in the article came from a health insurance executive who spoke anonymously, who expressed frustration with Washington, and stated that "the health system works better when people have access to coverage." The fact that this insurance executive felt the need to speak this simple fact anonymously does not make the the insurance industry look good. Apparently, not everybody in the industry feels the same way, given the history of coverage rescissions, refusals to cover people with pre-existing conditions, and skimpy insurance coverage peddled to many self-employed people. This executive was probably wise to to remain anonymous, if the executive wants to remain employed in the industry.


Cross-posted on Healthy Interests

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