Immigrant Policy and Healthcare

Introduction

 Early and consistent prenatal care (PNC) is one of the most important things that an expecting woman can do to protect the newborn from complications. Prenatal care is provided in various healthcare settings and it focuses on the health of the mother and the fetus. Obstetrician, primary care physicians, midwives, and nurse practitioners that have specialized in prenatal care can provide care. It is one of the ways that healthcare professionals can identify any health issues the mother may have that can affect delivery and issues that the fetus may have to better prepare for newborn care after the birth. PNC is one of the most important care aspects that is taken seriously in the United States (U.S).

 Legal residents that live in the U.S. or those that are born here have easier access to healthcare for their children. This is due to the fact that legal residents meet the eligibility criteria for healthcare coverage than do illegal or undocumented immigrants. Undocumented immigrants have challenges getting healthcare coverage because of their immigration status. And they may not seek due to fear that it may have punitive consequences, such as deportation and separation from the newborn. The topic of healthcare for immigrants is a broad topic also commonly discussed. The underutilization of healthcare by pregnant women puts their well-being in question. 

 The topic of immigration policy pertaining to healthcare benefits and citizenship is a sensitive issue that can be confusing to most individuals. This controversial topic impacts immigrants and their well-being. Among immigrants, expecting undocumented mothers are the most vulnerable. The barriers of healthcare such as immigration policy limitation or fear of consequences, for expecting mothers can have an effect on the outcome of the newborn’s health. With the increasing number of migrations to the United States, few policies are in place to help provide beneficial service to the rapidly climbing number of immigrants. There are several compelling arguments made against benefits for immigrants and the effects it has on the economy of the country. Some of the oppositions are related to cost, exhaustion of resources, and amount of debt it results.

 Undocumented expecting immigrants should gain access to healthcare benefits because  prenatal care  improves health outcomes and prevent complications in spite of some major policies formulated to limit access to care.

Background

-          What is migration? What are the reasons for migrating?

 Migration is the act of  people going to a different country from their birth country  for various reasons. Immigrants are individuals who have migrated from their country of origin to the destination country. Individuals choose to leave their country of origin for several reasons,  such as  to escape prosecution, avoid conflict or war,  seek  better healthcare or education, lack of employment,  and family separation.

https://justiceforimmigrants.org/what-we-are-working-on/immigration/root-causes-of-migration/

-          Difference between documented and undocumented immigrants?

 Documented or legal immigrants are those that are staying in the United States legally and are authorized to stay in the country. Aliens, illegal immigrants or undocumented immigrants are those individuals who entered  into the country illegally or those who have overstayed their authorized time.

-          What are the statistics on immigrants in the United States?

 As of January 1st, 2015, 12  million illegal immigrants lived in the united state which increased from 11.6 million in 2010. 80% of these population has lived in the United States for over 10 years. The leading group  of immigrants that live in the U.S.  are primarily from Mexico, with  California  having the largest concentration of these illegal immigrants.  California is followed by Texas, Florida, New York and Illinois as the destination states for most immigrants. According to the Department and Homeland Security, 60% of these immigrants are between the age of 24 to 44.  

https://www.dhs.gov/immigration-statistics

  A large number of immigrants are also found in detention centers located throughout  the country. “As of September 2018, the US immigration detention system held an average of 40,770 people on any given day, but the current administration has requested funding to increase that number to 47,000.”

https://journalofethics.ama-assn.org/article/how-should-health-professionals-and-policy-makers-respond-substandard-care-detained-immigrants/2019-01

Practical arguments for your stance

-          What is the current policy for healthcare coverage of immigrants?

