The Potential Conflict Between Policy and Ethics in Caring for Undocumented Immigrants at Academic Health Centers

Abstract

Academic health centers (AHCs) are at the forefront of delivering care to the diverse medically underserved and uninsured populations in the United States, as well as training the majority of the health care workforce, who are professionally obligated to serve all patients regardless of race or immigration status. Despite AHCs' central leadership role in these endeavors, few consolidated efforts have emerged to resolve potential conflicts between national, state, and local policies that exclude certain classifications of immigrants from receiving federal public assistance and health professionals' social missions and ethical oath to serve humanity. For instance, whereas the 2010 Patient Protection and Affordable Care Act provides a pathway to insurance coverage for more than 30 million Americans, undocumented immigrants and legally documented immigrants residing in the United States for less than five years are ineligible for Medicaid and excluded from purchasing any type of coverage through state exchanges. To inform this debate, the authors describe their experience at the University of New Mexico Hospital (UNMH) and discuss how the UNMH has responded to this challenge and overcome barriers. They offer three recommendations for aligning AHCs' social missions and professional ethics with organizational policies: (1) that AHCs determine eligibility for financial assistance based on residency rather than citizenship, (2) that models of medical education and health professions training provide students with service-learning opportunities and applied community experience, and (3) that frontline staff and health care professionals receive standardized training on eligibility policies to minimize discrimination towards immigrant patients.

Buffering the Uneven Impact of the Affordable Care Act: Immigrant‐serving Safety‐net Providers in New Mexico

“…CHWs have been demonstrated to be an especially important resource for immigrants and their children in navigating complicated eligibility and benefits policies (Cacari Stone et al. ).…”

“…In addition to the financial assistance program, the AHC had another program for self‐pay patients who were ineligible for the financial assistance program, which was an important source of care for immigrants who could demonstrate low‐income status and residency in the county (Cacari Stone et al. ). Its future was likewise uncertain.…”

“…Even though it is crucial that this support be available at the state level, clinics systems also need to make sure that providers have internal support as well to help them navigate the maze of complicated policies regarding immigrants (Cacari Stone et al. , 538).…”

“…Within this context—and especially if ACA provisions are rolled back—it is essential that these safety‐net clinics continue programs that align with their social mission to provide care to vulnerable immigrant and non‐immigrant populations (Cacari Stone et al. ).…”

HIV Prevention Among Diverse Young MSM: Research Needs, Priorities, and Opportunities

“…Although PrEP is viewed as a promising biomedical prevention strategy, interventions need to be developed to ensure providers and third party payers understand PrEP and to increase access to PrEP among those who are uninsured. Although the Patient Protection and Affordable Care Act provides coverage for US citizens, US nationals, and lawfully present immigrants, it bars undocumented or recent legal immigrants from receiving financial assistance for health insurance (Stone, Steimel, Vasquez-Guzman, & Kaufman, 2014). Thus, given an estimated 11.3 million undocumented immigrants in the US (Krogstad & Passel, 2015), many vulnerable MSM and other at-risk populations will continue to remain uninsured.…”