Running head: HEALTH POLICIES AND VULNERABLE POPULATIONS 1

Health Policies and Vulnerable Populations

Student’s Name
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HEALTH POLICIES AND VULNERABLE POPULATIONS 2

Health Policies and Vulnerable Populations

About 11 million unauthorized immigrants are residing in the U.S. today (The
Hastings Center, 2017). Most immigrants come to the U.S. with the hopes of living the
American Dream, and are often younger and healthier when contrasted with their
counterparts who are born in the U.S. This disparity is mainly associated with limited
access to healthcare that results in poorer health outcomes for undocumented
immigrants. Several barriers impede this population from accessing quality healthcare,
and they include communication difficulties, lack of support from the federal government
in relation to medical coverage, and limited access to job offerings, among others
(Hacker, Anies, Folb, & Zallman, 2015). Since time immemorial, discrimination toward
the immigrant population has been present as healthcare in the U.S. is regarded as a
scarce resource; thus, immigrants are perceived to drain the fund (Think Cultural
Health, 2013). This form of stigma associated with their immigration status contributes
to the vulnerability of this population (Shi, 2014). Nevertheless, taking into consideration
that undocumented immigrants are also human, the U.S. health system needs to
consider providing health services to undocumented immigrants. The accessibility and
quality of such services should be similar to that of both legal immigrants and U.S.
citizens.
Considerations for Policies Focused on Care
This section will constitute a discussion of both individual policies for and against
the provision of healthcare to undocumented immigrants, to allow for discussion of both
sides of the issue.
Legal Considerations
The U.S. healthcare system has been long governed by the 1996 Personal
Responsibility and Work Opportunity Reconciliation Act (PWORA) that excluded
unauthorized immigrants from all federal-funded insurance programs, such as the
Children’s Health Insurance Program, Medicare and Medicaid. Later on, in 2010, the
Affordable Care Act (ACA) was formed. Even though the U.S. lacks a constitutional right
to health, ACA instituted a ‘statutory right’ to health directing that citizens and legal
residents obtain private and public insurance, including the low-income earners
(Berlinger, Guidry-Grimes, & Hulkower, 2017). Moreover, similar to PWORA, ACA
prohibited undocumented immigrants from accessing federal insurance plans. The only
difference is that the ACA permitted undocumented immigrants to access care in the
case of emergency services freely. However, non-emergency services tend to be more
costly than emergency services (The Hastings Center, 2017). The ACA also guaranteed
the provision of language assistance services to vulnerable populations (HHS Office of
Minority Health, 2016).
Contrarily, there are some laws and statutes that advocate for access to health
services irrespective of the citizenship status. Under the Emergency Medical Treatment
and Active Labor Act of 1986, EMTALA, emergency services are to be provided to all
individuals irrespective of their immigration status (Berlinger et al., 2017). Furthermore,
other policy options, which are mostly under the state and local levels, have expanded
coverage and improved healthcare access to unauthorized residents (The Hastings
Center, 2017). In addition to the state legislature, is the Civil Rights Act of 1964, which
illustrates that federally funded medical facilities have to serve all patients of all
backgrounds.
HEALTH POLICIES AND VULNERABLE POPULATIONS 3

Ethical Considerations
The American Medical Association (AMA) opinions and policies emphasizes on
the provision of sanctuary doctoring by attending to the social and medical needs of
unauthorized immigrants. The AMA Code of Medical Ethics delineates the essentiality
of good health and summons medical practitioners to provide care to all patients and be
blind to other medically irrelevant details. Opinion 11.1.1 outlines the responsibility of
society to ascertain that all people have access to adequate quality of care, irrespective
of their capability to finance such services (Harbut, 2019). Opinion 11.1.4 further builds
on this concept by expounding on the specific ways through which medical practitioners
can ensure care for all by acting as advocates for the vulnerable patient population
(Harbut, 2019). Other ethical convictions that guide physicians is the Hippocratic Oath.
The oath does not condone physicians refuting care to patients simply because of their
citizenship status. Lastly, the American Nursing Association (ANA) ethical guidelines
affirm that healthcare is a fundamental human right; thus, all individuals living in the
U.S. should be granted access, including the undocumented immigrants (American
Nurses Association, 2015). It is essential to note that all ethical policies mandate equal
care.
Financial Considerations
Most undocumented immigrants are uninsured as they have low-paying jobs;
hence, they cannot afford out-of-pocket medical expenses or private insurance. Most
U.S. citizens perceive that illegal immigrants are a liability to the nation’s healthcare
system, with some thinking that unauthorized immigrants should be prohibited from
accessing social services provided by the federal and state governments (Flavin,
Zallman, McCormick, & Boyd, 2018). This perception is also reflected in the ACA which
has restricted the availability and accessibility of health insurance to U.S. citizens and
legal immigrants.
However, research shows that irrespective of the immigration status, presence
or absence of insurance and the age group, immigrants consume half to two-thirds of
that spent by the U.S. born population (Flavin et al., 2018). Moreover, unauthorized
immigrants do not financially burden taxpayers as they generate tax revenue through
filing federal and state tax returns, sales taxes, payroll taxes, and ad valorem taxes
imposed on rent or home-ownership. According to Gee, Gardner, Hill, and Wiehe
(2017), the total amount of state and local taxes collected annually from undocumented
immigrants is approximately $11.74 billion. Under Medicaid, unauthorized immigrants
are only eligible for discrete programs; for instance, emergency services. Furthermore,
children born in the U.S. from undocumented parents are granted U.S. citizenship;
hence, they are eligible for Medicaid or the CHIP program (Flavin et al., 2018). The
federal government also allocates funds to various states in the form of disproportionate
share hospital (DSH) payments, and upper-payment limit (UPL) supplemental
payments. States often target UPL payments to safety-net hospitals and community
health centers, which are often frequented by undocumented immigrants (Berlinger et
al., 2017). Collectively, these federal financing programs help to support the care of
unauthorized immigrants and reduce the burden on the local taxpayer.
HEALTH POLICIES AND VULNERABLE POPULATIONS 4

Public Health Considerations

By default, immigrants arriving in the U.S. are often healthier than their U.S.-born
counterparts. Therefore, they need less public health services in their initial periods of
stay. However, the “healthier” concept deteriorates over time. The state and local
governments have established community health centers and safety-net hospitals
through which they can access health care. Moreover, there are federal programs that
fund the healthcare of undocumented pregnant women and their children. Some local
governments, such as Montgomery County, created the “Montgomery Cares” program
has collaborated with local health centers to provide specialty treatment plans and
medication for anxiety disorders, diabetes, and orthopedic injuries, among others. This
is considered a substitute health plan for undocumented immigrants who are prohibited
from accessing Medicaid or subsidized private insurance.
Conclusion
From the above analysis, it is seen that undocumented immigrants have earned
their equal rights to receive quality healthcare similar to that provided to U.S. citizens.
The provision of healthcare services has to be centered on the patient’s medical needs
rather than that of other unrelated factors, such as nationality. A healthcare facility is not
a place of negotiating nor enforcing immigration policies. Therefore, since immigrants,
including their undocumented counterparts, are law-abiding citizens in almost all
aspects, and generate tax; hence, they must be given medical attention similar to that of
native-born Americans. The federal government should seek new ways of improving
coverage and access of healthcare to undocumented immigrants, for instance, by
making medical coverage part of the social contract between this vulnerable population
and their employers.
HEALTH POLICIES AND VULNERABLE POPULATIONS 5

References
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