Healthcare for Illegal Immigrants Serves the Public Interest


Illegal immigration is one of the more contentious social issues facing Americans in the last several decades, dominating political discourse and affecting other social debates including the economy, education, unemployment, equality, and often, healthcare.  The illegal immigration debate is fueled by a resurgent nativist movement in the United States that argue illegal immigrants are responsible for a variety of social ills as they take American jobs, fail to pay taxes, and use a disproportionate share of scarce community resources.  From a healthcare point of view, the rhetoric against illegal immigrants is fierce and misunderstanding is prevalent as many Americans are worried that illegal immigrants are overburdening the healthcare system at taxpayer expense (Blum, 2012; Bush, 2012; Eviatar, 2009).  Rather than appeal to historical arguments that describe the U.S. as a country of immigrants, economic arguments the demonstrate the economic contributions of illegal immigrants, or moral arguments that the U.S. has a moral responsibility to provide care for those who contribute to society, this paper will argue the practical merits of providing healthcare access to illegal immigrants, including improvements in overall public health and the reduction of healthcare costs.

Despite arguments that illegal immigrants are a burden to the U.S. public healthcare system, subsidized care for illegal immigrants represent a tiny fraction of overall healthcare spending and in particular, publicly funded healthcare.  Mohanty, Wolhandler, Himmelstein, Carrasquillo, and Bor, (2005) found that all immigrant healthcare expenditures in 1998 were  7.9% of total U.S. healthcare expenditures, and government funded healthcare for both legal and illegal immigrants was a mere 2.3% of total expenditures.  Another study by Goldman, Smith, and Neeraj (2006) found that because the “foreign-born are relatively healthy and have less access to health insurance, they are disproportionately low users of medical care” (p. 1710); also finding that in 2000, government funded healthcare for undocumented immigrants amounted to $1 billion dollars.  Besides lack of health insurance and overall health, there are a variety of additional social and economic reasons that illegal immigrant use of healthcare is far below that of U.S. citizens, including the Personal Responsibility and Welfare Reform Act of 1996, that prevents illegal immigrant access to federally-funded healthcare, the fear of deportation, limited English language proficiency, and social stigma (Derose, Escarce, & Lurie, 2007).  In essence, the liminal legality of many immigrants often prevent them from seeking access to healthcare (Menjivar, 2006).

While opponents of illegal immigration might consider the limited use of U.S. healthcare resources a positive outcome of tougher immigration policy, existing policies create a number of socioeconomic problems.  For example, the lack of access to basic preventative care exacerbates emergency room costs.  Mohanty, et al. (2005) found that emergency room costs for uninsured immigrant children were three times as high as those for U.S. born insured children, while annual per capita healthcare expenditures for immigrant children were 86% lower.  Medical practitioners suggest that while U.S. hospitals have an obligation to provide care without regards to income or immigration status, that the “early diagnosis and treatment in a primary care setting are both medically preferable and a better use of resources” (Okie, 2007, p. 526).  Consequently, in order to reduce healthcare expenditures for illegal immigrants, while improving outcomes, public policy should seek to improve illegal immigration access to primary care by providing low-cost, basic coverage for illegal immigrants and creating national legislation that creates a safe harbor for illegal immigrants in healthcare settings.

Another serious policy concern in the illegal immigrant healthcare debate is that of public health.  Opponents of illegal immigration argue that illegal immigrants “come most often from countries with endemic health problems [and] the rapidly swelling population of illegal aliens in our country has also set off a resurgence of contagious diseases that had been totally or nearly eradicated by our public health system” (Federation for American Immigration Reform, 2009, p. 1).  There is truth in their argument, insofar as “laws and bureaucratic barriers reduce their use of key preventive health services, such as immunizations and screenings for infectious disease” (Okie, 2007, p. 526).  However, while FAIR advocates for a public policy of immigration enforcement and deportation as the solution, there are serious flaws in their policy position, including high enforcement costs, labor shortages, and damage to the economy (Immigration Policy Center, 2012).   Rather, policy should encourage immunizations and infectious disease screenings for every uninsured person, immigrant or otherwise, within U.S. borders as a matter of public health.  Indeed, the U.S. Congress has provided significant funding to the Centers for Disease Control global fight against contagious disease, recognizing that “infectious disease knows no boundaries” (Centers for Disease Control and Prevention, 2011, p. 1).  In addition, since 2002, the United States has spent over $19 billion in the global fight against AIDS, TB, and Malaria (USAID, 2010).  It stands to reason that nativist sentiment and anti-immigrant rhetoric should not prevent the U.S. from implementing rational public health policy to prevent the spread of contagious disease within its borders.

The rise of nativist sentiment, fueled by anti-immigration groups like FAIR and others, has led to an irrational policy debate over public healthcare that is replete with misinformation and emotional appeals suggesting illegal immigrants are the cause of a disproportionate share of the problems in the U.S. healthcare system.  There is no room in the healthcare debate for scapegoating, given the U.S. has the highest healthcare spend in the world and the lowest quality of care in the developed world (Altarum Institute, 2012; Davis, Schoen, & Stremikis, 2010).  While illegal immigrants use disproportionally less healthcare than U.S. citizens, there remain problems with public policy that increase healthcare costs for illegal immigrants beyond what they should be, and increase public health risk.  Illegal immigrants live and work in the United States; it is simple fact.  Rather than continue to decry their presence or support unrealistic policy positions, the U.S. should work to implement pragmatic policy solutions that reduce healthcare costs and improve the public health by improving illegal immigrant’s access to primary care, immunizations, and infectious disease screening in a safe, and stigma-free environment.

