Health Care System and Illegal Immigrants Essay

Saul Diaz was a penniless, unemployed and uninsured undocumented alien living in Georgia.He got into a severe car accident.While he was in hospital, he racked up $1 million in medical expenses.

Before being sent back to Mexico, he died. The uncompensated bill was left over for the hospital. An illegal immigrant pregnant lady delivered her baby in U. S. She received Medicaid on her baby and prenatal care. Under the Medicaid, she got paid for her child delivery cost, her Spanish interpreter and diapers for her baby (Guzzardi, 2). What is the common thread in these two stories?

They are both about illegal immigrants who received medical care without paying for it. Health Care System and Illegal Immigrants Essay. Here comes another argument: Should we provide health care service to illegal aliens who have not contributed to our country? Would that be unfair to our citizens because we had shared a piece of our properties with the illegal aliens? No matter whether the answer is “yes” or “no”, the illegal immigrants are greatly disturbing out health care system. Since World War II, poor workers from largely Agrarian, Catholic and authoritarian Spain flocked northward into industrialized and more democratic Germany and France to find jobs (Hanson, 1).

Until now, people are still moving place to place for better living standard or better job opportunities. For some countries such as Mexico, people tries to get away from the impoverishment and the politic from entering U. S. borders illegally. According to “How Will the Illegal Immigrant Ends? ”, Mexico’s per capita gross domestic products is only a quarter of the United States (Hanson, 2). Wages in Mexico are far lower than in America. Many Mexican came to U. S. to achieve better living standard even by illegal method. There are approximately 14 to 22 millions of illegal immigrants in U. S. urrently, according to the data given by the Department of Homeland Security (Health Care Solution in the Real World). They are uninsured, most likely under the impoverished line. They are eligible for Medicaid by the law. Health Care System and Illegal Immigrants Essay. As we can see from the cases in the beginning, the hospital will provide emergency care for patients, regardless of whether they are undocumented or not. They failed to pay the bill and put a huge burden on the hospital. According to the article, “Why the Health Care Is So Costly? ”, U. S. hospitals in border states spend at least $1 billion a year in providing health care to illegal aliens.

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In 2005, eighty hospitals in Florida ended in closure due to unbearable costs and expenses (Schlafly, 3). This would be a big problem for the Florida citizens because the close out of hospitals makes them less accessible to health care service. Moreover, since the undocumented aliens are uninsured, they cannot afford to pay the expensive medical bills. Base on their identity, they cannot access regular health care service because they cannot provide a proof of their citizenship. As a result they can only use the emergency room service whenever they need medical care.

This leads to the abuse of emergency room service. According to the article, “Why the Health Care Is So Costly? ” hospitals in border states provide at least $200 million a year in uncompensated emergency cares to illegal aliens in 2005 (Schlafly, 2). Nevertheless, what we really concern is a person had died because he or she could not access to medical care immediately because of the abuse of ER service by those do not really need it. Furthermore, the illegal aliens affect our health cares system by carrying in diseases into our country.

According to the medical literature reports that many illegal immigrants carry fatal diseases or infections. They might carry diseases such as tuberculosis, malaria, polio, leprosy, plague, dengue fever and chagas diseases (Glueck and Cihak, 1). The reason behind is they may not get high quality medical cares in their own country, so they came here to achieve a more quality health care service. Health Care System and Illegal Immigrants Essay. Another reason is they are from some poor countries that lack of health care with poor sanitary situation. They are more likely carrying sicknesses.

If they don’t get treat properly, the disease will spread out and threaten other people’s health. While the illegal immigrants are affecting our health care system, how come we do not stop them from receiving cares? This is not an easy question to answer. We have to think about it in both moral and political ways. According to James Dwyer in his article, “Illegal Immigrants, Health Care, and Social Responsibility”, “Nationalists” argue that illegal immigrants have no claim to health benefits because people who have no right to be in the country should not have the right to share benefits in that country. Humanists” say access to health care is a basic human right and should be provided to everyone, no matter if they are illegal or legal here. Neither of the above ideas is correct enough. He suggests that there is no direct relation between violating the law and the right to share the health care. For instance, a lot of citizens violate the law in many ways. They did not get caught and still receive the medical benefits. The illegal immigrants violate the law only because they entered the U. S. in an unlawful way. They should also receive health care just the same as other citizens do.

