The politics behind immigration and the healthcare industry

In the midst of the GOP debates, immigration is an issue fueling the fire for many political platforms.

Republican candidate Donald Trump, renowned for his many controversial statements, made headlines when he said the following about immigrants from Mexico: "They're sending people that have lots of problems, and they're bringing those problems with us. They're bringing drugs. They're bringing crime. They're rapists. And some, I assume, are good people." Various presidential candidates have voiced their strategies concerning immigration in the United States and the ways our nation should appropriately address the issue.

The influx of undocumented immigrants are often uninsured, which has an impact on healthcare spending. Medical providers must administer care regardless of a patient's legal status, and many medical professionals believe the healthcare industry needs to change to meet the growing needs of the undocumented population.

"Immigration is a driver of the changing population and healthcare systems need to be prepared to adapt," says Ricardo Martinez, MD, of North Highland. "It cannot be ignored by medical providers and no matter which side of the debate you are on, diverse populations are quickly growing and their healthcare needs are largely underserved."

Undocumented immigrants are not eligible for coverage through the health insurance marketplace. The United States only provides healthcare coverage for U.S. citizens, U.S. nationals or lawfully present immigrants. As a result, government officials argue how undocumented immigrants care will be covered and who should bear that cost.

"From a public health standpoint, the costs of a blinded treatment policy has staggering ramifications to the system with respect to costs and utilization of resources," says Jeffrey Sterling, MD, of Sterling Medical Advice and Sterling Initiatives. "It is the ethical conversation that has won out here."

Although providers are legally required to care for all patients, Americans are divided as to how to pay for undocumented immigrant's coverage. California has one of the highest undocumented immigrant populations with an estimated 2 million illegal immigrants residing in the state. In a poll conducted by USC Dornsife and Los Angeles Times, nearly 48 percent of those polled felt illegal immigrants should be able to receive low-cost health insurance through Medi-Cal, with nearly 47 percent of those polled feeling illegal immigrants should not be eligible for low-cost health insurance.

Americans are concerned about the cost associated with covering undocumented immigrants, which estimates show could raise the amount American taxpayers are spending for illegal immigrants' healthcare from $11 billion to $30 billion each year, according to U.S. News & World Report.  

"Practicing physicians don't view patients through political lenses," says Dr. Sterling. "The medical mantra 'do no harm' dictates how we address individual patients without bias in real time."

In her 2008 Democratic presidential nomination, Hillary Clinton said she supported granting citizenship to people residing in the Untied States illegally if they met specific conditions such as paying back taxes and paying a fine to the government. Ms. Clinton also stated illegal immigrants would have to learn English to be granted citizenship under her plan.

Language continues to be a barrier when administering care for any immigrants who may not speak English, and this challenge may impact quality care.

"When a patient arrives whose primary language is Spanish, and they don't find any Spanish signage or a setting that embraces their cultural values, this creates fear and mistrust," says Dr. Martinez. "A few steps to rectify this situation include operating in Hispanic communities, such as in community clinics, and providing specific services to help navigate the system and provide cultural competency and Spanish proficiency for providers and staff. It also calls for greater representation of minority leaders in the healthcare system to address the under representation."

In the United States, current estimates report there are 11.2 million undocumented immigrants with 80 percent of undocumented immigrants in the United States being Hispanic. The Department of Health and Human Services reports Hispanic are more likely to be uninsured, more likely to have chronic diseases and less likely to seek preventative care than the general population.

A Mexican woman was detained on Aug. 17 after seeking care at a Houston clinic. The undocumented female immigrant's attorney claimed the clinic potentially violated HIPAA, but the clinic countered the patient gave false documentation and thus was reported. Cases such as these prevent many illegal immigrants from seeking care.

Other states such as New York grant limited exemptions for some undocumented immigrants to enroll in Medicaid or CHIP because undocumented immigrants are not included for ACA provisions. Time is also a factor — even legal immigrants have to wait up to five years to become eligible for Medicaid and the ACA.

"The healthcare system is best designed to provide compassionate care, not as a system to penalize people for reaching out for treatment. Our role as providers is to care for those who need help," says Dr. Martinez.  "We need to move healthcare from reactive to proactive, and that means reaching out to communities to be more effective in improving the nation's overall health."

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