Ethics with Dr.

Anson Koshy – Physician Advocacy

Carolyn Fan

Letter to an editor

As of 2018, there is an estimated 22 million or 7% of the US population are not citizens and
approximately 14% of these people live in Texas. With a growing number of non-citizen immigrants
and with a significant number of them living in Texas, it’s important to consider healthcare coverage
of immigrants. In this political climate, people are unsure and fearful for participating in Medicaid
and CHIP especially among immigrant families and their children. As a result, noncitizens are
significantly more likely than citizens to be uninsured.

There also needs to be a refocus on the healthcare of undocumented immigrants. The cost of
emergency healthcare is substantially more costly not only on the person, but financially. As of 1996,
the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) resulted in
undocumented immigrants are not given PRUCOL status and don’t receive any public or healthcare
benefits including Medicaid. Take dialysis for example. Studies done by the Texas Medical
Association revealed that inadequate care and poor resource allocation for undocumented immigrants
with end-stage renal disease resulted in many immigrants depending on emergency safety net
hospital systems for dialysis resulting in higher costs and worse patient outcomes. As a result, states
like California and Massachusetts have decided to give undocumented immigrants PRUCOL status,
especially for dialysis treatment.

We also need a change in public policy for noncitizen persons for growing fear of healthcare
coverage decline. Health insurance is essential to enable families to have access to health care and
protect families from extravagant healthcare costs. There is an alternative for families in these
situations. Non-citizens have access to primary care by using a federally qualified health center or
safety net hospital systems that allow uninsured, non-citizen patients to have access. The problem
with these hospitals is that they tend to only be located in large cities with longer wait times. An
unfortunate consequence of this current model is that patients don’t come into the hospital until they
are in a crisis resulting in an advance stage of the disease at the emergency room.

Another point to be added is that undocumented immigrants face language, cultural and social
barriers in preventing access of healthcare. A whopping 75% of the undocumented immigrants come
from Spanish speaking countries. This divide in languages demonstrates how essential translators and
culturally-competed educated healthcare workers are essential for treatment. There is added problems
with undocumented immigrants from obtaining essential healthcare. There is added difficulty in
keeping with medical appointments and a fear of deportation when exposed to a
federally/state/county hospital.

The counter argument is why should we even care about non-citizen immigrants. They are a drain to
financial and health care resources on an already taxed system. As stated above, research shows that
health insurance is necessary for affordable access to care that will overall prevent emergency
situations, which cost substantially more in the long-run on both the families and the hospital
infrastructures. The COVID-19 public health crisis just alerted us how important it is to include
everyone in the growing health care need. Preventing and providing public health services, like free
tests and preventative care, can slow pandemics like COVID-19.
We need health insurance coverage for noncitizens, improved public health and overall healthcare for
underserved communities, and help noncitizens overcome the language, cultural, and social barriers
preventing access to healthcare. Voting and contact local, state, and federal legislatures can help
make a difference in healthcare. As COVID-19 has shown us, we are all in this together to prevent
pandemics and debilitating diseases.