Last week, President Barack Obama took a step to ease many unauthorized immigrants’ fears by directing the immigration service not to deport those who have children who are U.S. citizens and have been in the country for five or more years. While this may give undocumented immigrants relief from their fear of using health services, it does nothing to help them access those services.
According to the Pew Center, there are 11.9 million unauthorized immigrants who, because they lack permanent legal status, are excluded from benefits and rights that Americans take for granted. Because of their insecure immigration status, they are concentrated in low-wage jobs that do not provide health insurance. As a result, 59 percent of adult undocumented immigrants have no health insurance, four times the level of immigrants with a green card.
This lack of insurance is compounded by policies that affect all low-income workers, such as a lack of paid sick leave. Research shows that immigrants, including those entering without authorization, come to the U.S. primarily for work and family, not for health care benefits.
The fear and exclusion faced by undocumented immigrants converge to limit their ability to afford and access needed health care. Public health professionals have frequently raised this issue, but government inaction has prevented meaningful action.
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The Deferred Action for Childhood Arrivals program in August 2012 was a first step to provide temporary permission to stay in the U.S. to those fortunate enough to qualify.
But this group of young people continues to be barred from benefits under the Affordable Care Act, and are even prohibited from buying their own private insurance on the new health exchanges.
Denying access to health care and other benefit programs was also built into the bipartisan immigration reform passed by the U.S. Senate in 2013. The legislation blocked all federal program eligibility for the first 10 years. The refusal of the House leadership to bring this bill up for a vote left us where we started, with nearly 12 million residents under the cloud of possible deportation and without access to health care.
Obama’s action will ease the fear of using health services, and will likely increase opportunities for jobs that offer employer-paid health insurance. But the new policy does nothing to help eligible individuals get health services.
States around the country have taken the lead where our federal government has not by extending health services to groups independent of immigration status.
Six states provide health insurance to all children regardless of their legal status, and 15 provide full prenatal and maternity care to all poor pregnant women. California has expanded Medi-Cal eligibility to poor young people who qualify for DACA, though there have been problems with implementation. And a number of counties provide access to a full range of health care services to all uninsured residents.
But this piecemeal approach continues to leave most undocumented immigrants with little access to health care.
Polls suggest that more than 70 percent of the public supports comprehensive immigration reform with a path to citizenship. And as the country’s demographics change and the children of immigrants become voters, the political incentives will shift and many of today’s undocumented immigrants are likely to eventually gain full legal status.
This means that the practical choice is whether we inherit a population in poor health because of a lack of insurance – or one that is even more ready to contribute to the economy and society.
It’s also a moral choice. As Martin Luther King Jr. said: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Access to health insurance is essential for all American residents – undocumented or documented – without any further delay.
Michael A. Rodriguez is director of the UCLA Blum Center on Poverty and Health in Latin America and professor of family medicine at the David Geffen School of Medicine at UCLA. Steven P. Wallace is professor and chairman of community health sciences at the UCLA Fielding School of Public Health. Manuel Pastor is professor of sociology and director of the Center for the Study of Immigrant Integration at the University of Southern California.