Even when people argue that illegal immigrant did not contribute to paying taxes; they do pay sales tax, gas tax, and value-added tax (Dwyer, 1). Health Care System and Illegal Immigrants Essay. In the worse case, if we insist to deny cares to illegal aliens, they will fail to seek care because of deportation, yet leads to more severe diseases and might harm the public in long term. But, if we say that we should give out benefits to everyone based on human needs and rights, we would have to owe people too many things that we don’t have enough resources to produce. Since the issue is so complex, it has been argued for many years.

The government proposed so many policies and laws to reduce the number of illegal immigrants. However, there are still approximately 300,000 to 500. 000 undocumented immigrants that enter the U. S. each year (Glueck and Cihak, 5). I would suggest some solutions here. For long term solution, we should modify the immigration process and law. First, we should restrict our border. In “Policy Analysis”, the author says that the Border Patrol has made significant gains in stopping illegal entries over the last 2 years, especially in El Paso, and San Diego (Miller and Moore, 2).

Many illegal immigrants are first here legally by visa and become illegal when they stay after the visa expires. If the visa policy is more restricted, for example, more documents needed or fewer visa issues, fewer people can enter easily. Also, if we put more fences or build a wall at the border, less people can enter by climbing over. Second, we should shorten the immigration process and time. The most effective method of reducing illegal aliens is to make them become legal. A lot of undocumented aliens here are willing to go through a lawful way, but they do not have the time or money to do so.

Yet, they are more risk-taking and willing to work hard, which would be a labor capital to U. S. Therefore, making them legal here will benefit the country because they can contribute more to the country. The third way is sending some support to where the most illegal immigrants are from. Based on my surveys on some illegal aliens here, they would rather stay in their own country if there were a better economy and more job opportunities. For short term solution, I suggest we should provide affordable medical care.

We should provide cheaper drugs and prescription to the illegal immigrants. According to the article, “Here’s a Health Care Solution Everybody Can Love” by Jack Lohman, we can also introduce a program which requires the graduates of U. S. medical school who are citizens of foreign countries to spend community service on helping the illegal aliens from their country (Lohman, 4). This program can join with the cheaper prescriptions policy, which can lower the price of medical care and meanwhile, lower the medical expenses from the government as well. Health Care System and Illegal Immigrants Essay.

We all understand that we are trying to help the illegal immigrants, not putting them in any harsh situation or deporting them. Yet, we need to keep the country runs in order and people are under control. Since the illegal immigrants are disturbing our country in many ways, not only in health system, but also in job opportunities, crime rates and other social problems, we need to solve the issue as soon as possible. And, I am sure this is the only way to keep America a nice and fair place to live.

Over the past two decades, new anti-immigration policies and laws have emerged to address the migration of undocumented immigrants. A systematic review of the literature was conducted to assess and understand how these immigration policies and laws may affect both access to health services and health outcomes among undocumented immigrants. Eight databases were used to conduct this review, which returned 325 papers that were assessed for validity based on specified inclusion criteria. Forty critically appraised articles were selected for analysis; thirty articles related to access to health services, and ten related to health outcomes. The articles showed a direct relationship between anti-immigration policies and their effects on access to health services. In addition, as a result of these policies, undocumented immigrants were impacted by mental health outcomes, including depression, anxiety, and post-traumatic stress disorder. Action items were presented, including the promotion of cultural diversity training and the development of innovative strategies to support safety-net health care facilities serving vulnerable populations. Health Care System and Illegal Immigrants Essay.

Keywords: Access to health services, Health outcomes, Health status, Anti-immigration policies and laws, Undocumented immigrants

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Introduction

Due to vastly different living standards caused by large income disparities between developed and developing countries, people have been moving to more promising and developed regions throughout history [1–3]. We have seen signs of this phenomenon in the 1990s when Africans crossed the Sahara desert and climbed barbed wire fences in the Spanish enclaves of Ceuta and Melilla in order to enter the European Union. During this time, the number of sub-Saharan undocumented immigrants to Europe started to rise, prompted by the rapidly changing political map of sub-Saharan Africa, which ultimately caused people to escape political instability and economic decline [4, 5].

