Is health care for undocumented immigrants a basic human right?
Updated: Dec 11, 2020
Back in 2019, California became the first state in the country to offer government-subsidized health benefits to low income, undocumented young adults age 25 and younger living in the U.S. This was an expansion from the California law that has allowed children under 18 to receive taxpayer-backed health care despite immigration status. As a doctor that took an oath when graduating medical school to always use all measures that are required to benefit the sick, it aids us ease pain and suffering in more patients that need help. However, there’s a large demographic remaining throughout the entire United States that are not able to receive the care they need.
One very late Thursday night, a 45-year-old woman came to the emergency department with excruciating abdominal pain. The ER physicians caring for her ordered imaging to diagnose what could be causing her symptoms. As the ER Radiologist for the evening, I interpreted the CT scan of her abdomen and was taken aback: she had the largest liver cyst that I had ever seen in my life. The cyst was so bulky that it was taking up the majority of the entire right lobe of her liver.
The patient was then transferred to an inpatient hospital team when she told her physicians that she had been living in Canada. The rest of her back story was less clear with some murmuring that she was visiting family in southern California for an indefinite amount of time. She said she had known about her liver cyst for the last two years, but she had not felt such agonizing pain before her visit, only some right upper quadrant aches every now and then.
To cure the patient of her symptoms, she would need an image guided drainage of her large liver cyst. However, for the patient to get this procedure performed by the Interventional Radiologists, she would have to get it done as an outpatient procedure. For the drainage to even be scheduled, the patient’s insurance would have to be approved. But the glaring problem was that the patient simply did not have any medical insurance to get the procedure authorized. So there was no choice but to discharge her from the hospital with pain medication (that she would have to pay for out of pocket) to get her through until she could have the procedure done elsewhere.
The unfortunate truth was that if the patient was able to obtain the procedure during her hospital visit, it would have taken care of the source of her pain. She would not have to be discharged in immense discomfort with opiate drugs that do have potential for abuse. Since the patient’s pain will only continue as the cyst was so large, she may need increasing amounts of pain medication to ease her discomfort over time. And although rare, bleeding or infection of hepatic cysts do arise which can lead to significant complications. If her condition were to become an emergency, it could potentially cost the patient and the healthcare system significantly more money.
Yes, the option to apply for PRUCOL (Permanently Residing in the U.S. Under Color Of Law) in order to have access to Medi-Cal does exist. However, the immigrant may only claim to be PRUCOL when they have a strong belief that U.S. Citizenship & Immigration Services will not pursue deporting them. So, for some people living in fear after escaping their home countries for a number of reasons, they have to choose between deportation or significant morbidity and possible death.
A month later, a patient with a history of breast cancer presented to our hospital with unrelenting right upper quadrant pain. Her CT scan showed a 2 cm lesion in her liver and the major concern was that the lesion may have been from a metastasis, or cancer spread to her liver. In order for the patient to be treated for this possible cancer metastasis, the diagnosis had to be proven. This patient would need a liver biopsy that could only be performed on an outpatient basis after insurance approval. But the patient admitted that she was in fact an undocumented immigrant from Mexico, lacked health insurance and was just too frightened to apply for PRUCOL. The health care providers, despite doing all they could to take care of her, were again at a loss.
But yet, there are lot of Americans out there – including other physicians - who may not agree that undocumented immigrants should have health care benefits.
Some people believe that these immigrants do too much harm by taking American jobs, lowering wages, and abusing the welfare system. One of my fellow physician friends living in Kentucky even posted this to his Facebook, which just about sums up how he feels about undocumented immigrants:
According to the center for immigration studies, the total cost of providing Affordable Care Act subsidies to illegal immigrants could be from $10.4 to $22.6 billion annually. That’s no doubt a hefty sum. Others may argue that except for those who were born on American soil, citizenship and the benefits that come with it are a privilege and that every immigrant, no matter their reason for needing to leave their country, should wait just like everyone else. Some believe that undocumented immigrants have “jumped the line”, stealing a better life from other people around the world who are entering the U.S. the lawful way.
I do understand why someone like my friend and many others like him would feel very disgruntled when they truly feel like someone is taking advantage of the system while they are paying their fair share. So, with those sentiments, it’s really difficult for him to support higher taxes to benefit those he believes are gaining disproportionately more. But I often wonder what may happen if those that oppose benefits for undocumented immigrants actually witnessed the pain and suffering that some of these individuals experience. After all, we are all human and deep down, I truly feel like we all do have compassion for one another’s lives. This could be all the more elevated if more people met and spoke to these patients in real life and listened to their stories.
I want to tell you that these cases are extremely rare, but they happen more often than you want to believe. And although many do support a health care system for undocumented immigrants, it is understandably an extremely complex issue with no clear present solution. But we physicians made a pledge to always remember we are treating a human being whose illness may affect the person's family and economic stability with sympathy and understanding. So, it’s difficult as a physician to be prevented from intervening when a patient struggles with pain or a health problem that can be treated. And in this situation and many others across the country, there was nothing for the physicians to do but to stand aside even though we promised to treat our patient, no matter a person’s immigration status.