Monthly Archives: June 2018

Healthcare is Confusing Part IV: Undocumented & Uninsured

The majority of the 11 million undocumented people living in the United States live in poverty. They often work minimum wage jobs (or are paid less than the minimum wage, if working under the table) that do not offer employer sponsored health insurance. Since they lack citizenship status, they aren’t eligible for any government benefits, like Medicaid, Medicare, SNAP (food stamps), or Cash Assistance. Preventative healthcare isn’t an option, unless a free clinic or a pay-what-you-can clinic will accept them as patients, and a lot of time these types of clinics require a social security number, meaning that undocumented people are shut out. Ohhh, and undocumented people are barred from even trying to find their own private plans through Healthcare.gov (aka the ACA, aka Obamacare).

A Kaiser-Permanente study recently looked at the number of undocumented and uninsured people currently living in the US and found the number to be around 6 million, which I was very surprised to learn (I think this is a pretty conservative estimate).  Regardless, that’s a ton of people to have basically no option for health coverage. The only way an undocumented person can get health insurance is either through employer sponsored plans or “off-exchange” plans. Both of these options are often unaffordable for undocumented people who are already living in poverty and they often choose to opt out of these coverages because they can’t afford the monthly premium that is deducted from their paychecks. These plans are also frequently classified as being “under-insurance” meaning that they don’t cover necessary medical treatments or have such a high deductible/monthly premium that they are basically useless. Of the entire US population who is uninsured, undocumented people make up 20% (out of the total US population, undocumented people only make up 3%).

undocumented and uninsured

So, what happens when someone who is undocumented and uninsured gets sick? The short answer is that they suffer. Securing any kind of healthcare while undocumented is virtually impossible. As stated above, the only place undocumented and uninsured people can get healthcare is 1.) either by going to a free or charitable clinics that doesn’t deny eligibility due to citizen status or 2.) going to the ER. Our country hasn’t yet barred undocumented people from getting emergency care in an ER, which is a blessing, but also contributed to the huge cost burdens that ER visits produce. When someone goes to the ER and are uninsured, they often are left with an astronomical bill (last year, my ER visit in May cost $7,000 and I was only there for a few hours- luckily I was able to get my insurance to cover it, a privilege of being born in the US and a privilege of having health insurance). If I couldn’t pay the $7,000, the burden of the cost would fall on those who are insured via the form of higher insurance premiums. Keeping people out of the ER is a huge initiative around the country since patients who can’t pay are more likely to utilize an ER, and the best way to do so is by having preventative care- a luxury often not available to those who are uninsured.

So what about when an undocumented person gets sick sick, like cancer sick? Well, they are pretty much in a pickle. The only solution to this, at least in Pennsylvania, is applying for Emergency Medical Assistance (EMA). EMA is tricky and difficult to obtain. First, the person has to prove that they have a life or death medical situation going on. They have to have a physician write a letter explaining what is wrong with the person, their diagnosis, and all medical records pertaining to the health need. This letter and information is then reviewed by a eligibility determining judge who decides whether or not the person has a drastic enough impairment or illness that they will not be able to survive without medical assistance. There are no clear eligibility requirements available to the public as to what consists of a emergency medical issue. For example, one person I know needs gallbladder surgery. She is often in pain, however she manages to go to work and get through her day. She received EMA and saw a specialist, who scheduled surgery in a the fall (6 months out). EMA is time limited, so she only had two months in the first place to secure all her medical needs. Since the EMA expired, she has to reapply and hope that it is granted it again in order to cover the necessary surgery.

Another example: a person I know has some type of neurological disorder in which his fingers became immobile and basically froze together. The disorder then progressed to his hands and arms to the point that he can’t bend his wrists, move his fingers, or stretch out his arms. He applied for EMA and was denied. He appealed the decision a month ago, and still hasn’t heard back. I think his chances are slim to none, and he’ll just have to learn to live with his body slowly shutting down on him.

And finally, what about the kids? Well, if you are a child and are undocumented and poor, guess what? You also are entitled to nothing. Undocumented kids aren’t eligible for CHIP, which means that they aren’t getting routine check-ups, they aren’t being monitored for developmental delays, and they aren’t getting vaccinated. Guys. This is an issue.

So what’s the solution? Other than changing our entire healthcare infrastructure, we can hope that Medicaid might be expanded to, at minimum, allowing CHIP to cover undocumented kids. We can also hope that Medicaid might be expanded to open up eligible disorders that would qualify someone for EMA. And we can also just hope that Medicaid is expanded in general, so that it covers everyone, regardless of citizen status. The sad news, is that Medicaid most likely isn’t going to be expanded, and massive cuts to both Medicaid and Medicare have been proposed in the last week. It’s looking bleak out there for people who are uninsured, and especially worse if you are undocumented.

How can you help, knowing that there is little health care options available for undocumented uninsured people? Look up your local free and charitable clinics and see if they will help undocumented people. If they do, consider donating your money, time, or talents to these organizations. Another way you can help is by spreading the truth- telling the people who complain about undocumented people using government benefits that they are incorrect in this assumption. Undocumented people aren’t entitled to ANY government benefits (even though they contribute to these benefits by paying billions in taxes each year, and never reap any of the benefits), which is a sad reflection of America’s current values, not just on immigration, but on social justice and human rights.   

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