Undocumented Dreamers” and the Health of the Dreamers

Loy­ola Uni­ver­si­ty Chica­go Stritch School of Medicine’s recent announce­ment that it would accept appli­ca­tions from Dream­ers – young undoc­u­ment­ed immi­grants eli­gi­ble for Deferred Action on Child­hood Arrivals (DACA) sta­tus – is an inno­v­a­tive and wel­come response to the promise implic­it in DACA. The idea that young peo­ple who had been brought to the U.S. as chil­dren should be freed from the threat of depor­ta­tion, allowed to work legal­ly, and encour­aged to com­plete their edu­ca­tion offers, in the form of pub­lic pol­i­cy, a vision of an open future in which young peo­ple have options and are not con­strained by their cur­rent legal and socio-eco­nom­ic sta­tus.  Through orga­ni­za­tion­al pol­i­cy, Loy­ola Stritch School of Med­i­cine now offers eli­gi­ble DACA ben­e­fi­cia­ries a path­way to Amer­i­can pro­fes­sion­al life. This med­ical school has also offered our soci­ety a new way of think­ing about today’s undoc­u­ment­ed immi­grants: as our future physicians.

Once they enroll in med­ical school, future “undoc­u­ment­ed doc­tors” will be eli­gi­ble to buy health insur­ance through Loy­ola, which requires all stu­dents to do so if they are not already insured, with the pre­mi­um cost being part of the cal­cu­la­tion used to deter­mine aid pack­ages.  How­ev­er, Dream­ers cur­rent­ly face the same bar­ri­ers to access to health care and health insur­ance as do oth­er undoc­u­ment­ed immi­grants. The Oba­ma Administration’s announce­ment of the DACA pro­gram in June 2012 was fol­lowed, two months lat­er, by the clar­i­fi­ca­tion that DACA ben­e­fi­cia­ries would not be eli­gi­ble for “pub­lic ben­e­fits,” includ­ing the Child Health Insur­ance Pro­gram (CHIP), Med­ic­aid, and the insur­ance pro­vi­sions of the Afford­able Care Act (ACA).  It is dif­fi­cult to rec­on­cile the idea that young undoc­u­ment­ed immi­grants should be encour­aged to be stake­hold­ers in Amer­i­can soci­ety, through work, edu­ca­tion, or mil­i­tary ser­vice, with the idea that they should be left out of the reform of the Amer­i­can health care sys­tem, includ­ing ACA ini­tia­tives that aim to pro­mote insur­ance cov­er­age among young adults  and among His­pan­ics, who con­sti­tute 80 per­cent of the undoc­u­ment­ed population.

This built-in ten­sion – between the future of the Dream­ers and the health of the Dream­ers – is the sub­ject of a video, “Dream­ing of Health­care,” pro­duced by the Cal­i­for­nia Endow­ment, a health care phil­an­thropy con­cerned about the prob­lem of the resid­u­al­ly unin­sured, includ­ing those who are exclud­ed from the insur­ance pro­vi­sions of the ACA.  In the video, Cal­i­for­nia Dream­ers ask, “Health care for every­one? Does every­one include me?” When the ACA is ful­ly imple­ment­ed in 2014, young immi­grants and their advo­cates will be watch­ing for an answer to this question.

Nan­cy Berlinger and Michael Gus­mano are research schol­ars at The Hast­ings Cen­ter and co-direc­tors of the Undoc­u­ment­ed Patients project

Com­men­tary was orig­i­nal­ly pub­lished on the Bioethics Forum.

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