Running head: LACK OF HEALTH CARE FOR UNDOCUMENTED IMMIGRANTS !

Lack of Health Care for Undocumented Immigrants in the United States:

Inclusive Programs and Increased Accessibility

Rino Watanabe

University of Washington

Dr. Dianne Hendricks

HONORS 392

November 17, 2019


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The rights of undocumented immigrants have been systematically disregarded and

undermined by the American government. In particular, their health care, or more so the lack of

it, and access to sufficient medical resources have been neglected. This injustice has not only

impacted their health outcomes but also their educational, economic, and work outcomes, among

its vast effects. The American health care system has already been a controversial issue for

decades and continues to be a point of division among politicians and the constituency. As it is

now, the U.S. health care system provides another platform to further dehumanize and oppress

this marginalized community. To eliminate this injustice, there should be a greater effort to

propose more inclusive health care policies and reduce the stigma around this group, as some

cities and states have already done; as a result, this group would have equitable health care and a

voice that is currently not represented in society. In other words, rather than perpetuating the fear

and discrimination they experience, society should focus on supporting undocumented

immigrants through equitable means.

Undocumented immigrants include people who entered the United States without legal

documentation and those who entered with a visa but then overstayed the time limit. As of 2017,

there are approximately 10.5 million

undocumented immigrants in the United

States; of these millions, around 45% of the

non-elderly population are uninsured (Artiga

& Diaz, 2019). As Figure 1 portrays,

undocumented immigrants are more

Figure 1. Uninsured rates among the non-elderly population by immigration status

Source: Kaiser Family Foundation, 2017 (Artiga & Diaz, 2019)
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uninsured than other immigration status groups. This imbalance can be attributed to the current

health care system, in which undocumented immigrants are not eligible for existing health care

programs such as Medicaid, CHIP (Children’s Health Insurance Program), and ACA (Affordable

Care Act). In non-emergency Medicaid, generally citizens and “qualified immigrants” are

covered after a five-year waiting period; this includes permanent residents (Green Card holders)

and those who are eligible for humanitarian forms of relief - human trafficking or domestic

violence victims, asylum-seekers, refugees, and Special Immigrant Juvenile Status children.

CHIP has the same immigrant eligibility and waiting period as Medicaid, and the ACA also only

covers “lawfully present” immigrants (Salami, 2017). Because undocumented immigrants are not

covered by these federal programs, they have to either be without health care or rely on the

limited resources that are available to them, including state- or city- sponsored coverage,

employer-sponsored coverage, private insurance, or safety-net providers. Safety-net providers

are “community and migrant health centers, public health clinics, hospital emergency

departments, and out-patient clinics as well as some private providers” (Galarneau, 2011).

Accessibility to health care and medical resources are also restricted due to factors such

as language barriers, unfamiliarity with the health care system, and fear. The American health

care system is already convoluted with different states implementing their own programs and

legislation regarding Medicaid, CHIP, and ACA. Furthermore, eligibility and cost can vary not

only by immigration status but also income level, pre-existing conditions, and disability, among

other factors; therefore, an immigrant or a non-English speaker would have greater difficulty

accessing health care (Salami, 2017). The daily fear and anxiety that undocumented immigrants

experience also restrict their accessibility to health care. Because of shifting immigration policies
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under the Trump administration and the negative representation of these immigrants in the

media, they are less likely to seek medical resources they need. Families are also more hesitant

for their children, who are born in the U.S. or eligible for certain programs, to utilize Medicaid

and CHIP (Artiga & Diaz, 2019). Under the Trump administration, deporting undocumented

immigrants has been made a national priority, as well as building a wall to “protect” American

citizens from these “illegal aliens,” as they’re often referred to in the media. The Trump

administration has threatened immigrant communities by preventing sanctuary cities from

receiving federal grants and has perpetuated their fear by proposing to end the DACA program

and including a citizenship question in the 2020 census. Their fear is exacerbated by the social

repercussions of the Trump administration’s actions - as Williams, Figuroa, & Tharpe (2019)

explains, “[The Trump administration] used inflammatory, racist rhetoric against immigrants and

people of color, which has amplified fear and stress among immigrants by intimidating them and

fomenting discriminatory acts against them.” The stigmatization of undocumented immigrants

has been reflected in the media as well, as conservative platforms have repeatedly argued against

them, and as of recent their health care, primarily from an economic perspective. Although,

research has demonstrated that undocumented immigrants pay taxes and contribute a substantial

amount to the state’s economy and local community (Williams et al., 2019). The term “illegal

aliens” itself, repeatedly used in the media, dehumanizes undocumented immigrants and implies

that they are inherently criminal and that “their very existence is illegal” (Garcia, 2019). As a

result, the media and Trump administration spread misinformation that contributes to people’s

prejudices against undocumented immigrants.

