Healthcare for Non-Documented Migrants

There are millions of undocumented migrants in the United States without coverage. California recently signed into legislation free healthcare to non-documented migrants under the age of 25. This extended the previous age limit of 19. The law goes into effect in 2020 and is estimated to cost taxpayers 98 million dollars and cover 90,000-138,000 residents.

At the state level, 6 other states, plus the District of Columbia, provide coverage to undocumented migrants up to 18 yrs. of age.

Pros

• Proponents say it’s an ethical issue. Indigent people need help regardless of citizenship. We have an ethical duty to help our fellow man. 
• Many non-documented migrant workers do, in fact, pay taxes. 
• Proponents say it will pay for itself. Denying a pregnant mother access to prenatal care can result in poor outcomes for the baby. Access to prenatal care for all reduces healthcare expenses in the long run and benefits us all.

Cons

• “Why should my hard-earned taxes go to pay the bills for someone who’s here illegally?”  The use of public services designed and paid for by U.S. citizens but used by anyone and everyone living here seems unfair to some taxpayers. 
• Rewarding bad behavior. Some believe free healthcare will encourage immigration of more non-documented migrants and even attract those with serious and chronic illnesses so they can obtain treatment.
• Other countries don’t provide unlimited healthcare to undocumented migrants. Other countries have strict public healthcare usage policies for non-documented migrants. 

Rights-Based Healthcare

According to international signed treaties, the majority of citizens and countries of the world agree that healthcare is rights-based. Even more agree that all children, everywhere, have a right to health care. But in reality, there are many barriers in place that prevent even children from receiving basic healthcare. 

In the United States, some underserved children are US-born children of migrant parents. The children may qualify for CHIP and Medicaid, but the parents are afraid to access services for fear of being deported.

But How?

Assuming a belief that healthcare is a human right, there is a gap between the belief and a plan to execute the belief.

Worldwide, countries are grappling with how to provide healthcare to undocumented migrants. Norway, which has a universal government-run healthcare system for its citizens, extends only emergent care, plus a few limited services, to undocumented migrant pregnant women and children. Likewise, undocumented migrant diabetics pay for their insulin and all diabetic complications requiring treatment.

Thailand’s undocumented migrants must register and only then are they eligible to purchase insurance managed by the Minister of Health, which covers most, but not all healthcare services. Some costly services are exempted from coverage. One such exception is a kidney transplant. Treatment for psychosis or drug dependency is also excluded. 

In the United States, there are approximately 1,400 federally funded clinics that provide primary care and prescriptions.  Patients are charged on a sliding scale depending on income, and proof of citizenship is not required. Likewise, everyone who shows up to an ED is treated.

Decision-Making

Almost every Democratic candidate running for President is in favor of healthcare for non-documented migrants.

But even those in favor of rights-based universal care are loath to offer concrete solutions. There are competing demands for resources. Who lives? Who dies? Who decides? And on what basis are decisions made?

Which populations are prioritized? Babies before seniors? What is essential, i.e., a right, and what is optional? Is a root canal a right or an option? 

Core values for decision-making proposed by the World Health Organization (WHO) include:

• Cost-effectiveness
• Priority to the worst off
• Financial risk protection

Difficult trade-offs, inclusions, and exclusions must be made. Prioritizing may mean undocumented migrants with mental health issues are not eligible for care, as in Thailand. In Norway, an undocumented pregnant migrant must pay to give birth in a hospital.

Services may need to be deemed low-priority or high-priority. Is dialysis low-priority and cardiovascular disease prevention high-priority because disease prevention is ultimately more cost effective? 

Or is dialysis high-priority because the population is sicker and worse off? Policy makers may have to choose the least unfair option among lobbying interest groups, which will not satisfy everyone.

As a global society, the improved health and well-being of any one of us is good for all of us. One unvaccinated child in a playground affects the whole group of children. We must put our best minds to work as citizens of the world to provide food, shelter and basic healthcare coverage for all.

References

Onarheim KH, Melberg A, Meier BM, et alTowards universal health coverage: including undocumented migrants BMJ Global Health 2018; 3:e001031.

Three Case Studies in Making Fair Choices on the Path to Universal Health Coverage.Alex Voorhoeve, Tessa Edejer, Kapiriri Lydia, Ole Frithjof Norheim, James Snowden, Olivier Basenya, Dorjsuren Bayarsaikhan,Ikram Chentaf, Nir Eyal, Amanda Folsom, Rozita Halina Tun Hussein,Cristian Morales, Florian Ostmann, Trygve Ottersen, Phusit Prakongsai & Carla Saenz- 2016 - Health and Human Rights 18 (2):11-22