Over 11.3 million undocumented immigrants in the United States, and between 1.9 million and 3.8 million in the European Union currently face barriers to health care access. Numerous legal issues and the current political climate regarding immigration policies present the complex reality of ensuring their basic right to health care. The lack of viable health care options is at its core a human rights issue, but it also prevents undocumented parents and their children from successful assimilation and integration into society. This essay will focus on the U.S. and examine the existing barriers to and possible solutions for the limited access to health care for undocumented immigrants.

Under the Affordable Care Act (ACA), undocumented immigrants in the U.S. are not eligible for Medicaid, Medicare, lower copayment or premium tax credits. Furthermore, they cannot purchase coverage through an exchange even at full cost. Lacking access to federal and private coverage, undocumented immigrants currently have three options: emergency care at any Emergency Department (ED), state-funded Medicaid coverage for emergency care, and safety-net hospitals or Federally Qualified Health Centers (FQHCs) for non-emergency care.

However, not only do the above-mentioned options provide only limited access to chronic disease management or preventive care services, but the ACA also cut funding to safety-net hospitals, leading undocumented immigrants to develop medical complications and depend on costly ED visits. Lack of health care access is also a generational challenge since non-citizen children and citizen children in mixed citizenship status families are more likely to be uninsured compared to children with naturalized or U.S. parents.

Unfortunately, current U.S. immigration policies do not provide concrete solutions. President Barack Obama’s current executive actions to offer 5.2 million undocumented immigrants work authorization and temporary relief from deportation do not grant lawful status to undocumented immigrants, and therefore do not guarantee access to financially feasible healthcare options. The immigration reform bill (H.R.15) introduced by House Democrats, which has not been brought to the floor, outlines a pathway to citizenship; however, undocumented immigrants would have to wait at least ten years for health insurance exchanges and 15 years in total to have access to federal coverage.

Lack of access to health care for undocumented immigrants is first and foremost an ethical issue grounded in the humanist view that all human beings have a basic right to health care. At the same time, it is also a policy issue regarding comprehensive immigration reform, which aims to incorporate undocumented immigrants into society as fully functioning and productive members. Undocumented immigrants are already contributing significantly to state and local taxes—an estimated $10.6 billion in 2010, and if the reform bill is passed, they are subject to more federally assessed tax liabilities, fees and penalties on their way to full citizenship. Granting access to health care will not only empower immigrant parents and children, but it will give them incentives to go to the back of the line.

It is noteworthy that several states with higher immigrant populations have made efforts to work around the system by expanding Children’s Health Insurance Program (CHIP) coverage and other state-funded programs. Many advocates also argue that the current reform bill should contain provisions to reduce the waiting period for health benefits. More importantly, both in the U.S. and the EU, civil society and non-profit organizations are playing an important role in filling the gap in the existing health systems by providing primary care, culturally appropriate services through community health workers, and undertaking research and advocacy activities. In the future, more comprehensive and collaborative approaches are needed to ensure undocumented immigrants’ basic rights to healthcare access.

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