July 3, 2019; New York Times

Is health care a right or a privilege? If you are an undocumented immigrant, it might not be either. In looking at the options for the many undocumented persons who reside in the USA, much depends on where they live, their ages, and what they do for a living. In addition, a lot of what factors into whether undocumented immigrants have access to health care is at the whim of government at the local, state, and federal levels.

The picture is complicated, so be prepared. If you are undocumented, you generally cannot enroll in Medicaid or Medicare, nor can you buy insurance under the Affordable Care Act. In addition, your children will not qualify for insurance under the Children’s Health Insurance Program (CHIP).

However, according to Jan Hoffman, writing for the New York Times, there is some hope.

Six states and the District of Columbia have expanded their Medicaid programs to cover children through 18 years old (California recently approved coverage through age 25), regardless of immigration status. About 16 states cover income-eligible pregnant women, also regardless of residency status.

Many [undocumented] immigrants receive primary care and prescription drugs for a sliding-scale fee at 1,400 federally funded health care centers spread across 11,000 communities. Those centers are required to treat anyone, regardless of ability to pay, and administrators do not ask patients about their citizenship status.

The centers serve some 27 million people, but do not have estimates on how many are undocumented.

Of course, when undocumented immigrants arrive at hospitals for medical emergencies, they will be treated.

There are, according to the Pew Research Center, about 10.5 undocumented immigrants in the United States, with close to 6 million still needing health coverage. Overall, undocumented immigrants tend to underuse available health systems due to fear of exposure to authorities that might lead to deportation. That fear became more real in 2018, as noted by NPQ, when the Trump administration determined to crack down on the use of benefits by legal immigrants, too.

The irony is that “protecting the American taxpayer” via this new plan punishes a group of people for availing themselves of benefits (healthcare, food subsidies, and benefits for members of their families who are disabled) that would allow them to move up the economic ladder and possibly out of poverty into a self-sustaining lifestyle. Now, these new rules put them in the dilemma of having to choose between what they need to live now and a future that could mean deportation. Families that have used Obamacare, the children’s health care program, SNAP, or other subsidy programs now face a future in which they can be punished for using those services.

So legal or undocumented, the path to healthcare for immigrants is strewn with roadblocks and possible traps that make taking that path risky. As immigrants arrive at our borders, seeking a better life and hoping to contribute and become part of the fabric of this nation, it seems we have done all that we can to make it difficult. Perhaps making this easier is a starting place for a conversation for 2020.—Carole Levine