Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed, to me: I lift my lamp beside the golden door.
— The Statue of Liberty
Two major political issues, undocumented immigrants and uninsured Americans, have recently been at the forefront of congressional legislative debate. The Patient Protection and Affordable Care Act (ACA) of 2010 will help provide health coverage for approximately 32 million uninsured Americans. Under the ACA, however, undocumented immigrants will not be eligible for health coverage. Undocumented immigrants will make up an estimated one-third of 23 million residents still lacking health coverage in the next five years. As a result, these uninsured residents will place a great financial strain on states with large undocumented immigrant populations. This strain will be secondary to state governments subsidizing health care facilities that provide care for residents unlikely to pay after services are rendered.
This study focused on New Mexico and its residents prospective on providing health care services to uninsured, undocumented immigrants. The state of New Mexico was an ideal location; it holds a large population in both undocumented immigrants (approximately 4 percent of the state) and uninsured adults and children (22 percent of the states population, as of 2007). A computer-assisted telephone survey conducted between October and December 2007 interviewed 1,076 randomly selected New Mexican residents ages 18 years and older. The survey was available in both English and Spanish; a large sample of Hispanic respondents ( approximately 25 percent) was captured mirroring that of the New Mexico adult population. Interviewees were asked to give their opinion about providing basic health care coverage through a proposed state health care reform plan for different subpopulations of the state – children, the homeless, the unemployed, new residents to the state, and undocumented immigrants. The interviewees either ranked their support as (1) strongly disagree, (2) disagree, (3) agree, or (4) strongly agree. Demographic information – gender, age, income level, number of children, employment status, ethnicity and political affiliation – was also collected during the interview.
Twenty-four percent of respondents either agreed or strongly agreed that undocumented immigrants should be provided with basic medical coverage by a state funded program. Thirty-three percent of respondents agreed/strongly agreed for new New Mexico residents. Overwhelmingly, respondents agreed/strongly agreed (85 percent) that all uninsured children should receive basic medical coverage. Hispanics and Democrats were more likely to support providing basic coverage compared to White, non-Hispanics and Republicans (p<.05). Looking at subgroups of the Hispanic population, Hispanic females and Hispanics with income over $100,000 were less likely to support providing basic medical coverage compared to Hispanic males and Hispanics from lower income levels (p<.05 and p<.001, respectively).
The complexity and necessity of providing publicly funded basic health care for all people residing in the United States is a long standing dispute. Although the results of this study are not surprising, the fact remains that supporters and opponents of providing health care to undocumented immigrants each have convincing arguments. Supporters who believe that health care is a right for all individuals regardless of their immigration status value the altruism in providing these services. Supporters also expect to decrease the subsidies necessary for institutions who seek remedy for “uncompensated care”. Opponents strongly feel that providing health care to undocumented immigrants rewards them for breaking federal law. Such a proposition allows undocumented immigrants to become free riders in a society whose rising taxes must fund state health care programs.
Both sides, however, must compromise while addressing each others concerns. Perhaps, as the data suggests, enough support could be garnered to at least provide health care for the children of undocumented immigrants. What to do with adult undocumented immigrants – amnesty, deportation, or earned legal status – then becomes an area for immigration policy experts.
Tyree Winters, DO
*this version is an update correcting the percentage of illegal immigrants living in New Mexico