 According to the Kansas Department of Health and Environment (KDHE), children below the age of 19 and pregnant women are covered by health insurance only if they have immigration status.   For some immigrants, a waiting period of five years is required before they can receive benefits. It is challenging to find health care coverage for immigrants without any status and the five year waiting period can be a hinderance to the well-being of many individuals.

http://www.kdheks.gov/hcf/medical_assistance/eligibility.html

 Another major concern is healthcare coverage and access for detained immigrants,  particularly expecting women. Regardless the knowledge of the media that these detention centers are equipped to provide care for pregnant women, it was reported that in 2017 that 10 women filed complaints claiming poor prenatal care and the stress of being detained that led to miscarriage.

https://journalofethics.ama-assn.org/article/how-should-health-professionals-and-policy-makers-respond-substandard-care-detained-immigrants/2019-01

 Without healthcare coverage the main question and concern is the outcome of the pregnancy and the newborn’s health. One study looked at the outcomes of expanding access to prenatal care for undocumented immigrants, it’s utilization, and effects. Medicaid provides coverage for all pregnancy related healthcare.  However for those individuals who do not meet the immigration status qualifications, their  only option is  Medicaid emergency which only covers  acute life-threatening conditions and cost of birth excluding prenatal care. The study also mentions that 32  states and the District of Columbia have began to provide limited prenatal care as of 2015 whereas the continuation of Children's Health Insurance Program (CHIP) after 2017 was controversial.

https://europepmc.org/articles/pmc5679477

-          Do we want to keep these policies, what are the benefits, what are my arguments for changing or keeping it?

 Undocumented pregnant women have the lowest income and often live in  poverty. This population doesn’t have the authorization to work and earn income,  which makes affording healthcare very challenging. Without citizenship or residency status it is difficult to get  preventive care. In Kansas, healthcare coverage is not provided without immigration status and that puts expecting mothers in grave danger. The policy needs to change to accommodate healthcare coverage for these vulnerable individuals. With healthcare coverage, more individuals will seek preventive care which will lower the amount of debt in case of emergency care.

 Detained pregnant immigrants are at risk for various types of health issues. Instead of increasing the number of detainees, it should be a priority to increase the healthcare quality of those who are already detained. Pregnant immigrants should not be detained unless it is absolutely necessary, and it is imperative that an alternative to detention centers is used.  The quality of healthcare that is provided should be evaluated routinely and pregnant individuals should receive  consistent care to avoid poor  outcomes.

  Increasing access to healthcare for immigrants can result in better outcomes. . It was found that expanding coverage increased the utilization  and quality of outcomes. Immigrant women were more open to seek prenatal care and encouraged other pregnant immigrants  to utilize prenatal services.  Long term,  this change can decrease the rate of pregnancy-related morbidity and  provide a  better start  for the newborn. “Pregnancies covered under Emergency Medicaid Plus saw a reduction in infant mortality by about 1.04 per 1000. As a point of comparison, this reduction is greater than the 30-year reduction in infant mortality from Sudden Infant Death Syndrome (SIDS) associated with the ‘Back to Sleep’ campaign (Swartz, Hainmueller, Lawrence, & Rodriguez, 2017)”. Expansion of healthcare also increases the likelihood  of these immigrants  becoming more educated regarding safety and complications.

Ethical frameworks/ethical values

-          Ethical frameworks that support my stance

 According to the Universal Declaration of Human Rights, healthcare coverage is a human right and no nation should take away the right of humans and prevent them from getting treatment. Every patient should get equal and fair treatment regardless of their sex, race or immigration status. Newborns of  immigrant mothers get citizenship in  the country where they are born  and these limitations to care may not affect children after birth.

 “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.”

https://www.un.org/en/universal-declaration-human-rights/

-          2 supporting ethical values or principles

 A defining ethical principle that healthcare providers try to honor is the principle of nonmaleficence and beneficence. While healthcare workers live by this rule there needs to be a clear  policy as to how to help immigrants that need healthcare service. With the current immigration policy, undocumented immigrants are denied  healthcare solely based on their status. This goes against the ethical values of healthcare providers to benefit all and do no harm. Expecting mothers are among the most vulnerable individuals and providing access for healthcare should be a priority.

 Another ethical principle that supports healthcare for noncitizens is social justice,  which means to provide care to undocumented immigrants the same as they  would for citizens of the country. There should not be a single patient restricted from getting healthcare based on their immigration status. The need for a policy to include undocumented immigrants is very important to free healthcare workers from making the decision of limiting care for noncitizens based on laws.

Possible objections

-          What are the major oppositions?

 “Spending on Medicare, Medicaid, and the Children's Health Insurance Program, all government programs that provide a right to health care for certain segments of the population, totaled less than 10% of the federal budget in 1985, but by 2012 these programs took up 21% of the federal budget and are predicted to reach 30% of federal spending by 2028.”

