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Soraya Ghebleh - Improving Access to Healthcare for Undocumented Immigrants Residing in Arizona


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This is a policy memo by Soraya Ghebleh that addresses improving access to healthcare for undocumented immigrants living in Arizona.

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Soraya Ghebleh - Improving Access to Healthcare for Undocumented Immigrants Residing in Arizona

  1. 1. 1 Policy Analysis Memo: Improving Access to Healthcare for Undocumented Immigrants Residing in Arizona Executive Summary Access to care is an issue that has been necessary to address for those with insurance or without insurance. A population that is vulnerable regardless of insurance status, however, is individuals who are undocumented but live and work in the United States. Under health care reform, these undocumented immigrants would remain uncovered and unprotected.1In many respects, they may become more visible as those who previously did not have insurance gain coverage. While in the short run it may appear as though providing undocumented immigrants with basic services and preventative care may create a burden for the system, the long- term ramifications of not providing these services will inevitably lead to larger and more expensive healthcare problems.2In 2010, Governor Jan Brewer of Arizona signed one of the toughest bills in the nation on illegal immigration, marking an extremely controversial shift in the politics of state law and immigration.3 Arizona has long been a hotbed for immigration politics but not providing access to basic healthcare services and preventing undocumented immigrants from seeking care poses not only ethical problems but will in fact increase the cost burden of healthcare in this country. Providing basic, preventative services could reduce the emergency room burden and have the potential to reduce systemic costs.
  2. 2. 2 Problem Statement: How can we provide access to healthcare for undocumented immigrants without increasing the cost burden or change health-seeking behaviors among undocumented immigrants in Arizona? Background of Access to Healthcare for Undocumented Immigrants Illegal immigration is a controversial issue for many individuals. Those living in border states such as Texas, New Mexico, Arizona and California may have stronger opinions on how to deal with immigration policies because the population of undocumented immigrants is very high in these states. The passing of Senate Bill 1070 by Janet Brewer demonstrated the lengths state legislation was willing to go to exert control over what was perceived to be a growing problem and threat to the local stability of the community.4 The main controversies that surround undocumented immigrants now are no different than many of the causes of anti- immigrant sentiment in the past. Individuals in Arizona, under the strain of the current economy, may view the existence of a large immigrant population as a threat to their employment or future employment status. As the economy is strained, individuals may be less inclined to support undocumented immigrants receiving any form of social services, including access to healthcare.5 Access to healthcare is unique for an undocumented immigrant in that many individuals who contribute much less to the American economy receive health benefits but undocumented immigrants often have no access to healthcare and are fearful. Many of these immigrants suffer disproportionate health consequences solely due to their socioeconomic status and existing racial disparities but the strict
  3. 3. 3 and extreme nature of the current immigration policies now in place in Arizona exacerbate this problem even more.6 Currently, the environment undocumented immigrants need to navigate through to receive access to any type of basic care involves decreased access to health care and social services and increased strict enforcement stringent policies. In 2011, Arizona attempted to pass even more specific legislation aimed at further reducing access to care but this measure did not reach fruition. The ramifications, however, continue to challenge immigrant use of healthcare in Arizona.6 Under health reform, there are further questions that need to be addressed. Many undocumented immigrants who do not have access to regular care often receive their only care in safety net settings. These settings include emergency rooms, which are the most expensive care setting and often cause the highest burden to the health system. Even with universal coverage being implemented as a requirement, this coverage extends only to citizens. Undocumented immigrants will still have access to the emergency rooms and will continue to utilize these services at a much higher cost than if they received access to these services elsewhere.7 The main issue lies at the crux of the moral obligation held by the United States to provide health care to all those who need it on one hand, and on the other hand that those illegally in this country should not receive the social benefits paid for by tax-payers and citizens.8 Under health care reform, the fate of the undocumented immigrant will be left to the hands of state governments and it is crucial in this moment to decide on how to move forward in addressing the undocumented immigrant’s access to health care resources and services in Arizona.9
