To explore the intersection between Immigration and Health Reform. To examine ways of protecting and increasing health care services and access that undocumented immigrants receive in order to preserve safety net hospitals viability and provide quality care to all.
We are at a particular moment in history that can be transcendental for immigration legislation. In addition, in 2010 we just recently passed the Affordable Care Act (ACA) the most significant piece of Health Care Legislation for Americans since 1965. Previous to the ACA an estimated 50million people were uninsured in the United States1, of these an estimated 15% are undocumented immigrants2. The ACA translates into some positive gains for legal immigrants10. However, undocumented immigrants are excluded from the ACA provisions and might fare worse off10. There are over 11 million undocumented immigrants in the US2. The ACA includes some significant cuts to public subsidies such as Disproportionate Share Hospital that has traditionally helped fund safety net hospitals where many undocumented immigrants receive health care services3,10. In states that are not expanding Medicaid, these cuts threatens the viability of safety net hospitals3,4,8 whereas much as 77% of the total discharges belong to Medicaid and uninsured patients versus <30% of discharges in Academic Centers5,4,6. In addition to the care they provide to the poor, >25% of safety net hospital own over 85% of the market share for some sub-specialty services that the whole community utlizes7.
Conducted a literature review regarding undocumented immigrant health care access. Conducted expert interviews and a review of immigration and health reform policies for the past 30 years
We are at an interesting point in history where an Immigration Reform bill S.744-Border Security, Economic Opportunity, and Immigration Modernization Act10 is on in the House of Representatives and a health care bill introduced in March, 2014 H.R.4240 “Health Equity And Access Under The Law For Immigrant Women And Families Act Of 2014″11 (HEAL) proposes including DACA eligible individuals to be included in the exchanges, to have Medicaid eligibility, and bans the five-year waiting for lawfully present individuals from receiving federal subsides11 are both in Congress. Commonalities of previous national insurance expansions have all been incremental. Products of this project include a policy brief, a position statement, and an informational advocacy guide
Some opportunities for gains can be achieved by advocating and creating a coalition that supports H.R.4240 initiatives. By focusing on incremental insurance expansions and compromising by choosing a subset of the population such as children, DACA eligible individuals or other vulnerable populations we can have achieve legislative change.
Bruce Siegel, MD,MPH, Chief Executive Officer, America’s Essential Hospitals and Shawn Gremminger, Vice President of Advocacy, America’s Essential Hospitals