Various organizations and government officials have cited estimates for the number of illegal immigrants at between eight and twenty million. With rising health care costs as a major issue for most Americans, this article considers the moral and practical issues of providing medical care for uninsured immigrants.
According to a research report entitled “The Size and Characteristics of the Unauthorized Migrant Population in the U.S.” {© [2006] Pew Hispanic Center, a Pew Research Center Project}, there are an estimated 11.5 to 12 million unauthorized migrants currently residing within The United States. The report was based on Census 2000 data, as well as the Current Population Survey of March 2005, and the monthly Current Population Surveys through January of 2006. The Pew Hispanic Center uses the term: ‘Unauthorized Migrants’. This term refers to persons residing in The United States who are not U.S. citizens, have not been admitted for permanent residence, and do not have specific authorized temporary status that permits extended residence and work within the United States.
The Pew Hispanic Center report found that the unauthorized population consisted of 5.4 million adult males, 3.9 million adult females, and 1.8 million children. Adult males are in the majority, making up 58% of the unauthorized adult migrants, while females account for 42%.
When discussing the percentage of unauthorized migrants, it is important to consider their labor force participation. Thirty-one percent of unauthorized migrants are employed in service industry jobs, while only sixteen percent of natives work in service. Native workers make up the great majority of white-collar jobs, while unauthorized migrants are underrepresented. Certain occupations have proportionately high concentrations of unauthorized migrant workers: Farming (24%), Cleaning (17%), Construction (14%), Food Preparation (12%), Production (9%), and Transport (7%). This is relevant to the issue of health insurance because the cited industries do not typically provide health insurance coverage.
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) addressed eligibility requirements for non-citizens to receive Federal means-tested public benefits. The Act resulted in significant restrictions on immigrants’ eligibility. Such benefits include Medicaid and the State Children’s Health Insurance Program (SCHIP). Certain immigrants are not eligible for Medicaid or SCHIP for five years from the date they enter the United States in a qualified-alien status.
Generally, only “qualified aliens” are eligible for coverage. Who is considered a qualified alien? There are nine basic types of qualified aliens: Aliens lawfully admitted for permanent residence under the Immigration and Nationality Act (INA), 8 USC 1101 et seq.; Refugees admitted under §207 of the INA; Aliens granted asylum under §208 of the INA; Cuban and Haitian Entrants, as defined in §501(e) of the Refugee Education Assistance Act of 1980; Aliens granted parole for at least one year under §212(d)(5) of the INA; Aliens whose deportation is being withheld under (1) §243(h) of the INA as in effect prior to April 1, 1997, or, (2) §241(b)(3) of the INA, as amended; Aliens granted conditional entry under §203(a)(7) of the INA in effect before April 1, 1980; Battered aliens, who meet the conditions set forth in §431(c) of PRWORA, as added by §501 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, P.L. 104-208 (IIRIRA), and amended by §5571 of the Balanced Budget Act of 1997, P.L. 105-33 (BBA), and §1508 of the Violence Against Women Act of 2000, P.L. 106-386. Section 431(c) of PRWORA, as amended is codified at 8 USC 1641(c).1; Victims of a severe form of trafficking, in accordance with §107(b)(1) of the Trafficking Victims Protection Act of 2000, P.L. 106-386.2.
Unauthorized migrants will be denied health care with the exception of emergency situations. This policy creates a problem for paramedics and other medical professionals, who will be forced to determine whether the individual’s life is at risk and what constitutes a medical emergency. How emergency health care workers are expected to enforce this policy is unclear. The Department of Health and Human Services is currently working on the terms, with the start date set for less than three months from now.
To receive health care, individuals will be required to provide proof of citizenship or proof that they are eligible as qualified aliens. This requirement creates potential problems for United States citizens, as well as immigrants. The homeless are perhaps the most obvious example of individuals who are eligible for care but may not have the proper documentation. Another, lesser known, example may be African-American senior citizens. African-Americans from the South were not allowed to be born in hospitals and therefore do not have proper birth certificates.
Another issue that needs to be addressed is the potential spread of disease. Testing for Tuberculosis, for example, is something that Americans take for granted. Those initiating and enforcing these policies should consider whether basic medical testing will be provided. Regardless of the apparent moral implications, denying health care services to individuals residing within the United States can easily result in more tangible problems.