Access to Health Care for Undocumented Immigrants as a Family Health Issue

The 2012 presidential election campaign is the latest reminder of how difficult it is to reach bipartisan consensus about health care policy in the U.S. In contrast, both parties offer rhetorical support to improving child health and providing children with access to health care.

The reality, of course, is more complex. Despite the importance of the Child Health Insurance Program (CHIP) and Medicaid for child health, President George W. Bush vetoed efforts to reauthorize and expand CHIP, but he also doubled the number of Federally Qualified Health Care Centers, which increased access to care for poor families and children. More recently, a number of Republican governors have threatened to refuse federal money to expand their Medicaid plans under the Affordable Care Act (ACA).{{1}} Disagreements about how best to achieve the goal of improving child health are likely to continue, but there is clear bipartisan support for the goal of healthy families and children. Our failure to provide access to undocumented patients, however, undermines this broadly held goal.

According the Pew Research Center, about 37% of adult undocumented immigrants have children who are U.S.citizens. As of 2009, there were at least 4 million children of undocumented immigrants who were born in the U.S.{{2}} Under the 14th Amendment to the U.S. Constitution children born in the U.S. are citizens. As citizens, they may be eligible for Medicaid, CHIP and other government health programs, but research suggests that these children are much more likely than other U.S. born children to be uninsured and more likely to go without needed care.

Research on the effects of insurance status of parents on access to care and the health of children is clear. Children of parents without health insurance coverage are less likely to have health insurance coverage and less likely to access needed care. Parents who go without health care are more likely to be in poor health and less able to provide care for their children.{{3}} Regardless of immigration status, children of uninsured parents are more likely to go without necessary health services than are children of parents with health insurance.{{4}} Not surprisingly, this problem is even more acute among children of immigrants. U.S. born children of immigrant parents are twice as likely to go without insurance and access to routine medical care than are U.S. born children of U.S. born parents.{{5}}

It is hard or impossible to separate the health and welfare of children from that of their parents. And yet, our health policy does that when citizen children have undocumented parents. U.S. born children of undocumented immigrant parents are eligible for Medicaid and the Child Health Insurance Program, but their parents may not enroll their children in these programs. Some of this may be due to fears that attempting to access these services for their children will result in deportation.{{6}} Even if they do not fear immediate deportation, immigrant parents may fear that applying for public health insurance will make it impossible for them to obtain citizenship or legal status at a later date.{{7}}

Beyond insurance, the extent to which parents have access to a “usual source of care” can influence the adequacy of care that children receive. Children of parents who do not have a usual source of care are more likely to go without needed care than children with parents that do have a usual source of care. This holds true even among children who have a usual source of health care for themselves.{{8}}

The debate about whether to use public funds to provide health care to undocumented immigrants generates strong reactions. Many people argue that it is inappropriate to use public funds to provide health care to undocumented patients when so many American citizens are uninsured and go without access to needed care. While reasonable people can disagree about the merits of these arguments, the existence of “mixed status” families in which at least one parent is undocumented and at least one child is a U.S. citizen complicates this discussion. When we contemplate the arguments for and against using public funds to provide health care to undocumented adults, we must consider the implications for their families. If we believe that justice requires offering all children an equal opportunity to live a healthy productive life, it is more difficult to justify denying care to their parents.

[[1]]1. Michael Cooper, “Many Governors Are Still Unsure About Medicaid Expansion,” New York Times, July 2012: A17.[[1]]

[[2]]2. Jeffrey Passel and Paul Taylor, “Unauthorized Immigrants and Their U.S.-Born Children,” Pew Research Center, August 11, 2010. Accessed October 2, 2012[[2]]

[[3]]3. Kinsey Alden Dinan and Jodie Briggs, “Making Parents Health Care a Priority,” National Center for Children in Poverty, April 2009. Accessed on October 2, 2012.[[3]]

[[4]]4. Jennifer E. DeVoe, Carrie J. Tillotson, and Lorraine S. Wallace, “Children’s Receipt of Health Care Services and Family Health Insurance Patterns,” Annals of Family Medicine 7, no. 5 (2009): 406-412.[[4]]

[[5]]5. Gilberto Granados, Jyoti Puvvula, Nancy Berman, and Patrick T. Dowling, “Health Care for Latino Children: Impact of Child and Parental Birthplace on Insurance Status and Access to Health Services,” AJPH 91, no. 11 (2001): 1806-1807.[[5]]

[[6]]6. Yoshikawa, H., & A Kalil, “The effects of parental undocumented status on the developmental contexts of young children in immigrant families,” Child Development Perspectives, 5 (2011): 291–297.[[6]]

[[7]]7. Kathleen M. Ziol-Guest and Ariel Kalil, “Health and Medical Care among the Children of Immigrants,” Child Development 83, no. 5 (2012): 1494–1500.[[7]]

[[8]]8. Jennifer E. DeVoe, Carrie J. Tillotson, Lorraine S. Wallace, Heather Angier, Matthew J. Carlson, and Rachel Gold, “Parent and Child Usual Source of Care and Children’s Receipt of Health Care Services,” Annals of Family Medicine 9, no. 6 (2011): 504-513.[[8]]