Project Overview

Undocumented Patients:
Human Rights, Access to Health Care & the Ethics of the Safety Net

Project Co-Directors

Nan­cy Berlinger & Michael K. Gus­mano


Over­brook Foun­da­tion Domes­tic Human Rights Pro­gram


June 2011-Decem­ber 2012

Efforts to address the health care needs of the 11 mil­lion undoc­u­ment­ed immi­grants in the Unit­ed States con­cern three lev­els of health care: clin­i­cal, orga­ni­za­tion­al, and reg­u­la­to­ry. Physi­cians, nurs­es, social work­ers, and oth­er health care pro­fes­sion­als who serve com­mu­ni­ties with sig­nif­i­cant year-round or sea­son­al pop­u­la­tions of undoc­u­ment­ed immi­grants need clear guid­ance, sup­port­ed by orga­ni­za­tion­al pol­i­cy, to help them address an unre­solved soci­etal ques­tion: what share of social goods is owed to undoc­u­ment­ed immi­grants as per­sons and as mem­bers of soci­ety, and how should the deliv­ery of health-relat­ed goods, in par­tic­u­lar, be autho­rized and paid for?  Fail­ure to address this fore­see­able chal­lenge can result in ad hoc reme­dies that can be unfair to patients, inef­fi­cient as resource allo­ca­tion process­es, and inef­fec­tive as reform efforts.

Sup­port­ing sys­temic change that can ensure access to high qual­i­ty and afford­able health care for all res­i­dents of the U.S. requires close atten­tion to dif­fi­cult ques­tions of resource allo­ca­tion. In the U.S. visions of health care as a right and as a priv­i­lege have long com­pet­ed.  Both health care and immi­gra­tion are like­ly to remain frag­ment­ed as sys­tems, and con­tentious with respect to polit­i­cal debate. As fed­er­al and state pol­i­cy­mak­ers face hard bud­getary choic­es affect­ing safe­ty net providers, this 18-month project is explor­ing the val­ues that can sus­tain or imper­il the domes­tic health care safe­ty net

The roll-out of the Patient Pro­tec­tion and Afford­able Care Act (PPACA) of 2010 offers a time­ly oppor­tu­ni­ty to address the health-relat­ed rights and needs of undoc­u­ment­ed immi­grants and, through care­ful analy­sis and con­crete rec­om­men­da­tions, to pro­mote the devel­op­ment and imple­men­ta­tion of equi­table and sus­tain­able pub­lic pol­i­cy that can help providers who serve this pop­u­la­tion. This project aims to take advan­tage of this oppor­tu­ni­ty.

The audi­ences for this project include:

  • health care pro­fes­sion­als, includ­ing clin­i­cians and orga­ni­za­tion­al lead­ers
  • human rights advo­cates work­ing on health care access and on immi­gra­tion reform
  • schol­ars work­ing at the inter­sec­tion of domes­tic human rights, health care ethics, and health pol­i­cy
  • jour­nal­ists and oth­ers who fol­low these issues.

Prod­ucts of this project will include:

  • a spe­cial report pub­lished online by The Hast­ings Cen­ter, tar­get­ed to health care pro­fes­sion­als and to human rights advo­cates
  • jour­nal arti­cles
  • this pub­lic web­site, which will chron­i­cle the course of the project through short essays, videos, links, and cita­tions.