In the United States, undocumented immigrants are subjected to high cost of care with little to no insurance coverage thus often forcing them to delay or refrain from any preventative or even, emergent care. This inequity causes constrains to the uninsured between the choice of further debt or poor health status.
So let's discuss this further. . .
- What is an undocumented immigrant?
An undocumented immigrant is a person born outside of the United States who does not have the legal documentation to reside or remain in the country. It includes individuals who "entered the country without inspection and proper permission from the government, and those who entered with a legal visa that is no longer valid (Immigrants Rising, n.d.)." According to National Conference in State Legislatures (2019), in 2016, approximately 11.3 million undocumented immigrants reside in the U.S., accounting for about 3.5% of the total U.S. population. - What are the healthcare options that exist in the U.S.?
- Medicare: the country's federal health insurance program for people age 65 or older in which one of the basic requirements for eligibility is to be a U.S. citizen or to be a lawfully admitted non-citizen, who has lived in the U.S. for at least five years (Social Security Administration, 2021).
- In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) in which undocumented immigrants have free access to limited medical emergency treatment and pregnancy-related services from Medicare-participating hospitals (Centers for Medicare & Medicaid Services, 2021).
- Affordable Care Act's (ACA) Health Insurance Marketplace: the platform created from Obamacare in 2010 in which private insurers offer plans to individuals, families, and small businesses in which undocumented immigrants are not eligible to access; however, they may apply for coverage through documented individuals (Healthcare.gov, n.d.).
- Medicaid & Children's Health Insurance Program (CHIP): the nation's public health insurance program for people with low income and limited resources in which qualified non-citizens are eligible, if state's income and residency rules are met. Undocumented immigrants who meet income and all the other eligibility criteria that varies in each state, can only receive limited emergency and pregnancy-related Medicaid coverage (Kaiser Foundation Family, 2020).
- As of January 2019, California as well as 16 other states has adopted the option to provide prenatal care to women regardless of immigration status through the extension of CHIP coverage to the unborn child.
- As of January 2020, California as well as six other states extended its healthcare coverage to cover undocumented immigrants from ages 19 to 25 through Medicaid/Medi-Cal funds.
- Employer-Sponsored Coverage: health insurance obtained through an employer for current employees and their families as well as retired employees in which the employer will contribute or pay for at least 50% of each employee's health insurance premiums, depending on the state the business is located in (Turbotax, 2020).
- Private Health Plans (outside of ACA Marketplace): health insurance obtained through some private insurance companies, agents, brokers, and online health insurance sellers in which undocumented immigrants may apply for, however, they must pay costly premiums. According to ehealthinsurance.com (2021), in 2020, the national average premium for single coverage is $448 per month.
So what about the undocumented immigrants outside of the age range of 19 to 25?; the undocumented immigrants ineligible for employer-sponsored coverage?; the undocumented immigrants who are of low income?
The enrollment barriers to health coverage that are in place within the U.S. healthcare system leaves the many undocumented citizens uninsured. The limited access to health care coverage options as well as employer-based sponsored coverage places the millions of undocumented people at risk to delay care outside of the limited medical emergency treatment and pregnancy-related services. Furthermore, according to Martinez et al (2015), "the anti-immigration policies and departmental policies with anti-immigrant rhetoric are a major global determinant of health, particularly mental health." Their study showed growing evidence in correlation of undocumented immigrants who screen for depression, anxiety, or PTSD--mental disorders that are known to lead to diminished productivity and impaired social functioning (2015).
Although, there are further barriers that exist within the undocumented population. There remains to be a level of apprehension in interacting with the healthcare system which is related to "feelings of fear, anxiety, confusion, shame and depression (Tuohy, 2020)." According to Tuohy (2020), undocumented individuals are impacted with the "intensified rise of anti-immigrant sentiment and policies in this country" that such feelings of unworthiness and shame are embedded as well as the obvious fear of deportation. The language barrier as well as confusion in eligibility of services may also cause hindrance to the attainment of access to care.
- Medicare: the country's federal health insurance program for people age 65 or older in which one of the basic requirements for eligibility is to be a U.S. citizen or to be a lawfully admitted non-citizen, who has lived in the U.S. for at least five years (Social Security Administration, 2021).
- In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) in which undocumented immigrants have free access to limited medical emergency treatment and pregnancy-related services from Medicare-participating hospitals (Centers for Medicare & Medicaid Services, 2021).
- Affordable Care Act's (ACA) Health Insurance Marketplace: the platform created from Obamacare in 2010 in which private insurers offer plans to individuals, families, and small businesses in which undocumented immigrants are not eligible to access; however, they may apply for coverage through documented individuals (Healthcare.gov, n.d.).
- Medicaid & Children's Health Insurance Program (CHIP): the nation's public health insurance program for people with low income and limited resources in which qualified non-citizens are eligible, if state's income and residency rules are met. Undocumented immigrants who meet income and all the other eligibility criteria that varies in each state, can only receive limited emergency and pregnancy-related Medicaid coverage (Kaiser Foundation Family, 2020).
