Health Justice for Immigrants

Should universal health coverage include immigrants in the definition of “universal?” Should federal taxpayers subsidize health insurance coverage for immigrants, even those who are undocumented? Should all immigrants be required to purchase health insurance? The author of this paper answers all these questions in the affirmative and in so doing, challenges both the cost-savings and “deservedness” arguments of restrictionists. She cites, for example, a number of studies that suggest that cost increases, such as spikes in the cost of uncompensated emergency room care, may partly or completely offset any gains to the system through the denial of benefits. She also fears that the ethos of deservedness reinforces the individualistic notion that some people, whether immigrant or not, are entitled to health care and others are not. This ethos also imposes a seemingly gratuitous punishment for lack of immigration status, above and beyond removal from the country.  The author then goes on to explicate a “health justice” framework for understanding coverage priorities -- a philosophical orientation quite different from the “individualistic” focus that seemed to dominate until the passage of the Affordable Care Act. Under this new framework, the starting point is not the health needs of the individual, however important in final outcome, but the needs of the community as a whole. “The Health Justice approach highlights evidence that disparities in access to health care do not merely affect the individuals or populations with restricted access; they can also have negative spillover effects in the general community,” such as increasing the threat of infectious disease, building antibiotic resistance, reducing worker productivity, and increasing wasteful spending and transaction costs for the entire healthcare system. (American Immigrant Policy Portal)

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