Access to Health Care for Undocumented Immigrants as a Family Health Issue

The 2012 pres­i­den­tial elec­tion cam­paign is the lat­est reminder of how dif­fi­cult it is to reach bipar­ti­san con­sen­sus about health care pol­i­cy in the U.S. In con­trast, both par­ties offer rhetor­i­cal sup­port to improv­ing child health and pro­vid­ing chil­dren with access to health care.

The real­i­ty, of course, is more com­plex. Despite the impor­tance of the Child Health Insur­ance Pro­gram (CHIP) and Med­ic­aid for child health, Pres­i­dent George W. Bush vetoed efforts to reau­tho­rize and expand CHIP, but he also dou­bled the num­ber of Fed­er­al­ly Qual­i­fied Health Care Cen­ters, which increased access to care for poor fam­i­lies and chil­dren. More recent­ly, a num­ber of Repub­li­can gov­er­nors have threat­ened to refuse fed­er­al mon­ey to expand their Med­ic­aid plans under the Afford­able Care Act (ACA).{{1}} Dis­agree­ments about how best to achieve the goal of improv­ing child health are like­ly to con­tin­ue, but there is clear bipar­ti­san sup­port for the goal of healthy fam­i­lies and chil­dren. Our fail­ure to pro­vide access to undoc­u­ment­ed patients, how­ev­er, under­mines this broad­ly held goal.

Accord­ing the Pew Research Cen­ter, about 37% of adult undoc­u­ment­ed immi­grants have chil­dren who are U.S.citizens. As of 2009, there were at least 4 mil­lion chil­dren of undoc­u­ment­ed immi­grants who were born in the U.S.{{2}} Under the 14th Amend­ment to the U.S. Con­sti­tu­tion chil­dren born in the U.S. are cit­i­zens. As cit­i­zens, they may be eli­gi­ble for Med­ic­aid, CHIP and oth­er gov­ern­ment health pro­grams, but research sug­gests that these chil­dren are much more like­ly than oth­er U.S. born chil­dren to be unin­sured and more like­ly to go with­out need­ed care.

Research on the effects of insur­ance sta­tus of par­ents on access to care and the health of chil­dren is clear. Chil­dren of par­ents with­out health insur­ance cov­er­age are less like­ly to have health insur­ance cov­er­age and less like­ly to access need­ed care. Par­ents who go with­out health care are more like­ly to be in poor health and less able to pro­vide care for their children.{{3}} Regard­less of immi­gra­tion sta­tus, chil­dren of unin­sured par­ents are more like­ly to go with­out nec­es­sary health ser­vices than are chil­dren of par­ents with health insurance.{{4}} Not sur­pris­ing­ly, this prob­lem is even more acute among chil­dren of immi­grants. U.S. born chil­dren of immi­grant par­ents are twice as like­ly to go with­out insur­ance and access to rou­tine med­ical care than are U.S. born chil­dren of U.S. born parents.{{5}}

It is hard or impos­si­ble to sep­a­rate the health and wel­fare of chil­dren from that of their par­ents. And yet, our health pol­i­cy does that when cit­i­zen chil­dren have undoc­u­ment­ed par­ents. U.S. born chil­dren of undoc­u­ment­ed immi­grant par­ents are eli­gi­ble for Med­ic­aid and the Child Health Insur­ance Pro­gram, but their par­ents may not enroll their chil­dren in these pro­grams. Some of this may be due to fears that attempt­ing to access these ser­vices for their chil­dren will result in deportation.{{6}} Even if they do not fear imme­di­ate depor­ta­tion, immi­grant par­ents may fear that apply­ing for pub­lic health insur­ance will make it impos­si­ble for them to obtain cit­i­zen­ship or legal sta­tus at a lat­er date.{{7}}

Beyond insur­ance, the extent to which par­ents have access to a “usu­al source of care” can influ­ence the ade­qua­cy of care that chil­dren receive. Chil­dren of par­ents who do not have a usu­al source of care are more like­ly to go with­out need­ed care than chil­dren with par­ents that do have a usu­al source of care. This holds true even among chil­dren who have a usu­al source of health care for themselves.{{8}}

The debate about whether to use pub­lic funds to pro­vide health care to undoc­u­ment­ed immi­grants gen­er­ates strong reac­tions. Many peo­ple argue that it is inap­pro­pri­ate to use pub­lic funds to pro­vide health care to undoc­u­ment­ed patients when so many Amer­i­can cit­i­zens are unin­sured and go with­out access to need­ed care. While rea­son­able peo­ple can dis­agree about the mer­its of these argu­ments, the exis­tence of “mixed sta­tus” fam­i­lies in which at least one par­ent is undoc­u­ment­ed and at least one child is a U.S. cit­i­zen com­pli­cates this dis­cus­sion. When we con­tem­plate the argu­ments for and against using pub­lic funds to pro­vide health care to undoc­u­ment­ed adults, we must con­sid­er the impli­ca­tions for their fam­i­lies. If we believe that jus­tice requires offer­ing all chil­dren an equal oppor­tu­ni­ty to live a healthy pro­duc­tive life, it is more dif­fi­cult to jus­ti­fy deny­ing care to their par­ents.

[[1]]1. Michael Coop­er, “Many Gov­er­nors Are Still Unsure About Med­ic­aid Expan­sion,” New York Times, July 2012: A17.[[1]]

[[2]]2. Jef­frey Pas­sel and Paul Tay­lor, “Unau­tho­rized Immi­grants and Their U.S.-Born Chil­dren,” Pew Research Cen­ter, August 11, 2010. Accessed Octo­ber 2, 2012[[2]]

[[3]]3. Kin­sey Alden Dinan and Jodie Brig­gs, “Mak­ing Par­ents Health Care a Pri­or­i­ty,” Nation­al Cen­ter for Chil­dren in Pover­ty, April 2009. Accessed on Octo­ber 2, 2012.[[3]]

[[4]]4. Jen­nifer E. DeVoe, Car­rie J. Tillot­son, and Lor­raine S. Wal­lace, “Children’s Receipt of Health Care Ser­vices and Fam­i­ly Health Insur­ance Pat­terns,” Annals of Fam­i­ly Med­i­cine 7, no. 5 (2009): 406–412.[[4]]

[[5]]5. Gilber­to Grana­dos, Jyoti Puvvu­la, Nan­cy Berman, and Patrick T. Dowl­ing, “Health Care for Lati­no Chil­dren: Impact of Child and Parental Birth­place on Insur­ance Sta­tus and Access to Health Ser­vices,” AJPH 91, no. 11 (2001): 1806–1807.[[5]]

[[6]]6. Yoshikawa, H., & A Kalil, “The effects of parental undoc­u­ment­ed sta­tus on the devel­op­men­tal con­texts of young chil­dren in immi­grant fam­i­lies,” Child Devel­op­ment Per­spec­tives, 5 (2011): 291–297.[[6]]

[[7]]7. Kath­leen M. Ziol-Guest and Ariel Kalil, “Health and Med­ical Care among the Chil­dren of Immi­grants,” Child Devel­op­ment 83, no. 5 (2012): 1494–1500.[[7]]

[[8]]8. Jen­nifer E. DeVoe, Car­rie J. Tillot­son, Lor­raine S. Wal­lace, Heather Ang­i­er, Matthew J. Carl­son, and Rachel Gold, “Par­ent and Child Usu­al Source of Care and Children’s Receipt of Health Care Ser­vices,” Annals of Fam­i­ly Med­i­cine 9, no. 6 (2011): 504–513.[[8]]


Browse the Commentary archive. : . Bookmark the permalink.