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News Round-Up (2/27/10)

Nolan Kline
University of South Florida

Current talk about excluding immigrants from health care reform raises crucial questions about the relationship between health care access and immigration status. Who deserves access to medical care, and why are immigrants sometimes viewed as less deserving of care?

Mounting evidence suggests that the current health care reform proposals – whatever their fate – will do little to address immigrants’ health care  barriers, as Feet in 2 Worlds notes, citing a press release from New Yorkers for Accessible Health Coverage and the New York Immigration Coalition. In some respects, current proposals would create additional hindrances for certain immigrant groups.  For example, unauthorized immigrants would be prevented from purchasing health care  coverage with their own funds, which, as New America Media reports, is not only discriminatory, but also antithetical to the goal of reducing health care costs. Preventing undocumented migrants from purchasing health care coverage effectively leaves emergency services as the only viable health care option for many immigrants living in the United States, and emergency services are often more costly to provide than other forms of care (cf. Bamezai & Melnick 2006).

What explains the motivation for preventing immigrants, legal entrants or not, from purchasing health care  coverage or accessing care? Although opposition is often grounded in economic arguments, there is a dearth of data in support of these arguments, according to a study by Jim P. Stimpson, Fernando A. Wilson, and Karl Eschbach that appeared in the policy journal Health Affairs.  Stimpson and colleagues found, in specific, that “health care expenditures among noncitizen immigrants were consistently lower than those of naturalized citizens and U.S. natives during 1999–2006.” In other words, the authors suggest, providing medical care to immigrants is actually less costly than providing care to U.S. citizens.  Their data also demonstrate that immigrants do not contribute more than U.S. citizens to the increasing costs of public programs like Medicaid.

Michelle Andrews echoed these findings in her recent New York Times health blog post, which incited fierce debate among readers.  Some of Andrews’ readers wrote in support of providing health care to immigrants regardless of their method of entry, and others wrote in vehement opposition. Despite evidence that immigrants are not an economic burden on the health care system, some news outlets such as Fierce Healthcare, an online news journal for “healthcare executives,” highlight Stimpson and colleagues’ finding that non-citizen immigrants account for higher levels than citizens in receiving uncompensated care. Yet Fierce Healthcare fails to mention the actual rates: 13 percent and 11 percent respectively. In other words, the difference Stimpson and colleagues found between non-citizen and citizen rates for receiving uncompensated care is hardly dramatic.

The economic argument for denying immigrants’ access to health care is tenuous at best, yet politicians and journalists continue to advocate for the exclusion of immigrants from health care  services by linking deservingness to health care with both citizenship and legal entry into the United States.  In an op-ed about undocumented immigration that appeared in the San Diego News Network, for instance, Beth Barber asks, “just what is it that liberals don’t understand about the word ‘illegal?’” She argues that “illegal immigrants” have arrived unlawfully and thus should not expect access to services available to citizens.  For Barber, among others, citizens and “legal” entrants in the United States are more deserving of care than “illegal” entrants or non-citizens.

Yet legal entry into the United States does not guarantee access to care, and many current policies ban access to services for legal immigrants. A recently proposed bill in Utah would lift the state’s five year ban for authorized immigrant children to access care, but Republican Senator Allen Christensen opposes the legislative change, claiming that repeal of the current waiting period is unnecessary.  “Five years is a reasonable expectation that you will support yourself and be on your own,” Christensen asserts. Christensen’s comment challenges us to ask who exactly can be expected to support themselves “on their own?”  Can authorized immigrant children be expected to provide for their own health care  needs? Would this logic apply to children born in the United States? And would Rep. Christensen expect this policy to apply to any of his eleven grandchildren?

Christensen’s comment demonstrates a strong commitment to individual responsibility regarding health care. While concepts of individual responsibility and deservingness are often tied to the health care  debate, children (and the elderly) have traditionally fallen on the side of those “deserving” of services.  Conversely, unauthorized immigrants and non-citizens have often fallen on the “undeserving” side of the argument. The suggestion that immigrant children should be denied access to low-cost health care for at least five years because they should “support [themselves] and be on [their] own” signifies an important moment in health care debates.  Immigrant children now seem to fall outside of concepts of deservingness that apply to other children, but why? The only justification for restricting certain immigrant children’s access to care is immigration status.

These cases raise challenging questions about our conceptions of deservingness to health care. They are also alarming demonstrations of how immigrants in the United States often are denied rights and privileges even when they make social and economic contributions and even when, as Stimpson and colleagues data suggest, they are not an economic drain on the health care system.

References

Bamezai A, Melnick G.

2006 Marginal cost of emergency department outpatient visits: an update using California data. Medical Care 44 (9): 835-841.

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