Project Overview

Undocumented Patients:
Human Rights, Access to Health Care & the Ethics of the Safety Net

Project Co-Directors

Nancy Berlinger & Michael K. Gusmano

Funder

Overbrook Foundation Domestic Human Rights Program

Timeframe

June 2011-December 2012

Efforts to address the health care needs of the 11 million undocumented immigrants in the United States concern three levels of health care: clinical, organizational, and regulatory. Physicians, nurses, social workers, and other health care professionals who serve communities with significant year-round or seasonal populations of undocumented immigrants need clear guidance, supported by organizational policy, to help them address an unresolved societal question: what share of social goods is owed to undocumented immigrants as persons and as members of society, and how should the delivery of health-related goods, in particular, be authorized and paid for?  Failure to address this foreseeable challenge can result in ad hoc remedies that can be unfair to patients, inefficient as resource allocation processes, and ineffective as reform efforts.

Supporting systemic change that can ensure access to high quality and affordable health care for all residents of the U.S. requires close attention to difficult questions of resource allocation. In the U.S. visions of health care as a right and as a privilege have long competed.  Both health care and immigration are likely to remain fragmented as systems, and contentious with respect to political debate. As federal and state policymakers face hard budgetary choices affecting safety net providers, this 18-month project is exploring the values that can sustain or imperil the domestic health care safety net

The roll-out of the Patient Protection and Affordable Care Act (PPACA) of 2010 offers a timely opportunity to address the health-related rights and needs of undocumented immigrants and, through careful analysis and concrete recommendations, to promote the development and implementation of equitable and sustainable public policy that can help providers who serve this population. This project aims to take advantage of this opportunity.

The audiences for this project include:

  • health care professionals, including clinicians and organizational leaders
  • human rights advocates working on health care access and on immigration reform
  • scholars working at the intersection of domestic human rights, health care ethics, and health policy
  • journalists and others who follow these issues.

Products of this project will include:

  • a special report published online by The Hastings Center, targeted to health care professionals and to human rights advocates
  • journal articles
  • this public website, which will chronicle the course of the project through short essays, videos, links, and citations.

Immigrant Health and the Moral Scandal of the “Public Charge” Rule

A long-anticipated policy change proposed by the Trump administration that would count the use of many federally-subsidized programs against immigrants currently eligible to use them threatens public health and would undermine ethical practice in health professions and systems. The policy would expand the definition of a public charge, someone likely to become dependent on government […]
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Beyond Breaking News: Ways of Seeing Migrants and Their Children

In his iconic 1977 essay on migration, A Seventh Man: A Book of Images and Words about the Experience of Migrant Workers in Europe, John Berger wrote: “To try to understand the experience of another it is necessary to dismantle the world as seen from one’s own place within it, and to reassemble it as […]
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Migrants’ Lives, Immigration Policy, and Ethics Work

The Russian poet Anna Akhmatova was a mother separated from her child by a state policy of terror. During the 1930s, she and other mothers would gather outside a Leningrad prison, desperate for information. One day, after 17 months of “waiting in prison queues,” another woman whispered to her, “‘Could one ever describe this?’ And […]
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Shocking the Conscience: Justice Department versus the Health of Immigrant Women and Children

In April, the U.S. Justice Department announced that it would criminally prosecute migrants who had been apprehended after crossing the U.S.-Mexico. border. An immediate consequence of this announcement, explained in detail here, is the separation of children from their parents. Rather than being allowed to stay with their children in an immigrant detention center while […]
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