America prides itself for being a nation built by migrants. Providing comprehensive health cover for undocumented migrants has been highlighted as a policy that the next president should address. Undocumented immigrants in the US are prohibited from enrolling into Medicaid and Medicare and buying insurance from other corporations provisioned by the Affordable Care Act (Samra et al., 2019). Immigrants such as Fernando, can only access healthcare through 1400 healthcare centers funded by the federal government (Garcini et al., 2017). Federal health centers are mandated to treat anyone regardless of their ability to pay and citizenship status. A majority of undocumented immigrants do not have an employer-provided plan since they face difficulties in securing jobs.
Fernando, a 69 year-old Hispanic who lives with his wife, is reported to be facing some difficulties including frequently crying, not wanting to leave his house and notable weight loss. Establishing dialogue with Fernando is the first step towards directing him towards a healthier life (Kuczewski et al., 2019). Undocumented immigrants are often skeptical in trusting outreach workers and physicians with their health issues due to the fear of potentially having to answer a question about their immigration status (Kuczewski et al., 2019). Having the friend who reported his condition accompany a health worker could make the environment more bearable. Once Fernando open ups, it is imperative to address the patient’s experience, which may include a sense of shame and isolation (Kuczewski et al., 2019). One can do so by reassuring the patient that many people are facing the same issues.
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Once Fernando has been reassured of the situation, he can receive resources that can help in his mental health condition. Multiple stressors and lack of income for undocumented immigrants may lead to increased risk for mental disorders including depression and anxiety disorders (Kuczewski et al., 2019). Fernando can be classified as critically ill due to his deplorable state of living and evident mental illness (Kuczewski et al., 2019). He can access health through the ER. State Medicaid programs exempt low-income individuals from various cost-sharing expenses. Fernando can access short-term noncash emergency disaster services, in-kind services such as adult protective services and meals-on-wheels.
The case of Fernando and his wife illustrates some of the barriers affecting undocumented patients in America from achieving medical and social well-being. The patient protection and affordable care act (PPACA), was aimed at reducing the number of uninsured Americans (Garcini et al., 2017). The PPACA completely overlooked citizens such as Fernando. Statistics show that there are currently million uninsured Americans (Garcini et al., 2017). Fernando is a long standing contributing member of his community but he still faces barriers in accessing quality healthcare. His access to mental health, health care, and social work is likely to be impeded by the “public rule” change, which penalizes immigrants who access public assistance through Medicaid (Garcini et al., 2017). For example in the current Covid-19 pandemic, the CARES act (Kuczewski et al., 2019), provides free testing services for immigrant communities but requires individuals such as Fernando and his wife to share the cost of treatment with the government. The emergency medical treatment and active labor act restricts the use of federal funds for the undocumented immigrants to “acute symptoms of sufficient severity” (Kuczewski et al., 2019). Such policies force undocumented immigrants to wait until their medical symptoms are life-threatening in order to seek treatment.
Federal and state governments are not doing enough to make life easier for immigrants suffering from mental health challenges. Unfortunately, the government places numerous barriers to prevent undocumented immigrants from accessing medical cover and ACA provisions until their issues are critical to the point of imminent death. Undocumented immigrants working in the United States already pay taxes using individual taxpayer identification numbers in the hope that they can be recognized as citizens in the future. Therefore, individuals such as Fernando have a right to more than just mere ER services whenever their conditions worsen.
References
Gracin, L., Galvan, T., Malaren, V., & Pena, J. (2017). Mental Disorders among Undocumented Mexican Immigrants in High-Risk Neighborhoods: Prevalence, Comorbidity, and Vulnerabilities. Journal of Consulting and Clinical Psychology , 85(10), 927–936. https://doi.org/10.1037/ccp0000237
Kuczewski, M., Mejias-Beck, J., & Blair, A. (2019). Good Sanctuary Doctoring for Undocumented Patients. AMA Journal of Ethics , 21(1), E78-85. https://journalofethics.ama-assn.org/article/good-sanctuary-doctoring-undocumented-patients/2019-01
Samra, S., Taira, B., Pinheiro, E., & Trotzky-Sirr, R. (2019). Undocumented Patients in the Emergency Department: Challenges and Opportunities. The Western Journal of Emergency Medicine , 20(5), 791-798. https://doi.org/10.5811/westjem.2019.7.41489
