Since its inception, Single-Payer healthcare’s most enduring rallying theme has been “Everybody In! Nobody Out!” This vision, which resonates with our most basic striving for equality, is being challenged now, as progressives and sections of labor rally behind Bernie Sanders’ new single-payer law, S.915, which contains the fatal flaw of excluding undocumented immigrants. (Section 102, Universal Entitlement) Single Payer has always been about EQUAL, comprehensive, accessible, affordable, economical healthcare for EVERYONE. The damage the working class would suffer from passing this bill as is, and splitting us into “legal” and “not legal” groupings, would negate any advances that would be made by getting rid of insurance companies.
I would like to present a resolution that was submitted to the American Public Health Association in response to the Obama Health Plan’s exclusion of undocumented immigrants. In the year before the American Public Health Association (APHA) had its 2010 annual meeting on the theme of “Social Justice,” a massive health reform law had passed which totally excluded some 12 million undocumented immigrants. And while immigrants had been hoping for far-reaching reforms and a measure of long-delayed justice, harassment and deportation of undocumented immigrants had markedly increased. In response, members of the Health-Not-War group at APHA proposed the following resolution to send an unequivocal message that this is intolerable to us as human beings and as public health workers.
Opposing the Exclusion of Undocumented Immigrants from Health Care Reform
November 5, 2010
The American Public Health Association,
Noting that this March, 2010, Congress passed and the President signed a massive Patient Protection and Affordable Care Act (PPACA), which not only leaves at least 23 million uninsured1, but explicitly excludes ALL undocumented immigrants,1 and,
Noting that the PPACA even forbids undocumented immigrants from using their own money to buy health insurance at discounted prices through the exchanges,2 and,
Noting that, of all groups, undocumented immigrants have arguably the greatest need of having healthcare expanded to them because:
FIRST: Undocumented immigrants are twice as likely to be uninsured as documented immigrants,3 and,
SECOND: Undocumented immigrants are generally excluded from Medicaid and SCHIP by federal law, and state-funded exceptions to this pattern will become rarer as state budgets languish. Moreover, most undocumented immigrants must wait five years after gaining legal residency to apply for Medicaid and SCHIP.4
THIRD: Undocumented immigrants’ future access to healthcare will be more challenging because (1) increasing raids5 and deportations6, Arizona’s SB 10707, and the Secure Communities Initiative8 are likely to make undocumented immigrants more fearful of registering at health facilities and traveling to them, (2) State and County budget cuts are eliminating health services for undocumented immigrants9, (3) Anti-immigrant groups are pressing jurisdictions to withdraw health services from undocumented immigrants10, and (4) Legislators are considering withdrawing citizenship from US-born children of undocumented immigrants, compromising their children’s access to healthcare as well as overturning a 150-year old constitutional right,11 and,
FOURTH: Many of the factors contributing to poor access to healthcare for immigrants in general are worse for undocumented immigrants, such as immigrants’ fears of presenting at health institutions, immigrants’ increasing unemployment rates combined with the higher cost of buying individual insurance, and health institutions’ fear of losing funding for treating immigrants. Even among the insured, immigrants’ and their children’s access to ambulatory and emergency care is worse than that of citizens,12 and,
FIFTH: Future funds for hospitalization of the uninsured, including undocumented immigrants, will be reduced, as PPACA reduces Medicare and Medicaid Disproportionate Share Hospital payments to hospitals serving the uninsured. Though these hospitals’ burden of uninsured will drop over time, PPACA specifies DSH payments must drop faster13, and Center for Medicare & Medicaid Services Chief Actuary estimated that the combined reductions at $64 billion over ten years.14
SIXTH: Reducing undocumented immigrants’ already poor access to healthcare is particularly dangerous and morally indefensible in light of their increased rates of injury, illness15, and death16 from hazardous occupations17 and housing18, compounded with their vulnerability to deportation if they report dangerous conditions or seek treatment.