Another important moment in the history of mass migration occurred in 1980 and in August 1994 in Communist Cuba. In 1980, the economic and political pressure placed on Cubans living in the island had reached a breaking point. In the midst of this distress, more than 10,000 Cubans flooded the Peruvian Embassy seeking asylum. Health Care System and Illegal Immigrants Essay. The Cuban government responded by opening the port of Mariel to those wishing to leave the country while also taking advantage of the situation to “clean up” the Cuban penitentiary system by expelling hundreds of imprisoned homosexuals and other individuals with criminal records. As a result of this mass exodus, more than 125,000 Cuban refugees arrived in Miami in what became known as the “Mariel boatlift” [6, 7]. Again in August 1994, the Cuban balseros, or rafter crisis, occurred in which more than 35,000 people fled the island toward Florida in the span of a few weeks [8, 9].

Ironically, these two examples of the migration of Sub-Saharan Africans to Europe and Cubans to the US resulted in radically different responses from the receiving nations: Cubans were granted refugee status in the US, while Africans struggling with similar economic and political conditions did not receive the same treatment from European nations [10, 11]. Refugee status for Cubans allowed them greater access to health services in the US, which was not the case for undocumented Africans in the European Union. Together, these two cases point to the complexity of immigration laws and policies and how they relate to access to health services and health outcomes. In this paper, we consider this complexity and offer a critical analysis of immigration laws and policies and how they impact access to health services and health outcomes among undocumented immigrants and their families, an area of research which merits greater scholarly attention.

There are several factors that lead to the implementation of immigration policies aimed at curbing “illegal immigration,” including political, racial, terrorism, and economic factors. However, economic crisis and financial instability can lead governments to respond with stricter immigration laws, and oftentimes, undocumented immigrants are invoked as the scapegoats for these economic and financial crises. The world has gone through major financial crises before, including the Great Depression in 1929–1933, when the US lost one-third of its Gross Domestic Product (GDP) [12, 13]. Health Care System and Illegal Immigrants Essay. Similarly, Japan, which had a dynamic economy, was weakened considerably and ended up in stagnation for more than a decade starting in the 1980s [14]. Argentina’s economy shrunk by 20 % in 2001–2002, leading to a period of economic turmoil and instability plaguing the entire region of Latin America [15,16]. Interestingly, these global financial crises did not result in the implementation of harsher immigration policies. However, the current financial crisis across the globe has incentivized receiving nations to respond to waves of migration by targeting undocumented immigrants and illegal immigration through various laws and policies. The current global financial crisis has also led to the emergence of draconian immigration policies and laws that have had a tremendous impact on immigrants’ access to critical health services and health outcomes, including access to HIV and STI screenings and care. Understanding this impact in different countries will help develop appropriate solutions to address the wide range of health issues affecting undocumented immigrants. Our main objective is to advocate responsible positions on undocumented immigrants’ health and on immigration policy relating to health care for the benefit of the public, our patients, and the medical profession as a whole.

Undocumented Immigrants

Immigrant is a term used to describe foreign nationals who enter a country for purposes of permanent resettlement. In most countries, the immigration laws, including in the United States and Canada, do not classify “temporary workers” as immigrants. However, when temporary workers decide to settle permanently in their new nations, they are then reclassified as immigrants. In general, there are three broad categories of immigrants: (1) voluntary migrants who come to join relatives already settled in the receiving nation or to fill particular jobs for which expertise may be lacking among nationals; (2) refugees and asylum seekers who enter the country to avoid persecution; and (3) undocumented immigrants who enter the country illegally. Health Care System and Illegal Immigrants Essay.

The term undocumented immigrant has been operationalized using certain factors: (1) legally entered the nation state or territory but remained in the country after their visa/permit expired; (2) received a negative decision on their refugee/asylee application but remained in the country; (3) experienced changes in their socioeconomic position and could not renew residence permit but remained in the country; (4) used fraudulent documentation to enter the country or territory; or (5) unlawfully entered the country or territory, including those who were smuggled.

