Policy Brief

FSU Nursing 450 Do Undocumented Immigrants in the US Deserve Access to Healthcare?

An Ethical Analysis

November 2014

This policy brief is intended to examine the ethical issue and provide recommendations regarding the rights of undocumented

immigrants to access health care in the US.

Key Issues for Nurses

Some 11.4 million undocumented immigrants reside in the US today (US Department of Homeland Security, 2012). Of this approximate 11.4 million people, health care is unavailable and inaccessible. In 2010 Congress passed the Patient Protection and Affordable Care Act (PPACA), or more commonly known as the ACA. This act prohibits undocumented immigrants within the US from purchasing private health insurance through the health care exchanges. Previously enacted immigration laws prohibit the use of federal monies to insure or treat undocumented immigrants and deny access to even basic health care for this population. Under the Personal Responsibility and Work Opportunity Reconciliation Act and the Illegal Immigration Reform and Immigrant Responsibility Acts (IIRIRA) undocumented immigrants are denied access to government funded programs and services such as Medicaid. Under the IIRIRA (USDHS, 2012) individual states are allowed to fund programs to legally provide needed services, however. Without access to federal funding for undocumented immigrants, health care organizations must shoulder the burden of providing necessary services, such as emergency room visits. Primary care practitioners as well as public health clinics are unavailable to the undocumented immigrant to provide preventative care unless private organizations and practitioners volunteer their services.

Lack of legal documentation of citizenship makes the undocumented immigrant vulnerable to unscrupulous medical practices, self-medicating for illnesses, and poor outcomes for conditions such as diabetes, tuberculosis, and other treatable diseases. The Center for Disease Control (CDC, 2013), states that contagious diseases that were previously “under control is now seen in border states which make up an epidemiologic region. The impact of undocumented immigrants upon the US public health is often overlooked.

Among the issues undocumented immigrants face as barriers to accessing health care are, language, culture, and literacy issues; transportation issues, job loss, and fear of deportation. These issues, along with the lack of health insurance, discourages many undocumented immigrants from seeking health care knowing that they will be responsible for paying for services. The majority of undocumented workers are young male Latinos looking for work. Most work in maintenance, agriculture, and the food processing industry and have not completed high school, which corresponds to higher poverty rates (National Immigration Law Center, 2013).

FSU

November 2014

ISSUE: UNDOCUMENTED IMMIGRANT HEALTH CARE THEADLINE HERE

ETHICAL CONSIDERATIONSNurses on the Forefront

Undocumented Immigrants health care issues are identified as:

Arrive from countries with endemic health concerns. By-pass routine health screening during the centralized immigration process leading to a rise in

communicable diseases. Only about 1200 federally funded, qualified community health centers and migrant health clinics

are scattered throughout the US. Federal funding for hospitals and health care organizations through the Safety Net program

does not meet all of the health care needs of the undocumented immigrant.

“Health care is a human right.”

Bias and Cultural Competency

Nurses need to be aware of the socio-economic and environmental obstacles which hinder the humanitarian rights of undocumented immigrants.

Bias occurs despite our best efforts to remain neutral in the context of fair treatment of persons outside our own culture. Bias’ can create barriers for patients and nurses, alike. Awareness of one’s own bias’ can give a better understanding of the difficulties that are involved in obtaining access to health care as a human right.

By being culturally competent nurses are able to be open to other peoples’ ideas and ways of living. It prepares one to question their own feelings regarding life styles, belief systems, and priorities cultures place on certain activities or actions. By examining ones’ own values a nurse can develop a practice that provides care that is ethical and socially responsible. Through cultural competence nurses can assure undocumented immigrants are treated with respect and provide accessibility to quality, cost efficient health care.

FSU

November 2014

CAROLYN ZIELINSKI, RN

FERRIS STATE UNIVERSITY NURSING 450

References available on request at: zielinski@ferris.edu

AMERICAN NURSES ASSOCIATION 2010 POSITION STATEMENT

In 2010 the American Nurses Association House of Delegates,

“Resolved, that the American Nurses Association will reaffirm its position that all individuals living in the U.S., including documented and undocumented immigrants, have access to health care; andResolved, that the American Nurses Association will educate nurses regarding the wide-ranging social, economic and political ramifications of undocumented immigrants’ lack of access to health care services” (ANA, 2010).

In taking this stand the ANA, along with other international nursing organizations, addressed the ethical and moral obligation of nurses in health care. Through continued advocacy the ANA encourages nurses to take an active role in the ethical and moral arena of undocumented immigrant health care.

What can nurses do?

Nurses are at the forefront of identifying where the needs are in this vulnerable population. Allowing immigrants, regardless of documentation status, to be eligible for health care benefits and be able to purchase healthcare coverage will improve their access to healthcare. Nurses can support immigration and healthcare policy changes that provide access to health care services to immigrants. Nurses can support organizations such as the ANA in efforts to take a stand for human rights in regards to equitable health care. Without changes to present policies, public health in the US will continue to be impacted with this increased burden.

“Health care is a basic human right…all individuals who reside in

the US should have access to health care, including documented and

undocumented immigrants.”American Nurses Association (ANA) 2010.