Various organizations and government officials have cited
estimates for the number of illegal immigrants at between eight
and twenty million. With rising health care costs as a major
issue for most Americans, this article considers the moral and
practical issues of providing medical care for uninsured
immigrants.
According to a research report entitled "The Size and
Characteristics of the Unauthorized Migrant Population in the
U.S." {© [2006] Pew Hispanic Center, a Pew Research Center
Project}, there are an estimated 11.5 to 12 million unauthorized
migrants currently residing within The United States. The report
was based on Census 2000 data, as well as the Current Population
Survey of March 2005, and the monthly Current Population Surveys
through January of 2006. The Pew Hispanic Center uses the term:
'Unauthorized Migrants'. This term refers to persons residing
in The United States who are not U.S. citizens, have not been
admitted for permanent residence, and do not have specific
authorized temporary status that permits extended residence
and work within the United States.
The Pew Hispanic Center report found that the unauthorized
population consisted of 5.4 million adult males, 3.9 million
adult females, and 1.8 million children. Adult males are in the
majority, making up 58% of the unauthorized adult migrants, while
females account for 42%.
When discussing the percentage of unauthorized migrants, it is
important to consider their labor force participation. Thirty-
one percent of unauthorized migrants are employed in service
industry jobs, while only sixteen percent of natives work in
service. Native workers make up the great majority of white-
collar jobs, while unauthorized migrants are underrepresented.
Certain occupations have proportionately high concentrations of
unauthorized migrant workers: Farming (24%), Cleaning (17%),
Construction (14%), Food Preparation (12%), Production (9%),
and Transport (7%). This is relevant to the issue of health
insurance because the cited industries do not typically provide
health insurance coverage.
The Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (PRWORA) addressed eligibility requirements for
non-citizens to receive Federal means-tested public benefits.
The Act resulted in significant restrictions on immigrants'
eligibility. Such benefits include Medicaid and the State
Children's Health Insurance Program (SCHIP). Certain immigrants
are not eligible for Medicaid or SCHIP for five years from the
date they enter the United States in a qualified-alien status.
Generally, only "qualified aliens" are eligible for coverage.
Who is considered a qualified alien? There are nine basic types
of qualified aliens: Aliens lawfully admitted for permanent
residence under the Immigration and Nationality Act (INA), 8 USC
1101 et seq.; Refugees admitted under §207 of the INA; Aliens
granted asylum under §208 of the INA; Cuban and Haitian Entrants,
as defined in §501(e) of the Refugee Education Assistance Act
of 1980; Aliens granted parole for at least one year under
§212(d)(5) of the INA; Aliens whose deportation is being withheld
under (1) §243(h) of the INA as in effect prior to April 1, 1997,
or, (2) §241(b)(3) of the INA, as amended; Aliens granted
conditional entry under §203(a)(7) of the INA in effect before
April 1, 1980; Battered aliens, who meet the conditions set forth
in §431(c) of PRWORA, as added by §501 of the Illegal Immigration
Reform and Immigrant Responsibility Act of 1996, P.L. 104-208
(IIRIRA), and amended by §5571 of the Balanced Budget Act of
1997, P.L. 105-33 (BBA), and §1508 of the Violence Against Women
Act of 2000, P.L. 106-386. Section 431(c) of PRWORA, as amended
is codified at 8 USC 1641(c).1; Victims of a severe form of
trafficking, in accordance with §107(b)(1) of the Trafficking
Victims Protection Act of 2000, P.L. 106-386.2.
Unauthorized migrants will be denied health care with the
exception of emergency situations. This policy creates a problem
for paramedics and other medical professionals, who will be
forced to determine whether the individual's life is at risk and
what constitutes a medical emergency. How emergency health care
workers are expected to enforce this policy is unclear. The
Department of Health and Human Services is currently working on
the terms, with the start date set for less than three months
from now.
To receive health care, individuals will be required to provide
proof of citizenship or proof that they are eligible as qualified
aliens. This requirement creates potential problems for United
States citizens, as well as immigrants. The homeless are perhaps
the most obvious example of individuals who are eligible for care
but may not have the proper documentation. Another, lesser
known, example may be African-American senior citizens. African-
Americans from the South were not allowed to be born in hospitals
and therefore do not have proper birth certificates.
Another issue that needs to be addressed is the potential spread
of disease. Testing for Tuberculosis, for example, is something
that Americans take for granted. Those initiating and enforcing
these policies should consider whether basic medical testing will
be provided. Regardless of the apparent moral implications,
denying health care services to individuals residing within the
United States can easily result in more tangible problems.
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