Health Care Reform Is Intimately Linked to Immigration Reform – Peter Guarnaccia
Peter J. Guarnaccia
As a long-term advocate of universal health care, I am cautiously optimistic that current bills will make a positive difference for many. But as someone who has rapidly become more involved with transnational Mexican communities and their health issues, I am dismayed by the current refusal to include unauthorized immigrants in the health care plan.
In preparing our book, A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship (2006), Keith Wailoo, Julie Livingston and I organized two conferences to discuss issues of organ transplantation, Latinos in the U.S. health care system, and rights to medical care. I came to this project amazed that Jesica Santillan, an 18-year-old undocumented Mexican immigrant who had come to the U.S. explicitly to try to get a heart-lung transplant, had managed to receive such a procedure. In my experience in central New Jersey, the doors to medical care, beyond care in a local free clinic and a federally qualified health center, were relatively inaccessible to undocumented immigrants. Jesica’s story was remarkable on a number of levels: her mother got a job with health insurance, a local builder became an advocate and fundraiser for Jesica’s cause, and Duke University Hospital put Jesica on its waiting list for a heart-lung transplant because she had the financial resources to pay for the procedure.
Tragically, when Jesica got the transplant, she received mismatched organs in terms of blood typing, and she died – despite a second transplant with organs that did match. The second transplant provoked a flurry of vitriolic posts on anti-immigrant websites, and Jesica’s case became a lightning rod for promoting the denial of organ transplants to undocumented immigrants. As the contributors to the volume argued so cogently, these reactions were uninformed by how the U.S. organ sharing system treats non- citizens: 5 percent of organs are allowed to go to non-citizens, though the stereotype is that they go to wealthy individuals from abroad. Less known is that undocumented immigrants donate many more organs than they receive in the U.S. The deep analysis of this case offered in our edited volume provides many insights relevant to current debates about undocumented immigrants and their rights to health care.
The current debates on health care for immigrants – or, more appropriately, the denial of health care to undocumented immigrants – make evident that health care reform and immigration reform are inextricably linked.
At a basic level, I believe health care is a right and that all people in the U.S. have a right to health care. Undocumented immigrants are making tremendous contributions to U.S. society – our food, children, homes and communities depend on their labor. Somewhere between 20 and 40 percent of undocumented immigrants receive health insurance through their employer; all should, as should all employees. Many pay for health insurance – and pay social security and Medicare taxes – and do not realize they are paying for these benefits for themselves and for older Americans.
Immigrants are the lowest users of health services, and undocumented immigrants lower users still. They are not overwhelming our health care system; rather they are suffering with illness until it is a crisis, and then they appear at the emergency room very sick. These are the sensational stories that appear in the media, but they are the tail end of lack of access to health care. These desperately ill individuals are typically covered by uncompensated care funds or charity care because their more-than-full-time jobs do not provide health coverage. One of my concerns about the impact of health care reform on undocumented immigrants is that these kinds of funds to cover the poor and uninsured will be severely curtailed or even disappear. Paradoxically, if health care reform succeeds, there will no longer be a rationale for these kinds of funds as all citizens will have insurance coverage in theory, and hospitals will no longer need to provide charity or uncompensated care.
Some fledgling ideas for addressing the health care issues of Mexican immigrants have recently begun to circulate. Last year, at Binational Health Week, representatives of the Mexican government discussed potential solutions that would involve linking Mexico’s national health insurance system with the U.S. Other intriguing ideas would make Mexican insurance portable. Emergency care would be provided locally, and major medical care would be provided back in Mexico, with provisions to allow people to return to work once they are well. These ideas, however, will go nowhere unless there is a serious discussion of immigration reform linked to health care reform.
These ideas are those of the author and do not in any way reflect policy positions of Rutgers University.
Peter Guarnaccia, PhD, is Professor in the Department of Human Ecology at Cook College and Investigator at the Institute for Health, Health Care Policy and Aging Research at Rutgers University. His research interests include cross-cultural patterns of psychiatric disorders, cultural competence in mental health organizations, and processes of cultural and health change among Latino immigrants.
Guarnaccia, Peter. 2009 Health Care Reform Is Intimately Linked to Immigration Reform. AccessDenied: A Conversation on Un/authorized Im/migration and Health. Accessed (date) at http://accessdeniedblog.wordpress.com/2009/12/01/health-care-reform-is-intimately-linked-to-immigration-reform/