In this systematic review, we focus on the third category of immigrants, undocumented immigrants, due to the vulnerability of this particular community and the existing research establishing health disparities among this group when compared to other subcategories of immigrants, including documented immigrants [17–19]. Undocumented immigrants originate from countries with long-term war or civil unrest, or in some cases they migrate for particular economic, cultural, social, and political reasons. Undocumented immigrants have often experienced multiple pre-and-post migration stressful events, including imprisonment, rape, ethnic cleansing, physical violence, economic distress, torture, and many others. These unique challenges make them prone to higher rates of morbidity and mortality [20–24].

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Methods

A multiple streams (MS) model of policy process was used to conceptualize the policy process regarding immigration policies targeting undocumented immigrants. MS is a framework that explains how policies are made by national governments under conditions of ambiguity. It theorizes at the systemic level, and it incorporates an entire system or a separate decision as the unit of analysis. Health Care System and Illegal Immigrants Essay. The MS model views the policy process as composed of three streams of actors and processes: a problem stream, consisting of problems and their proponents; a policy stream, containing a variety of policy solutions and their proponents; and a political stream, consisting of public officials and elections. These streams often operate independently except during windows of opportunities, when some or all of the streams may intersect and cause substantial policy change [25–27].

In addition, we designed and reported this systematic review according to the PRISMA statement which ensures the highest standard in systematic reviewing [28]. The PRISMA statement consists of an evidence-based checklist of 27 items and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. Articles were critically appraised according to the methodology by O’Rourke [29] and Portney [30]. The articles were assessed for validity based on sampling bias by analyzing the subjects and inclusion criteria; internal validity was determined by analyzing the design and methods used in the study; reliability was assessed by analyzing the procedures used; and attrition bias by reviewing the data analysis sections, including qualitative and quantitative methods. Each article received a grade according to its ability to meet these criteria. Policy analysis manuscripts were further assessed based on the legal framework used to conduct the analysis.

Article Selection

The timeframe chosen was 1990–2012, as the results aimed to be as relevant as possible to the current global state of affairs regarding immigration policies and health status as well as health outcomes among undocumented immigrants. A total of eight databases were used to search relevant papers, including three legal and four health and medical databases (Pegaus-Columbia Law Library’s online catalog, CLIO Beta, LexisNexis, Westlaw, JAMA and Archives, MEDLINE, PsychINFO, PubMed). Health Care System and Illegal Immigrants Essay.

Article abstracts were recommended for full-length initial review if the abstract subject pertained to immigration policies and access to health services and health outcomes, and met the following conditions: (1) mentioned the terms “undocumented immigrants”, “refugees”, “asylees”, “immigration laws”, “immigration policies”, “anti-immigration rhetoric”, “access to health care”, “health outcomes”, or “health disparities”; and (2) established association between immigration policies and access to health services or health outcomes. The authors selected the search terms based on a preliminary test search. The search was further refined by including the terms “methodology”, “outcome”, and “intervention”.

The authors excluded articles that did not feature a title or abstract. They also excluded articles that were book chapters, conference abstracts, had no listed authors, or were not available in English or Spanish. Articles that did not include undocumented immigrants in their analysis were excluded. In addition, articles that did not describe a research project or study were excluded. Articles were included for full-length final review if they fit the following criteria: (1) the immigrant population included was undocumented as opposed to documented immigrants; (2) access to health services and health outcomes were the primary focus of the study; (3) the study reported quantitative or qualitative results or rigorous policy analysis; and (5) articles were published in English or Spanish.

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Results

Immigration Policies and Laws

Using the multiple streams (MS) model of policy process, we were able to deconstruct the framework that explains how immigration policies are made and implemented (Table 1). The passage of anti-immigration policies through the legislative, executive, and judicial branches, as exemplified in our review, was fueled in most cases by an anti-illegal immigration rhetoric that came about as a result of “economic and social problems” in the country. Health Care System and Illegal Immigrants Essay. As shown by the cases of Australia [31], United States [17,32], Spain [33], and France [34] to mention a few, undocumented immigrants are being negatively perceived by many policymakers and powerful interest groups and scapegoated as causing domestic economic downturn. Our review also found that most of these anti-illegal immigration initiatives were proposed under a “policy” or “political” umbrella to attract voters in certain localities with strong “anti-immigration” sentiments.