Noting that measures taken to deny healthcare to undocumented immigrants often result in citizens losing healthcare also, as exemplified by the 2004 cancellation of Colorado’s Presumptive (Medicaid) Eligibility program, which had allowed pregnant women to receive prenatal care while their Medicaid applications were being processed. The entire program was eliminated because about half of the women were found to be ineligible by immigration status. Citizen and immigrant women alike were put at risk, as well as their unborn children.19
Noting that APHA has taken a clear positions against withholding medical care from undocumented immigrants in its resolution 2001-23, which “Urges the President and the Congress to oppose denial of eligibility for programs providing nutritional, prenatal, public health, medical care, and behavioral health benefits and services to any person residing in the United States on the basis of her or his immigration status”;20 its resolution 9501, which “Opposes any mandates and initiatives that would limit access to public health interventions and health services for undocumented and documented immigrants and their children;”21 and its resolution LB04-07, which “Deplores and warns against measures curtailing, eliminating, or disrupting health care to undocumented immigrants.”22
And finally, noting that the recent passage of this massive Health Reform law that explicitly and categorically excludes the grossly underserved undocumented immigrant population presents public health advocates with a grave challenge,
Therefore, the American Public Health Association
1. Calls on the President, and Congress to end the exclusion of healthcare for undocumented immigrants from Health Reform, and
2. Calls on the President and Congress to support health reform that provides equal, comprehensive, affordable, accessible healthcare for every person, regardless of their status of health, employment, income, or legalization, and
3. Calls on the President and Congress to assure that community health centers receiving $11 billion of dollars of federal aid over the next five years through the PPACA23 continue to give undocumented immigrants comprehensive health care, and
4. Encourages public health advocates to attend future events on immigration reform (public rallies, demonstrations, press conferences and the like) with the demand of comprehensive, affordable, accessible medical care for all immigrants, regardless of legalization status.
1. Kaiser Health News. Some Will Remain Uninsured After Reform. Available at: http://www.kaiserhealthnews.org/Stories/2010/March/24/Some-Will-Remain-Uninsured.aspx. Accessed October 3, 2010.
2. Lewin Group. Patient Protection and Affordable Care Act (PPACA): Long Term Costs for Governments, Employers, Families and Providers. Available at: http://www.lewin.com/content/publications/LewinGroupAnalysis-PatientProtectionandAffordableCareAct2010.pdf. p. 22. Accessed October 3, 2010.
3. Pew Hispanic Center. Hispanics, Health Insurance and Health Care Access. Available at: http://pewresearch.org/pubs/1356/hispanics-health-insurance-health-care-access. Accessed October 3, 2010.
Working Immigrants. Health uninsured rates among immigrants: far higher. Available at: http://www.workingimmigrants.com/2009/08/health_uninsured_rates_among_i.html. Accessed October 3, 2010.
4. Kaiser Commission on Medicaid and the Uninsured, Summary: Five Basic Facts on Immigrants and Their Health Care. Available at: http://www.kff.org/medicaid/upload/7761.pdf. Accessed October 3, 2010.
5. Coalicion de Derechos Humanos. Massive ICE sweep terrorizes Arizona communities following state passage of anti-immigrant profiling law. Available at: http://www.derechoshumanosaz.net/index.php?option=com_content&task=view&id=166&Itemid=1. Accessed October 3, 2010.
6. Common Dreams. Obama Administration Immigration Deportations Exceed Bush’s Record. Available at: http://www.commondreams.org/print/56327. Accessed October 3, 2010.
7. Arizona Daily Star, National Physician Groups Condemn Arizona SB 1070. Available at: http://azstarnet.com/news/blogs/health/article_ca3a8c46-62c6-11df-9a0a-001cc4c002e0.html. Accessed November 3, 2010.
8. San Francisco Immigrant Legal and Education Network. San Francisco Immigrant Legal And Education Network Opposes The Implementation Of The Dangerous Secure Communities Program In San Francisco. Available at: http://www.sfimmigrantnetwork.org/comments/sfilen_opposes_implementation_of_secure_communities_program_in_san_francisc, Accessed October 3, 2010.
