July 16, 2019

'Handout' or 'human right'? Inside the debate over covering undocumented immigrants.

Daily Briefing

    Immigration has long been a hot-button issue and, over the past few weeks, it's intersected with health care policy in notable ways. For instance, California last week became the first state to offer Medicaid coverage to undocumented, low-income young adults. And last month, candidates seeking the 2020 Democratic presidential nomination made waves when they indicated their support for extending health coverage to undocumented immigrants in the United States.

    Where do the 2020 Democratic hopefuls stand on health care?

    While some argue that extending health coverage to undocumented immigrants satisfies a human right to access health care, others categorize it as a handout and say government resources should be used to help U.S. citizens.

    The current state of health coverage for undocumented immigrants

    According to the Kaiser Family Foundation, undocumented immigrants generally are not eligible to enroll in Medicaid or CHIP, and are barred from purchasing coverage through the Affordable Care Act's exchanges. The New York Times' Jan Hoffman notes that undocumented immigrants also typically are prohibited from enrolled in Medicare.

    However, six states and Washington, D.C., have extended Medicaid coverage to undocumented children up to 18 years old, and 16 states have extended coverage to undocumented pregnant women who meet income qualifications for Medicaid. This week, California became the first state to extend Medicaid coverage to low-income undocumented immigrants through age 25.

    While undocumented immigrants largely are blocked from federal coverage programs, they are able to pay a sliding-scale fee to access primary care and prescription drugs at 1,400 federally funded health care centers that serve 11,000 communities in the United States, Hoffman writes. According to Hoffman, "Those centers are required to treat anyone, regardless of ability to pay, and administrators do not ask patients about their citizenship status."

    Also, Hoffman notes that U.S. hospitals are not allowed to deny undocumented immigrants emergency treatment, and that some undocumented immigrants are covered by employer-sponsored health plans. Even so, estimates indicate that 5.5 million to six million undocumented immigrants living in the United States do not have health coverage, according to Hoffman.

    'A handout'

    How to address the health care needs of those uninsured, undocumented immigrants is a divisive topic.

    On one side of the debate are those who believe government resources should be used exclusively to serve U.S. citizens, and who categorize providing public health coverage to undocumented immigrants as a type of handout.

    For instance, President Trump in a tweet posted after the Democratic primary debate wrote, "All Democrats just raised their hands for giving millions of illegal aliens unlimited health care. How about taking care of American Citizens first!?"

    Similarly, Republican National Committee Chair Ronna McDaniel in a tweet wrote, "Millions of Americans struggle to pay their own health care bills. Now Democrats want us to pay illegal immigrants?"

    And as Hoffman notes, "Even countries with universal, government-run coverage like Norway place tough restrictions on health care for undocumented immigrants. Most immigrants can get emergency care but have to pay other costs."

    'A human right'

    Still, during the second night of last month's Democratic presidential nominee primary debate, all of the 10 participating candidates raised their hands in support of extending health coverage to undocumented immigrants. In addition, Hoffman notes that nearly all of the 19 candidates seeking the Democratic presidential nomination told the New York Times they believed "undocumented immigrants should be covered under a 'Medicare-for-all' system, a public option, or other government health programs."

    Those who support extending health coverage to undocumented immigrants generally believe it's an extension of human rights. Mark Kuczewski, a professor of medical ethics and director of the Neiswanger Institute for Bioethics and Health Policy at Loyola University Chicago Stritch School of Medicine, in an opinion piece published by The Hill writes that extending health coverage to undocumented immigrants aligns with "fundamental American fairness," noting that some "undocumented immigrants pay into government safety-net systems that they cannot access."

    For instance, Pete Buttigieg—a 2020 Democratic presidential candidate and mayor of South Bend, Indiana—during the primary debate said, "This is not about a handout. This is an insurance program. We do ourselves no favors by having 11 million undocumented people in our country be unable to access health care."

    Further, Kuczewski argues that giving undocumented immigrants health coverage ultimately will benefit U.S. communities. He writes, "Immigrants tend to be young and healthy and therefore can be ideal contributors to the ACA … exchanges who need young subscribers" to help keep down premiums.

    Where do most Americans stand?

    According to a recent poll by CNN, 58% of Americans oppose extending public health coverage to undocumented immigrants, compared with 38% who do.

    Given the sharp divides between Trump and the Democratic candidates for president, it's likely the issue will continue to be a sticking point in the 2020 presidential election, and an issue states will continue to address in their own ways.

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