Table 1

Policy process

Streams	Description
Problem stream	Given the various conditions that exist regarding illegal migration, policy makers and political stakeholders define these as problems using a number of criteria such as statistics based on independent research determining that undocumented immigrants are not only a burden to the state but also to the federal governments or the existence of dramatic events or crises as a result of illegal migration, including refugee crises, existence of drug cartels, and border health and criminal history.
Policy stream	Immigration policies are generated by various groups or stakeholders including think tanks, bureaucrats, congressional staff, politicians, and academics. Immigration policies are usually drafted by considering the level of technical and implementation feasibility as well as their acceptable value. As is the case with most strict immigration policies, they are usually effectively introduced in localities with high levels of anti-immigration sentiments.
Political stream	The political consists of the “national mood” or the overall sentiment of a country or region that may change at any given time due to pressure from campaigns created by particular interest groups with a political agenda, and administrative or legislative turnover where new administrative staff is likely to create an environment of change regarding immigration policies.

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In addition, using the MS model led us to further understand how the sources of immigration enforcement power vary by country and jurisdiction. Countries use the judiciary, legislative, or executive branches to enforce these powers. Powers come through a complex body of statutes, rules, and case law governing entry into a particular country. Health Care System and Illegal Immigrants Essay. However, there is a general consensus that immigration control is an exercise of the executive power; that is, it is exercised by the executive arm of the government. A unique characteristic encountered in the field of immigration law is the retention of discretion, which is less amenable to control than the application of specific rules and standards. A subjective approach is introduced with discretion and issues such as discrimination, bias, and prejudice might be present. Hence, the discretionary nature of immigration law is at the root of much of the criticism that has been directed against these laws.

In the United States, for example, one can easily see the intersection of the different branches of government as they each relate to immigration law. There are two sources of immigration powers in the United States: (1) the enumerated powers which are reflected through the Commerce Clause, Migration or Importation Clause, Naturalization Clause and the War Clause and (2) Implied Constitutional Powers. However, several states including Arizona, Alabama, Indiana, North Carolina, and others have recently tried to implement statewide immigration laws, even though Supreme Court precedents grant only the federal government the power to control immigration law. For well over a century, since Congress first passed comprehensive immigration legislation, it has been firmly established that the federal government has exclusive reign over immigration and nationality law. As the Court stated unequivocally in De Canas v. Bica (1976), “[p]ower to regulate immigration is unquestionably exclusively a federal power.” Therefore, the US government enforces immigration laws without interference from the states. Health Care System and Illegal Immigrants Essay.

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A casual diagram presenting how anti-immigration policies affect access to health services and health outcomes has also been developed as a result of the application of the MS methodology (Fig. 1). The way anti-immigration laws and policies influence health status is illustrated in this figure. In general, the independent variable will be an aspect of lawmaking (Path A) guided by any of the policy streams (i.e., problem, policy or political). Anti-immigration laws and policies are the outcome variables and political and other jurisdictional characteristics are often the key explanatory variables tested.

Fig. 1

Influence of Anti-immigration Policies and Laws on Health Status

Path B and C examine key mediators in the causal chain linking anti-immigration laws and health. Laws and policies may vary considerably in the degree to which they are effectively implemented. Paths C and D involve studying the effect of law on environments and health behaviors. The term environment does not only refer to the physical environment, but also to social structures and institutions such as private and federally-funded health clinics and not-for-profits. Anti-immigration laws and their implementation affect social institutions and environments by increasing or decreasing available resources or expanding or reducing rights. Laws may affect health behaviors both directly (Path D) and by shifting the environmental conditions that make particular behavioral choices more or less attractive (Path C-E). Ultimately, changes in environments and behaviors lead to changes in health status (e.g., access to health services and heath outcomes) leading to changes in population-level morbidity and mortality. Health Care System and Illegal Immigrants Essay.