References

Altarum Institute. (2012). Health Sector Economic Indicators: Spending Brief (pp. 1-2). Ann Arbor, MI: Center for Sustainable Health Spending.

Blum, S. (2012, February 20, 2012). week eight discussion [online forum comment]  Retrieved February 25, 2012, from http://csuglobal.blackboard.com/webapps/portal/frameset.jsp?tab_tab_group_id=_4_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_92142_1%26url%3D

Bush, M. (2012, February 20, 2012). RE: week eight discussion [online forum comment]  Retrieved February 25, 2012, from http://csuglobal.blackboard.com/webapps/portal/frameset.jsp?tab_tab_group_id=_4_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_92142_1%26url%3D

Centers for Disease Control and Prevention. (2011, November 28, 2011). Global Vaccines and Immunizations  Retrieved February 25,, 2012, from http://www.cdc.gov/vaccines/programs/global/default.htm

Davis, K., Schoen, C., & Stremikis, K. (2010). Mirror, mirror on the wall:  How the performance of the U.S. health system compares internationally (pp. 1-22). Washington DC: The Commonwealth Fund.

Derose, K. P., Escarce, J. J., & Lurie, N. (2007). Immigrants and healthcare: Sources of vulnerability. Health Affairs, 26(5), 1258-1268. doi: 10.1377/hlthaff.26.5.1258

Eviatar, D. (2009, August 14, 2009). Anti-Immigration Activists See Opportunity in Health Care Debate  Retrieved February 25, 2012, from http://washingtonindependent.com/55044/anti-immigration-activists-see-opportunity-in-health-care-debate

Federation for American Immigration Reform. (2009, 2009). Illegal Immigration and Public Health  Retrieved February 25, 2012, from http://www.fairus.org/site/News2?page=NewsArticle&id=16742&security=1601&news_iv_ctrl=1007

Goldman, D. P., Smtih, J. P., & Sood, N. (2006). Immigrants and the cost of medical care. Health Affairs, 26(6), 1700-1711.

Immigration Policy Center. (2012, February 16, 2012). Bad for Business  Retrieved February 25,, 2012, from http://www.immigrationpolicy.org/just-facts/bad-business

Menjivar, C. (2006). Liminal legality: Salvadoran and Guatemalan immigrants’ lives in the United States. American Journal of Sociology, 111(4), 999-1037.

Mohanty, S. A., Woolhandler, S., Himmelstein, D. U., Carrasquillo, O., & Bor, D. H. (2005). Health care expenditures of immigrants in the United States: A nationally representative analysis. American Journal of Public Health, 95(8), 1431-1438. doi: 10.2105/AJPH.2004.044602

Okie, S. (2007). Immigrants and health care: At the intersection of two broken systems. The New England Journal of Medicine, 357, 525-529.

USAID. (2010, October 29, 2009). Global Fund to Fight AIDS, Tuberculosis, and Malaria  Retrieved February 25,, 2012, from http://www.usaid.gov/our_work/global_health/id/tuberculosis/partnerships/globalfund.html


HELP: I need input to select Masters program


Hello!  As I near completion of my Bachelors in Applied Social Science at Colorado State, I am considering a number of Master’s programs.  In short, I thought I would reach out to my friends and associates to get your input, based on your knowledge of me, my skills, my gaps, and your view of the future.

I chose to pursue social science, because so many of society’s challenges and opportunities in both the public and private sector usually have solutions, but lack an understanding of how to organize the social environment for change; the environment, globalization, inequality, healthcare, and economic growth are all examples.  At the same time, we are in a period of great change with the advent of a global communication network, global transportation network, and the Internet, as we construct the social meaning of our future with these incredible capabilities.  As I consider Master’s programs, I am looking at it through the lens of social change in digital era, and the potential impact we can have on our major challenges, specifically focusing on the role of businesses, government, or NGOs in engineering the social element of solutions.

Therefore, I have thought about a Master’s program in the following ways:

  • Continue focus on social science, going deeper on communication as the key skill to affect change that can be applied to any situation.  These programs typically include focus on communication & media or communication & leadership.  The programs at Gonzaga, John Hopkins University, Seton Hall, University of North Carolina, and University of Southern California fall into this category.
  • Starting applying what I have learned about social science towards one of the most pressing opportunities and challenges of our time, environmental sustainability.  I think that both the public and private sector will need to address sustainability in a meaningful way in the future and will need leaders with a social science background to help affect change.  The programs at Colorado University, Duke, and University of Denver fall into this category.

The attached PDF, named masters thoughts, includes more detail for each program, including curriculum, costs, and duration.  I would very much like to hear your perspective.  Please provide your feedback using the blog comments.  Thanks!

masters thoughts