  4. 4. 4 Statement of the Policymaker’s Interest in the Issue Senator Flakehas been interested in broad immigration reform but now maintains a strong stance where border control and security are concerned. Senator Flake understand the dangerously high costs associated with providing the majority of care in an emergency room setting and has supported obtaining federal funding reimbursement for emergency health services to illegal aliens. Because Senator Flake is interested in reducing these costs and improving issues associated with immigrant populations, he is potentially the best politician for this proposal to be seen by.10 Existing Programs addressing Health Care for Undocumented Immigrants Various programs and policies have been implemented that have affected immigrant access to healthcare. Medicaid provided coverage to poor legal immigrants and their children and Medicare provided access if immigrants were covered in the United States legally or if a spouse had covered employment for at least ten years after the introduction of the programs.11 The Emergency Medical Treatment and Active Labor Act of 1986 requires all hospitals to assess and stabilize patients in the emergency room and this in turn provided presumptive Medicaid coverage to every individual entering the emergency room, including undocumented immigrants.11 The Personal Responsibility and Work Opportunity Reconciliation Act in 1996 began to deny undocumented immigrants access to Medicaid and food stamps and required documented immigrants to wait five years for Medicaid. Under the Patient Protection and Affordable Care Act, undocumented immigrants are largely excluded despite the overarching principle of reform being
  5. 5. 5 to provide coverage for nearly every American.11 Increased restrictions as well as changes to Medicaid and SCHIP coverage have reduced the access to care and increased expenditures on emergency room care for undocumented immigrants place a burden that could potentially be reduced if care was supported and provided in an alternative setting.11 Policy Recommendations One policy option in the light of healthcare reform is to ensure that a robust safety-net system exists in order that those excluded from health care reform, like undocumented immigrants, will still have access to care. This should not, however, be in the form of an emergency department setting. If increased funding and support is given to free clinics to provide very basic services and preventative care for undocumented immigrants in a safe setting that does not require immigrants to produce documents, this could have the potential to reduce the cost burden by reducing the number of undocumented immigrants who seek care in emergency room settings.8 These services can be provided in much of the same way they were previously provided to uninsured individuals.7 Another policy option is to ensure that women continue to retain their ability to access certain services like childbirth and health screening and be covered under Medicaid.8 This policy is not indicating that equal and identical services be provided but that there remains a viable option to seek care without fear of penalty. Health care centers should not be institutions that instill fear for individuals who are already burdened with disease and should not be looked at as places to potentially discover and punish undocumented immigrants.12
  6. 6. 6 Conclusions Health reform and current trends in healthcare have been aimed at accomplishing increased access, improved quality, and reduction in cost.13 Implementing policy that is aimed at reducing emergency room expenditures that will be spent on undocumented immigrants can have the potential to accomplish all three of these components. Because of the Emergency Medical Treatment Act, undocumented immigrants will have access to healthcare services regardless of any policy that is instituted unless this particular law is overturned. With this in mind, it is prudent to consider that rather than continuing down a path that will singularly provide access to health care in the emergency department, policymakers should consider cheaper alternatives. Increased access in community health centers that may not even include being seen by a physician but instead by a nurse or a physician’s assistant could drastically reduce the emergency department burden that gets shifted between the federal government and the state. The increasing numbers of undocumented workers who contribute to the economy in the form of consumption are not going to disappear and they will continue to require access to medical care. Therefore, it is essential that we affect policy change that is in the best interests of the financial burden of the nation but also policy that provides essential health services to all individuals, regardless of their documentation or paperwork. Bibliography 1. Chavez LR. Undocumented immigrants and their use of medical services in Orange County, California. Social Science & Medicine 2012;74:887-93.
  7. 7. 7 2. Galarneau C. Still missing: undocumented immigrants in health care reform. Journal of Health Care for the Poor and Underserved 2011;22:422-8. 3. Archibold RC. Arizona enacts stringent law on immigration. The New York Times 2010. 4. Arizona Senate Bill 1070 S, 49th Legislature, 2nd Sess. (2010). In. 5. Diaz P, Saenz DS, Kwan VSY. Economic Dynamics and Changes in Attitudes Toward Undocumented Mexican Immigrants in Arizona. Analyses of Social Issues and Public Policy 2011;11:300-13. 6. Hardy LJ, Getrich CM, Quezada JC, Guay A, Michalowski RJ, Henley E. A Call for Further Research on the Impact of State-Level Immigration Policies on Public Health. American Journal of Public Health 2012;102:1250-3. 7. Katz MH. Future of the safety net under health reform. JAMA: The Journal of the American Medical Association 2010;304:679-80. 8. Glen PJ. Health Care and the Immigrant. Georgetown University Law Center 2012;Georgetown Business, Economics and Regulatory Law Research Paper. 9. Sanchez GR, Sanchez-Youngman S, Murphy AAR, Goodin AS, Santos R, Valdez RB. Explaining public support (or lack thereof) for extending health coverage to undocumented immigrants. Journal of Health Care for the Poor and Underserved 2011;22:683-99. 10. Border Security. 2012. (Accessed January 23, 2012, at 11. Warner DC. Access to health services for immigrants in the USA: from the Great Society to the 2010 Health Reform Act and after. Ethnic and Racial Studies 2011;35:40-55. 12. Barnes N. What does the 2010 US Health Care Reform Mean for Securing Immigrant Health in North America? 2012. 13. Berwick DM. Health Care Leaders and the" Triple Aim": MedMedia Services, Yale University School of Medicine; 2009.