by Lila Rubenstein and Dario Maciel
Indulge us for a moment in a little exercise; use your imagination.
Put on a blindfold and throw a dart at a world map. If your aim is decent, and you hit a landmass, consider that you’ve just determined the location of your birthplace. By chance alone, your dart toss has set into motion a lifelong cascade of events that will be sculpted by the circumstances into which you are born.
The point we’re trying to make is that we have little agency over some of the most significant factors that govern our lives. Race, ethnicity, class and socioeconomic status are measures by which we are constantly judged—on the street, in school, in the workplace, and in the media. More importantly, these are all factors that fundamentally predispose us to varying degrees of illness or good health.
Given the arbitrary nature of our life circumstances, why are undocumented immigrants systematically excluded from access to health and social services in the US? This past fall, the Obama administration revealed that the 11.2 million undocumented immigrants currently living in the United States would be excluded from coverage under the Affordable Care Act (ACA). In fact, without an explicit inclusion policy, the ACA may actually increase the proportion of undocumented immigrants who are uninsured.
Under the ACA, undocumented immigrants are ineligible for employer sponsored health insurance, Medicare, Medicaid, and are barred by law from opting into the Health Insurance Exchanges using their own resources. This means that they must continue to rely primarily on community healthcare clinics and safety net hospitals. These institutions often provide care to people regardless of their financial or documentation status. However, under the ACA, federal reimbursements provided to these institutions will be halved.
The consequences of these cuts will not go unnoticed. Undocumented immigrants already face many obstacles to their day-to-day wellbeing as a result of exclusion from the legal rights afforded to others; for example, exclusion from labor laws that protect against wage theft and exploitation, or housing laws that protect against discrimination and inadequate housing conditions. Add to that the reality that undocumented immigrants who are diagnosed with either acute or chronic conditions may only seek treatment —if they even seek it out at all for fear of being ‘found out’—when the condition is far advanced and potentially life-threatening.
The policymakers responsible for defining the terms of care in the ACA are, in effect, perpetuating a legacy of discrimination that places a significant portion of the American population into a vulnerable status. By excluding undocumented immigrants from healthcare reform, we are undermining the basic ethos of the healthcare system envisioned by the ACA.
The sentiment among some opponents of inclusion of undocumented immigrants in the ACA seems to be that extending care to undocumented immigrants expends valuable resources on a group of people that do not contribute to the growth of the US economy. However, the reality is that by not extending health care coverage, we are skirting our responsibility to care for a population who are fundamentally intertwined in our society and our economy. The majority of undocumented immigrants work comprising roughly 5% of the US work force. Furthermore, many members of this group pay Social Security and other taxes, but do not reap the benefits.
We live in a society where access to health is unequally distributed, where the most vulnerable lack resources to seek care, and where wealth and good fortune are arbitrarily parsed out. The inclusion of undocumented immigrants in health reform is both an ethical necessity and an overall benefit to our health care system.
The ACA has already set into motion big changes that will have an overall positive impact on the wellbeing the American people, and this is decidedly a success we should celebrate. But this is only a first step. Now, let’s build on that first step and envision ways in which we can make healthcare in the US even better for everyone.
 Zuckerman S et al. Undocumented Immigrants, Left Out of Health Reform, Likely to Continue to Grow as Share of the Uninsured. Health Affairs. 2011, 30 (10).
 Passel JS et al. Undocumented Immigrants: Facts and Figures. Urban Institute. 2004. http://www.urban.org/UploadedPDF/1000587_undoc_immigrants_facts.pdf