- As of January 2019, California as well as 16 other states has adopted the option to provide prenatal care to women regardless of immigration status through the extension of CHIP coverage to the unborn child.
- As of January 2020, California as well as six other states extended its healthcare coverage to cover undocumented immigrants from ages 19 to 25 through Medicaid/Medi-Cal funds.
- Employer-Sponsored Coverage: health insurance obtained through an employer for current employees and their families as well as retired employees in which the employer will contribute or pay for at least 50% of each employee's health insurance premiums, depending on the state the business is located in (Turbotax, 2020).
- Private Health Plans (outside of ACA Marketplace): health insurance obtained through some private insurance companies, agents, brokers, and online health insurance sellers in which undocumented immigrants may apply for, however, they must pay costly premiums. According to ehealthinsurance.com (2021), in 2020, the national average premium for single coverage is $448 per month.
The enrollment barriers to health coverage that are in place within the U.S. healthcare system leaves the many undocumented citizens uninsured. The limited access to health care coverage options as well as employer-based sponsored coverage places the millions of undocumented people at risk to delay care outside of the limited medical emergency treatment and pregnancy-related services. Furthermore, according to Martinez et al (2015), "the anti-immigration policies and departmental policies with anti-immigrant rhetoric are a major global determinant of health, particularly mental health." Their study showed growing evidence in correlation of undocumented immigrants who screen for depression, anxiety, or PTSD--mental disorders that are known to lead to diminished productivity and impaired social functioning (2015). 
About the author: My name is Camila and I am a student in pursuit of a career in the medical field. As a nursing student, we are taught of the importance of comprehensive preventative care in reducing the odds of developing acute or serious health conditions as well as early detection and treatment to reduce the prevalence of diseases and further severe complications. The aforementioned practices are typically executed within a doctor's appointment. Although, for undocumented immigrants, only if they qualify within the very limited list of eligibility will they be able to enroll, be insured and schedule a doctor's visit. I complied this research in hopes to not only raise awareness, but also provide important information of resources for the undocumented population. The issue of accessibility to healthcare and the inequality amongst the undocumented immigrants is important to me as I believe that the right to health should be universal. No one should have to debate between getting examined or treated by a medical professional versus going poor in paying for health insurance premiums or hospital bills. No one should have to delay treatment and risk poor health to deter deportation. No one should have to suffer and lose a loved one due to an oppressive system. Discrimination should not exist within the healthcare setting.
References:
Centers for Medicare & Medicaid Services. (2021, March 4). Retrieved from CMS.gov:
Centers for Medicare & Medicaid Services. (2021, March 4). Retrieved from CMS.gov:
https://www.cms.gov/regulations-and-guidance/legislation/emtala
eHealthInsurance. (2021, January 11). Retrieved from eHealthInsurance.com:
eHealthInsurance. (2021, January 11). Retrieved from eHealthInsurance.com:
https://www.ehealthinsurance.com/resources/small-business/employer-health-insurance-requirements
Healthcare.gov. (n.d.). Retrieved from Healthcare.gov:
Healthcare.gov. (n.d.). Retrieved from Healthcare.gov:
https://www.healthcare.gov/immigrants/coverage/ Immigrants Rising. (n.d.). Retrieved from ImmigrantsRising.org: https://immigrantsrising.org/resource/defining-undocumented/
Kaiser Foundation Family. (2020, March 18). Retrieved from KFF.org:
Kaiser Foundation Family. (2020, March 18). Retrieved from KFF.org:
https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-of-immigrants/
Martinez, O., Wu, E., Sandfort, T., Dodge, B., Carballo-Dieguez, A.,
Martinez, O., Wu, E., Sandfort, T., Dodge, B., Carballo-Dieguez, A.,
Pinto, R., Rhodes, S. D., Moya, E., & Chavez-Baray, S. (2015). Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review. Journal of immigrant and minority health, 17(3), 947–970. https://doi.org/10.1007/s10903-013-9968-4
National Conference of State Legislatures. (2019, March 29). Retrieved from NCSL.org:
National Conference of State Legislatures. (2019, March 29). Retrieved from NCSL.org:
https://www.ncsl.org/research/immigration/snapshot-of-u-s-immigration-2017.aspx
Social Security Administration. (2021). Retrieved from SSA.gov:
Social Security Administration. (2021). Retrieved from SSA.gov:
https://www.ssa.gov/pubs/EN-05-10043.pdf
Tuohy, B. (2020). Health Without Papers: Immigrants, Citizenship, and
Tuohy, B. (2020). Health Without Papers: Immigrants, Citizenship, and
Health in the 21st Century. Social Forces 98(3), 1052-1073. https://www.muse.jhu.edu/article/750459.
Turbotax. (2020). Retrieved from Turbotax.intuit.com:
Turbotax. (2020). Retrieved from Turbotax.intuit.com:
https://turbotax.intuit.com/tax-tips/health-care/what-is-employer-sponsored-coverage/L01gcZpTR
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