HEALTHCARE COVERAGE FOR NON-U. S. CITIZENS Lisa H. Stokes HCS/545 December 2, 2013 Professor Charles Barron

Healthcare Coverage for Non-U. S. Citizens Lack of health care coverage is a serious issue for the citizens of the United States. Imagine if you were a non-citizen, or even worse, an illegal immigrant to this country. In 2005, the United States population included 36 million foreign-born residents (Lee & Choi, 2009). In this same time, non-citizens were 1.6 times less likely to access health care compared to the citizens (Lee & Choi, 2009). Non-citizen refers to foreign-born people legally in the United States, and follow the same rules and rights as US Citizens, but do not have the right to participate in political issues (Lee & Choi, 2009). Illegal immigrants will describe persons who have entered this country without proper authority or who no longer have a valid visa (Lee & Choi, 2009). The effects of health care, or the lack of health care, affect persons in the United States regardless of status of citizenship. Disease and accidental injury do not discriminate based on citizenship, nationality or financial class. Treatment of disease and injury currently does vary greatly. Access to Health Care There is a shortage of primary care physicians and specialists across this country, and this provides the flexibility of these provides to choose who to provide care to in the physician office. Private physicians may refuse to treat patients who have Medicaid or cannot pay to time of service. Even persons with health insurance may find accessing primary care difficult due to the lack of primary care providers. This ability for physicians to choose selectively the patient population creates an inequitable situation in accessing care for prevention, screening, and chronic disease conditions. This also creates hardship for patients who have an acute need to have medical treatment. This leaves little option for these patients to access the necessary care. Positive health outcomes are associated with regular health care, including well patient visits, diagnostic screening testing and medication management (Lee & Choi, 2009). Regular health care is also associated with lower levels of disabilities, improved management of chronic conditions resulting in fewer hospitalizations, and improvements in patient satisfaction with providers (Lee & Choi, 2009). This includes mental health (Lee & Choi, 2009). Non-citizens may also have difficulty accessing health care because of the lack of English proficiency and the inability to negotiate the health care system (Lee & Choi, 2009). Non-citizens are more likely to work in jobs without benefits, and for the elderly populations, the Welfare Reform Act of 1996 mandates that non-citizen immigrants will not receive federal funds for Medicaid or Social Security (Lee & Choi). Lack of access to health care is a public problem that affects the economy on a national level (Lee & Choi, 2009). Non-citizens will still access emergency care, including hospitalization for emergency and non-treated chronic disease exacerbations. The Emergency Department in hospitals become overcrowded with patients seeking both emergency care and care for chronic and acute conditions. Wait times increase for all patients seeking care and can create unsafe conditions for the extremely ill if treatment is not timely. Without health care coverage, the costs of this care may be unpaid. The result of unpaid portions of health care costs lead to higher health care costs for the insured.

