College students Alexa and Eileen Flores* and their sisters are among the over 11 million undocumented immigrants residing in the United States, 40 percent of whom are still uninsured. In the U.S., people usually receive health insurance through their employers, but most low-income, self-employed or off-the-books undocumented residents do not.
“We’ve just been lucky to have been raised in California, so we’re covered and we’ve been covered our whole lives,” Eileen said. “That’s only the reality for [a few] other states and there are people like us all across the nation so that means that there are hundreds of thousands of other kids who never will be covered throughout their entire lives.”
Alexa and Eileen have been eligible for health insurance throughout their childhoods and now as Deferred Action for Childhood Arrivals (DACA) recipients, but their parents must rely on free clinics.
“Health care needs aren’t determined by immigration status,” said Nancy Berlinger, research scholar at the Hastings Center and co-director of its Undocumented Patients project. “They’re determined by the fact that people have health care needs from birth to death. […] And health care is a basic right that people need in order to live.”
However, in the U.S., health care is not considered a basic right. Only people lawfully residing in the country are eligible for federally funded health insurance programs like Medicare and Medicaid, which leaves many undocumented immigrants without access to health care.
In California, more undocumented individuals are eligible for health insurance or health care than in most other states. DACA recipients are eligible for a state-funded Medi-Cal, which provides health insurance to low-income Californians.
The Flores sisters were covered throughout their lives by California Kids, a community-based program for otherwise uninsured children, as Medi-Cal for undocumented children has only been available since 2015. Now that Alexa is attending UC Santa Cruz and Eileen is at Cabrillo College, they are still eligible for insurance because of their DACA statuses. The future of their health care as DACA recipients, however, is unclear following the repeal of DACA.
Undocumented UC students receive grants to cover the UC Student Health Insurance Program (UC SHIP), a health insurance plan among the best available, said Diane Lamotte, ancillary services director for UCSC Student Health Services. Most coverage at the Health Center on campus is free or low-cost. If UC SHIP-covered students need coverage outside of the Health Center after hours, copay and co-insurance rates are significantly reduced.
Outside California, there are few health care options for the undocumented population in the U.S., other than emergency medicine. The Emergency Medical Treatment and Labor Act (EMTALA), states that everyone in the U.S. has the right to emergency medical treatment for life-threatening conditions until they are stable, regardless of ability to pay or immigration status.
This does not include ongoing treatment that could be needed outside the emergency room after a patient is released, which leaves low-income undocumented patients unable to receive additional necessary care, such as physical therapy or outpatient checkups.
“Our parents have been healthy up until now, but they’re getting older and are not covered under any form of insurance that can be reliable to cover anything that would come their way aside from just the free clinic,” Alexa Flores said.
Federally qualified health centers or community health centers are also able to provide care on a sliding scale, meaning people with low income will pay less. These centers can provide care for conditions like diabetes, dental and reproductive health, but are not equipped to treat illnesses like cancer.
Santa Cruz residents can also receive low- or no-cost episodic, or reactive, care at community organizations like RotaCare Bay Area, Santa Cruz Community Health Centers and Encompass Community Services, among others, or at Dominican Hospital’s Mobile Wellness Clinic at various locations.
Even undocumented individuals eligible for health insurance or health care, and citizen children of those ineligible are less likely to apply or get treatment because of the chilling effect — a fear of exercising rights due to potential consequences. In this case, disclosing personal information to health care providers may result in deportation for them or their family members.
“Our family is more concerned with getting covered than anything else, and thats how its been,” Alexa said. “Our family kind of has no choice but to place some sort of blind trust in the system.”
Undocumented patients technically have greater protection from deportation in hospitals. Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP) have memos in place that classify hospitals and other health care facilities as “sensitive locations” in which immigration enforcement actions should be avoided.
The Fourth Amendment also protects against unreasonable search and seizure, which constitutes within private spaces in hospitals, but these measures do little to alleviate fear.
Even when undocumented individuals are able to get health care, paying for it is often difficult. Although immigration status does not affect one’s ability to receive emergency care, EMTALA is not a way to pay for medical treatment.
California and some other states have emergency Medicaid programs available to help pay for care recieved under EMTALA. With this program, someone can apply for emergency Medicaid on behalf of a person needing insurance, but this program only covers specific services and will run out if that person needs long-term care or extended treatment.
If states do not have infrastructure in place to provide payment for this kind of care, patients will most likely be charged and accumulate debt. They may be eligible for charity care, where the hospital finds outside or governmental funding for the patient, but this is difficult to find for undocumented patients because of their immigration status.
“If you’ve lived in a place for a long time you become a kind of citizen of the place you live; even if you don’t have citizenship status, you are members of the community,” Nancy Berlinger said. “So when a hospital or clinic is thinking about who’s in [its] community, […] [it] means the people who live [t]here.”
Health care providers should be able to provide health care for their communities, Berlinger said, but the U.S.’s insurance policies related to undocumented immigrants have made this difficult and left millions without access to care.