Healthcare Of The Undocumented Immigrant
“You must count him [a stranger] as one of your own countrymen and love him as yourself – for you were once strangers yourselves in Egypt.’ This quotation from Leviticus (19:34) suggests that the problems of immigration have been with us a very long time.
The immigrant is defined as a foreign-born person not holding US citizenship; an alien.
The immigrant may have the legal authority to live and work in this country, such as a green card holder, or be undocumented, lacking permission for residence or work. There are slightly more than 11 million undocumented immigrants in the U.S., a number that has not changed appreciably in several years. They make up more than five percent of this country’s workforce. Most are from Mexico and Latin America. The majority come to the States legally but overstay the limits of their visas. More than 80 percent are Christian; most are Catholic.
The work they perform in cleaning services, agriculture, meatpacking, restaurants, construction and landscaping has been described as dirty, dangerous and difficult. Yet, they work so their families in their countries of origin can benefit. Often, tremendous sacrifices are made.
Juan (not his real name) came to America leaving behind a wife and three small children ages 9, 5, and 3. He became a migrant worker picking fruit. For the next 17 years, he faithfully sent the money he earned back home. He was able to send his children to school and have his family enjoy a higher standard of living.
One day they received news that Juan had suffered a severe stroke. The medical experience was trying. It was marked by delays in the family obtaining permission to travel to the U.S., communication difficulties because of language and of understanding the poor prognosis, trust issues because of a lack of health insurance (was everything being done that could and should be done?), and a decision to remove life support after nearly 30 days in intensive care.
This story is not unique. Similar occurrences are becoming commonplace and beg the question – what is our responsibility toward the healthcare of the undocumented immigrant?
As providers of healthcare, our responsibilities should be no different from what is considered the standard of care – even if the delivery of that care is more challenging to the patients, their families, and the healthcare providers. Undoubtedly, barriers such as language, culture, false identity, literacy and understanding, availability of family support, fears of deportation and issues of trust enhance the challenges to deliver appropriate healthcare.
The Affordable Care Act (Obamacare) specifically denies the availability of health insurance to the undocumented immigrant. By law, anyone presenting to a hospital’s emergency department must be treated. In some cases, emergency Medicaid funds can be used. Insurance coverage for long-term chronic care, on the other hand, is mostly unavailable to the undocumented immigrant.
In Houston, a portion of the county taxes are specified to help pay for kidney dialysis for undocumented immigrants. Recent studies have shown dialysis performed on an emergency basis and covered by emergency Medicaid funds, results in costs to the healthcare system nearly fourfold greater than if routinely scheduled dialysis is implemented. Availability of a health-maintenance program is cost effective.
Our country produces the least expensive food in the world thanks in no small part to our undocumented-immigrant farm workers, who make up more than 20 percent of the farming workforce. Why not tax food to help pay for their healthcare?
The care of the undocumented immigrant is complicated and raises moral and ethical concerns that cannot be ignored. One can argue that Juan did the work many others refuse to do. He provided a service that put fruit on our tables. In providing for our needs, is it fair not to provide for his? The Catechism of the Catholic Church (2241) implies “public authorities” must see to the protection of these vulnerable individuals. I believe this includes medical care too.
Comprehensive immigration reform is needed to allow immigrants lawfully into the country to help fill labor needs and assist in family reunification. Immigration status should not be a barrier to healthcare. Low-cost insurance, affordable primary-care facilities, improved working conditions to help avoid injuries, private sources of funding and local, state, or federal tax options, are all ideas to be considered.
We should encourage preventive healthcare, build trust and alleviate fear in order to deliver the standard of care equally and economically. Immigration status is one of several factors that should not determine how healthcare is to be administered.
Perhaps St. Paul, in his letter to the Hebrews (13:2), says it best, “… remember always to welcome strangers, for by doing this, some people have entertained angels without knowing it.”
Dr. Rosario is president of the Southwestern Indiana Guild of the Catholic Medical Association.