9. New York Times. Reprieve Eases Medical Crisis for Illegal Immigrants. Available at: http://www.nytimes.com/2010/01/06/us/06grady.html. Accessed October 3, 2010.
Kaiser Daily Health Policy Report. Economic Recession Forcing Local Health Departments To Reduce Services to Undocumented Immigrants. Available at: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=57497. Accessed October 3, 2010.
New York Times, Immigrants Facing Deportation by U.S. Hospitals. Available at: http://www.nytimes.com/2008/08/03/us/03deport.html?_r=1&hp=&pagewanted=all. Accessed October 3, 2010.
10. Washington Independent. Anti-Immigration Activists See Opportunity in Health Care Debate. Available at: http://washingtonindependent.com/55044/anti-immigration-activists-see-opportunity-in-health-care-debate. Accessed October 3, 2010.
11. Newsweek Magazine. The Next Front on Immigration. Available at: http://www.newsweek.com/2010/08/01/the-next-front-on-immigration.html. Accessed October 3, 2010.
Politico. John McCain backs citizenship hearings. Available at: http://www.politico.com/news/stories/0810/40589.html. Accessed October 3, 2010.
12. Health Affairs. Left Out: Immigrants’ Access to Health Care and Insurance January/February 2001. Available at: http://www.projectshine.org/files/shared_images/Left_Out.pdf , Accessed October 20, 2010.
13. The Hospital & Healthcare Association of Pennsylvania. The Patient Protection and Affordable Care Act
(PPACA) of 2010 and the Health Care and Education Affordability Reconciliation Act (HCEARA) of 2010. Available at: http://www.haponline.org/downloads/HAP_Summary_2010_PPACA_HCEARA_April2010.pdf. Accessed November 4, 2010.
14. Centers for Medicare & Medicaid Services. Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended. Available at https://www.cms.gov/ActuarialStudies/Downloads/PPACA_2010-04-22.pdf. Accessed November 4, 2010.
15. Moure-Eraso R, Friedman-Jimenez G. (2004) Occupational health among Latino workers: a needs assessment and recommended interventions. New Solutions. 14/4:319-47. Available at: http://www.nap.edu/openbook.php?record_id=10641&page=129. Accessed November 4, 2010.
16. Richardson, S. Fatal work injuries among foreign-born Hispanic Workers. Monthly Labor Review, October, 2005. Available at: http://www.bls.gov/opub/mlr/2005/10/ressum.pdf. Accessed on November 4, 2010.
17. APHA Policy Statement 2005-4: Occupational Health and Safety Protections for Immigrant Workers. December 14, 2005. Especially see Richardson S, Ruser J, Suarez P. Hispanic Workers in the United States: An Analysis of Employment Distributions, Fatal Occupational Injuries, and Non-fatal Occupational Injuries and Illnesses in National Research Council: Safety is Seguridad. Washington, D.C., National Academies Press, 2003. Available at: http://www.nap.edu/openbook.php?record_id=10641&page=48 and http://www.nap.edu/openbook.php?record_id=10641&page=57. Accessed November 4, 2010.
18. Robert Wood Johnson Foundation. Living in America: Challenges Facing New Immigrants and Refugees. Available at: http://www.rwjf.org/files/publications/other/Immigration_Report.pdf. Accessed November 4, 2010.
19. Wall Street Journal. Prenatal Care Is Latest State Cut In Services for Illegal Immigrants. Available at: http://www.uniset.ca/naty/maternity/wsj_imm_med.htm. Accessed October 3, 2010.
20. APHA Policy Statement 2001-23: Protection of the Health of Resident Immigrants in the United States. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=262. Accessed October 3, 2010.
21. APHA Policy Statement 9501: Opposition To Anti-Immigrant Statutes. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=96. Accessed October3, 2010.
22. APHA Policy Statement LB04-07: Responding to Threats to Health Care for Immigrants. November 9, 2004.
23. PPACA Health Care Reform Timeline. Available at: http://stabenow.senate.gov/healthcare/Health_Care_Timeline.pdf. Accessed October 3, 2010.
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