 A major opposition against healthcare coverage for immigrants is the effects it has on the economy of the country. Another argument is the concern that immigrants may overuse their benefits if the are not held responsible for paying. This will increase the debt of the country and it will also exhaust healthcare resources.

https://healthcare.procon.org/

-          Rebut the opposition

 While there is a need to use federal funds to cover  healthcare costs, it is important to know that immigrants also increase the economy of the country as they join the workforce. Immigrants are innovative and they help in producing more job opportunities for the country. On the other hand, providing continuous healthcare opportunities can lower the cost of health care during emergent case. 

This means that we are providing health care for undocumented immigrants, but only in the most expensive way: in the hospital, when the disease is advanced enough to cause a disaster.

 https://projects.propublica.org/graphics/gdp

Facilitating change

-          What can be done to change this?

 In order to help pregnant women get access to healthcare, it is important to change the current policy that excludes undocumented immigrants from getting healthcare benefits. Policies that provide supplemental funding can also be useful in increasing better outcomes. There needs to be more opportunities that allow undocumented pregnant immigrants to  access  prenatal care.  Universal prenatal care coverage needs to be implemented. An  effective way of expanding care and coverage to undocumented immigrants is  forming a pathway to citizenship.

-          What are the roles of the nurse?

 Nurses have the responsibility of advocating for their patients. Nurses should utilize resources and notify patients what their rights are and what options they have to care for themselves. Nurses should also be aware of public policies so that they can direct patients to organizations that can provide them with care.

 Nurse should also develop rapport with their patients and provide a safe place where patients can discuss their fears without consequences. It is also important to know where patients can go to apply for benefits that will not use the information they provide against them. With immigrants that speak a different language, it is beneficial to have translators available. And as healthcare workers we should not assume that these patients are familiar with the health system organization. It is important to know their expectations and address any miscommunications.

Summation and conclusion

-          List major arguments and conclude

• Providing healthcare coverage for expecting immigrants can improve outcomes. Prenatal care can prevent complications that may arise.
• Limiting care for some select individuals based on their immigration status goes against the rights of humans.
• Detained immigrants are among some of the most vulnerable.
• There are evidences of how healthcare expansion lowered the rate of morbidity and mortality.
• Expanding care can allow immigrants to seek care and to recommend it to their friends.
• Prenatal care is the most important care aspect that has a multi-generational consequence on health outcome. The barriers and policies that prevent expecting mothers from accessing care can impact the health of the child and may also lead to morbidities or mortality for both. Evidence shows the importance of prenatal care and there is also evidence of an overwhelming number of undocumented immigrants without access to it. . There is a need for a more inclusive policy in regards to healthcare coverage and undocumented pregnant women  having  access to healthcare regardless of status.

References

• Feldman, R. (2016). Maternity care for undocumented migrant women: The impact of charging for care. British Journal of Midwifery, 24(1), 52–59. https://doi-org.bakeru.idm.oclc.org/10.12968/bjom.2016.24.1.52
• Fitzgerald, E. M., Myers, J. G., Clark, P., ( 2016) Nurses need not be guilty bystanders: Caring for vulnerable immigrant populations The Online Journal of Issues in Nursing, 22(1).
• Ohta, R., & Long, C. (2019). How should health professionals and policy makers respond to substandard care of detained immigrants? AMA Journal of Ethics, 21(1), 113–118. https://doi-org.bakeru.idm.oclc.org/10.1001/amajethics.2019.113
• Percheski, C., & Bzostek, S. (2017). Public Health Insurance and Health Care Utilization for Children in Immigrant Families. Maternal & Child Health Journal, 21(12), 2153–2160. https://doi-org.bakeru.idm.oclc.org/10.1007/s10995-017-2331-y
• Root causes of migration. (n.d.). Retrieved from https://justiceforimmigrants.org/what-we-are-working-on/immigration/root-causes-of-migration/
• Swartz, J. J., Hainmueller, J., Lawrence, D., & Rodriguez, M. I. (2017). Expanding prenatal care to unauthorized immigrant women and the effects on infant health.
• Universal declaration of Human Rights. (n.d.). Retrieved from https://www.un.org/en/universal-declaration-human-rights/