GovRx: Prescription for immigrant healthcare

Regardless of nationality, people from all over the world are treated in American hospitals. You don’t have to be a U.S. citizen to purchase private health insurance in the U.S. nor do you have to be a citizen to pay to see a doctor. The U.S. has a private healthcare system that is open to everybody, who pays.

Unfortunately, the cost of health care and insurance can be as much as a family annual income depending on the type of work you do. So why do some wait until a health problem requires the most expensive emergency room care to treat it? One reason is the federal law. In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) sought to reduce federal spending. This law has had the opposite effect.

Some who are uncertain of their immigration status do not apply for benefits because they are afraid.

Under this legislation, undocumented immigrants became ineligible for Medicaid and other federally-funded social services, and only eligible for emergency medical assistance. The Act also requires that all state and federal welfare agencies report any illegal immigrants who apply for benefits to the Immigration and Naturalization Service (now the Department of Homeland Security) unless it’s health care delivered in the emergency room.

Emergency Medicaid is predominantly a program for childbirth coverage, although use and spending are shifting toward non-pregnant adults, particularly those who are elderly and disabled. Whether or not a person is eligible for Medicaid will depend on the State where he or she lives. Medicaid spending for emergency care, of recent and undocumented immigrants (although a small proportion of the total Medicaid budget) is increasing in some states. While states are not required to identify or report their Medicaid expenditures specific to undocumented aliens, some states do provide data suggesting that most of their emergency Medicaid expenditures were for services provided to undocumented aliens.

According an article in the Journal of the American Medical Association, treatment of unauthorized immigrants contributes to uncompensated care costs, but the main reason such costs are increasing is the rise in the number of people who lack health insurance. Immigrants represent only about 20% of the uninsured.

We now have a growing, uninsured, aging population. We need a better alternative to our current system because in the end, we are all paying for this expensive emergency room care. Here are a few suggestions.

  • Reduce costly healthcare expense by creating legislation that does not direct people to the emergency room
  • Encourage the sharing of aggregate, non-confidential provider data to track expense trends
  • Consider alternatives to voluntary, ad hoc state reports in guiding national health policy
  • Focus on reducing government expense and not enforcement in the healthcare setting

About Dena Wurman

Dena Wurman has a Masters Degree in Public Administration, a Juris Doctorate and worked as a business and financial administrator in the public sector before starting a law practice. She is a member of the American Bar Association and the American Immigration Lawyers Association. For a free consultation visit, e-mail or follow me on Twitter @denawurman.


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