Physicians call for better access to health care for immigrants

"Currently immigrants, both documented and undocumented, face many barriers to adequately accessing badly needed health care," said J. Fred Ralston, Jr., MD, FACP, president of ACP. "They are more likely to lack health insurance than U.S. citizens; they may lack the funds necessary to pay for health care services without insurance; and, they may face the additional barrier of being fearful that seeking medical attention may lead them to be reported to authorities."

In order to address these concerns, ACP is calling for the development of an immigration policy on health care that includes:

• A national policy. Individual state laws result in a patchwork system that is not adequate to address this complex problem.
  
• Taxpayers should not be required to subsidize health insurance coverage for persons who are not legal residents of the United States and people should not be prevented from paying out-of-pocket for health insurance based on immigration status.
  
• The same access to health coverage and government-subsidized health care for U.S.-born children of parents who lack legal residency as any other U.S. citizen.
  
• Acknowledgement of the public health risks associated with undocumented persons not receiving medical care because of concerns about criminal or civil prosecution or deportation. Immigration policy should include increased access to comprehensive primary and preventive care, and vaccinations and screening for prevalent infectious diseases. This will make better use of public health dollars by improving the health status of this population and alleviating the need for costly emergency care.
  
• Federal government support for safety-net health care facilities and offsets for costs of uncompensated care provided by these facilities.
  
• Acknowledgement that physicians and other health care professionals have an ethical and professional obligation to care for the sick. Immigration policy should not interfere with the ethical obligation to provide care for all.
  
• Policies that do not foster discrimination against a class or category of patients in the provision of health care.

"Access to care for immigrants is a public health issue that should be of concern to all of us," continued Dr. Ralston. "Take the case of immigrants with tuberculosis; under the current system they may be afraid that going to a hospital to seek treatment would place them at risk for deportation. If they decide to delay care because of this fear, it could increase the number of people exposed to the disease exponentially. Imagine if those same immigrants were not only unafraid to visit the hospital, but they were receiving regular primary care services. They may be treated before experiencing any symptoms and decrease the public exposure that much more."

The new policy will need to be complex to adequately reflect the complexity of the issue. It will need to take into consideration:

• The need for the country to control whom it admits within its borders.
  
• The need for the U.S. to differentiate its treatment of those who comply with the law in establishing legal residency from those who do not.
  
• That hospitals and physicians have an ethical obligation to provide care for residents lacking legal documentation who seek care in an emergency situation.
  
• That society has a public health interest in ensuring that all residents have access to health care, particularly for communicable diseases. And, that delayed treatment may be costly and could endanger the rest of the population.
  
• That any policy that intends to force the millions of undocumented residents to return to their countries of origin could result in severe health consequences for affected persons and their family members. This could create a public health emergency resulting in enormous costs to the health care system, including costs associated with correctional health care during periods of detention.

"Any national immigration policy will need to balance the legitimate needs and concerns to control our borders and to equitably differentiate in publicly-supported services for those who fully comply with immigration laws and those who do not," concluded Dr. Ralston. "However, access to health care for immigrants is crucial to the overall population of the U.S. We all have a vested interest in ensuring that all residents have access to necessary care."

Provided by American College of Physicians