Governance and Social Responsibility Under United States law, children, and women in the United States have access to some care regardless of their legal status (Glen, 2013). State and local governments provide Medicaid coverage for certain procedures, including pregnancy (Glen). As of 2002, 13 states allowed the use of state funds to provide Medicaid coverage to non-citizens, because the use of state funds is at the discretion of the state government (Lee & Choi, 2009). Some communities have set up community health care centers and free clinics to meet the needs of the uninsured. The purpose of establishing these clinics is to provide health care for persons without health care coverage regardless of citizenship status. The non-citizen population often uses these types of health care facilities as the primary location for health care health care (Lee & Choi, 2009). The Emergency Medical Treatment and Active Labor Act (EMTALA) require any hospital that receives funding from Medicaid to provide medical screening for any patient who arrives to the facility with an emergency medical condition (Glen, 2013). For hospitals that care for these patients without health insurance or other coverage, the facility will incur these costs with no reimbursement to offset the expense. There is no law in the United States that requires the extension of health care coverage to to illegal immigrants (Glen, 2013). As the number of illegal immigrants and non-citizens continues to grow in the United States, the concern is that someone will continue to bear the cost of the non-covered individuals. At the current time, hospitals, and other health care providers bear the cost of service with no revenue to offset these costs. This is not a sustainable business model. These unpaid costs are offset by increases in health care charges to the insured. Finding a way to include illegal immigrants in a public or private insurance company plan could save the costs of emergency expenses at the state and federal level because this same population of persons could access lower cost preventative care (Glen, 2013). This could reduce the use of emergency departments for routine treatments and enable hospitals and health care providers to lower costs for outpatient treatments (Glen). By treating and recognizing disease processes in the early stages for this population, there could be reduction in costs over the current process of waiting until the disease is in acute stages (Glen, 2013). The cost of treating at a critical state is much higher than the preventive treatments of a disease in most cases. One example is treatment for expectant mothers. Providing prenatal care to this population of pregnant females will result in healthier babies being born. This will result in lower costs for the care of the newborn, and in healthier babies being born to these parents (Glen, 2013). The outcome in this situation should far outweigh the cost of care to the pregnant mother. Health Care Reform, also known as the Patient Protection and Affordability Act, does not cover the illegal immigrants in the US, which currently number nearly 11 million (Galarneau, 2011). This has been a political issue with claims by some in the House and the Senate suggesting that offering health care reform to non-citizen and illegal immigrants would draw more illegal immigrants into the United States (Galarneau). Another issue for discussion includes concern that illegal immigrants would be able to access physicians’ offices and other services, creating a longer wait for the US Citizens (Galarneau). It also suggests that quality of care for citizens would diminish because of the increased number of people accessing care (Galarneau). Others propose that illegal immigrants should expect to abide by U.S. policies, including the expectation that these people obtain health coverage to improve the health of the US population (Galarneau, 2011). Some politicians think that the lack of health care poses a risk on society by the spread of disease and the costs of emergency care (Galarneau). However, this same person states that affordable health care is available to everyone but many choose not to purchase it (Galarneau). Some people will disagree with this statement as not everyone can obtain health care coverage currently and even some who could obtain it cannot afford to purchase insurance and pay the premiums, co-payments and deductibles. There are moral arguments for inclusion in the health care reform for everyone because regardless of immigration status, these people are human beings (Galarneau, 2011). The question to consider is whether health care is a privilege of being a United States citizen or is health a right that all humans should have access to equally. Recommendations for Health Care There are moral and ethical issues relating to the provision of health care for all people. Quality health care should not be dependent on how much money a family earns, where a child’s parents work, or even where a person was born if we are truly treating everyone equal (Galarneau, 2011). Because there is much debate about health care coverage for non-citizens and illegal immigrants, it would appear that the same standard would apply to persons who choose not to work. Using the argument about providing care to illegal immigrants would cause more people to come to the United States one could surmise that by providing Medicaid and other charity care will encourage citizens to become unemployed. When citizens pay for health insurance either through a cost-sharing plan through employment or by paying the premiums privately, non-citizen immigrants and illegal immigrants should receive the same opportunity at the same rate paid by citizens. This would improve the health of the population of the United States. This would decrease the use of emergency care for non-emergency situations and could ultimately drive down health care costs since because facilities would receive improved reimbursement and health care providers and facilities would write off less money every year to bad debt. Provision of well patient and sick patient care would be available through lower cost means than the expensive emergency room care. Health care costs would also decline as more people receive treatment and less people would require hospitalization. When conditions are allowed to go untreated, by the time the person seeks health care it is likely an acute situation that will be more costly through diagnostic testing, medications, and hospitalization. Conclusion Health care is the right of all people, not just citizens. Regardless of the way one enters the country, affordable, and available health care should be an option. By improving health through well check-ups, diagnostic screening, diagnostic testing, and early prevention the costs of health care in the United States will allow for reduction. Health care is not the place to battle immigration status. Choose a different forum to decide how and what should happen about illegal immigration, but keep the public healthy by withholding access to health care.

References Galarneau, C. (2011). Still missing: Undocumented immigrants in health care reform. Journal of Health Care for the Poor and Underserved, 22(2), 422-8. Retrieved from http://search.proquest.com/docview/868333756?accountid=458. Glen, P. (2013). Health care and the illegal immigrant. Health Matrix (Cleveland, Ohio: 1991), 23(1), 197-236. Lee, S., & Choi, S. (2009). Disparities in access to health care among non-citizens in the United States. Health Sociology Review, 18(3), 307-320. Retrieved from http://search.proquest.com/docview/203147074?accountid=458