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To combat the lack of health care and limited access to medical resources, there should

not only be increased administrative effort to implement inclusive health care policies but also

reduce the social stigma and its implications beyond health outcomes. Several states like Arizona

and Illinois have already made efforts to help undocumented immigrants gain access to health

care by implementing programs that provide preventive and emergency health services and

communication assistance with health care providers (Salami, 2017). Some states have also

expanded their Medicaid programs to include all children until the age of 18. There has also been

an increase in the number of sanctuary cities, which have been pivotal in increasing awareness of

health care rights for undocumented immigrants. These sanctuary cities play an important role in

current society, since they refuse to comply with federal immigration enforcement and prevent

immigration officers from collecting information on people’s legal statuses. In addition, these

cities provide undocumented immigrants with medical resources, such as preventative care, that

in other cities they would either not have access to or would be too fearful to try to obtain. As

Sheyda (2016) describes, “Aside from noncompliance protocols, sanctuary cities have provided

local benefits and resource networks, including city-wide minimum wage laws, anti-

discrimination employment statutes, extension of the local franchise to all residents, and city

health insurance and healthcare programs.” Thus, sanctuary cities not only have inclusive health

care but also inclusive societies, in which these families can contribute to and not have their

educational or professional outcomes limited by their health outcomes. Society should also

implement more inclusive policies and programs to support undocumented immigrants in their

day to day lives. From allowing them to obtain driver’s licenses to strengthening labor law

enforcement, there are several options to allow undocumented immigrants to have the
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opportunities to achieve the same health, educational, and economic outcomes as everyone else,

regardless of immigration status (Williams et al., 2019). Another option is to expand health care

coverage to all children, which would be a step towards expanding health care coverage to

everyone. As a result, undocumented children would be more likely to achieve higher education

and receive higher income jobs, and there would be more economic security in this community.

Some 2020 Democratic presidential candidates have recently advocated for universal healthcare

or some other government-run health care plan, extending coverage to undocumented

immigrants. Trump responded in a tweet “All Democrats just raised their hands for giving

millions of illegal aliens unlimited healthcare. How about taking care of American Citizens

first!? That’s the end of that race!” (Trump, 2019). As this tweet demonstrates, the current

administration and lack of empathy towards undocumented immigrants are just a few of the

many barriers.

Some barriers towards inclusive health care programs and increased accessibility to

medical resources include lack of funding, systematic social stigmas, stringent immigration

policies, lack of diversity in healthcare professions, and lack of culturally competent health care

providers. Those who support excluding undocumented immigrants from government-run health

care make their arguments while holding American citizens on a pedestal and deeming these

immigrants as a financial burden. On the other hand, those who argue for expanding health care

to undocumented immigrants emphasize how “undocumented immigrants are human beings with

health care needs and a right to health care (Galarneau, 2011).” As a result of implementing the

changes, there will be equitable health care, regardless of immigrations status, culturally

competent providers, less pressure on local, safety-net health systems, increased educational
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outcomes, as well increased participation in the workforce and number of tax contributors, less

xenophobia and spread of misinformation, and more representative research/health studies. Not

providing health care to undocumented immigrants impacts every one since they depend on

safety-net providers, which everyone funds, and their health ultimately impacts everyone else’s

health since they are a part of society and still interact with other children and families.

In essence, health care is a fundamental right and should not be a privilege to those of a

certain immigration or citizenship status. Undocumented immigrants should not have to

prioritize staying with their family over receiving medical attention for themselves or for their

children. Sanctuary cities can serve as a model of how society can increase support for

undocumented immigrants and provide them with more access to health care and medical

services, among employment options and other benefits. As a result, undocumented immigrants

can live with less fear, and use the resources available to them to achieve equal health outcomes

as other immigrants and citizens. Although there is much division now on the rights of

undocumented immigrants, it is critical to remember in these debates that undocumented

immigrants are humans too.

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References

Artiga, S., & Diaz, M. (2019, July 15). Health Coverage and Care of Undocumented Immigrants.

Retrieved November 3, 2019, from https://www.kff.org/disparities-policy/issue-brief/

health-coverage-and-care-of-undocumented-immigrants/.

Galarneau, C. (2011). Still Missing: Undocumented Immigrants in Health Care Reform. Journal

of Health Care for the Poor and Underserved, 22(2), 422-428. doi:10.1353/hpu.

2011.0040.

Garcia, S. D. (2019, July 19). Why no one should call undocumented immigrants 'illegals'.

Retrieved November 3, 2019, from https://www.seattletimes.com/opinion/why-no-one-

should-call-undocumented-immigrants-illegals/.

Salami, A. (2017, October 19). Immigrant Eligibility for Health Care Programs in the United

States. Retrieved November 3, 2019, from http://www.ncsl.org/research/immigration/

immigrant-eligibility-for-health-care-programs-in-the-united-states.aspx.

Sheyda, A. M. (2016). Undocumented Immigrants and the Inclusive Health Policies of Sanctuary

Cities. Retrieved November 3, 2019, from http://harvardpublichealthreview.org/

undocumented-immigrants-and-the-inclusive-health-policies-of-sanctuary-cities/.

Trump, D. [@realDonaldTrump]. (2019, June 27). All Democrats just raised their hands for

giving millions of illegal aliens unlimited healthcare. How about taking care of American

Citizens first!? That’s the end of that race!. [Tweet]. Retrieved from https://twitter.com/

realdonaldtrump/status/1144419410729242625?lang=en.

Williams, E., Figueroa, E., & Tharpe, W. (2019, August 21). Inclusive Approach to Immigrants

Who Are Undocumented Can Help Families and States Prosper. Retrieved November 3,
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2019, from https://www.cbpp.org/research/state-budget-and-tax/inclusive-approach-to-

immigrants-who-are-undocumented-can-help.