Although the issue of health policy, coverage, and access to care for the undocumented population involves a seemingly small number of actors (such as the government and the undocumented), this issue is actually far more reaching and involves many other institutions, organizations, and individuals.
Historically
The following is a brief look at previous health policy in relation to the undocumented.
State Government of New Mexico
Due to current federal regulations, the responsibility of figuring out what to do and how to fund healthcare for those who are undocumented are left to the individual states. Currently in New Mexico, a program called Indigent Care exists for individuals who are not eligible to receive Medicaid and do not have insurance (Dona Ana County, 2014). Under this program, individuals who qualify include those who are undocumented. As the ACA continues to roll out its requirements, more than likely the undocumented population will make up the majority of individuals covered under Indigent Care. Due to the implementation of the ACA, the likelihood of future funding being cut from this program is very high. As a result, if Indigent Care were to continue (being possibly the only form of healthcare coverage available for those who are undocumented), sources of funding must be considered.
Voters and Tax Payers
Many politicians active in health policy would not be in their position if it weren’t for the people who voted for them. As such, the people of a district/ state have an impact on the types of legislation that are passed. Letter writing and calling legislators to voice support, opposition, or concern are methods by which individuals influence policy makers. Given the controversy of immigration reform and healthcare for the undocumented, these voices would result in highly polarizing opinions. In addition, extra funding for such programs may be pulled from tax payer money depending on legislation. For example, if Indigent Care is to continue despite cuts to funding, the state of New Mexico could decide to utilize some of the money obtained from tax payers to fund these programs.
Hospitals, Clinics, and Healthcare Providers
Also as a result of the ACA, healthcare providers will receive less money from the federal government in the form of reimbursements for treating the uninsured. For instance, hospitals in New Mexico will face pending cuts over a 10-year period that will amount to approximately $697 million from the ACA (Domrzalski, 2013). As such, many non-profit hospitals and rural clinics located in an area where the percentage of individuals who remain uninsured are high, must find other programs or resources for assistance with payment for care. Unfortunately, some may have to close their doors.
Immigration Reform
Legislation concerning health policy for the undocumented population affects all departments, organizations, and individuals that are involved in immigration reform. To an extent, one must agree with the other or disorganization and confusion will occur. If undocumented individuals are able to receive healthcare coverage despite immigration policy that says they are violating the law, how will this affect future reform? As others have posed before, how will this affect the rates of illegal immigration? Some fear that allowing this population to receive coverage would result in a significant increase in the number of individuals who immigrate to the states illegally, further burdening state and federal budgets.
Missing Voices
The voices of healthcare providers are seemingly silent on this issue. Their opinions, expertise, and experience may provide additional insight into the possibility of legislation that would allow undocumented individuals to be covered and receive adequate access to care.
References
American Congress of Obstetricians and Gynecologists. (2009, January). Health care for undocumented immigrants. Obstetrics and Gynecology, 113, 251-254.
Domrzalski, D. (2013, March 8). What should happen to indigent funds after ACA? Albuquerque Business First. Retrieved from: http://www.bizjournals.com/albuquerque/print-edition/2013/03/08/what-should-happen-to-indigent-funds.html?page=all
Dona Ana County. (2014). Chapter 52: Indigent health care program. Retrieved from: http://ecode360.com/9674912
nm health policy: exploring health policy for the undocumented 
Great job reviewing the history and current issues with indigent care. I think another part to this is immunizations! Is there a minimum level of care that should be provided, such as immunizations and TB testing to decrease the possible spread of these communicable diseases. Many say no, however, unless these individuals are sent back to their home country immediately, there is a public health issue if we do not cover basic health needs.
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You bring up a an important point given current issues and concerns in light of the Disneyland measles outbreak. If undocumented individuals (especially children in public schools) become infected with a contagious yet preventable disease because they could not access care or lack insurance to cover immunizations, significant outbreaks could occur even more so since an increasing number of parents are opting their own children out of immunizations. I believe that opinions regarding the minimum level of care would vary greatly just as there are differences of opinion on calls for the government and schools to require immunizations.
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You bring up a great point in this post about pieces of legislation being in conflict. Hospitals in particular are a financial puzzle. They are required to provide emergency services to everyone. These are the most expensive services of course. Now any means of reimbursement through medicaid for providing care to undocumented immigrants has been removed. Although it seems that immigration reform must certainly be a part of the answer, this is such a “hot button” topic politically that is difficult to see any easy agreement on that issue.
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It seems that many hospitals are already having financial trouble especially with the additional requirements that come (and are coming) with the ACA. Without any resources to help pay for the emergency care that is provided to individuals who are not covered by insurance and cannot afford to self-pay, these hospitals will be forced to foot the bill.
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I Have enjoyed your blog. Having worked in the underserved populations for many years, I have worked with the undocumented patients, mainly in the public health setting. Most of the needs seen are in the interest of public health such as STDs, and vaccinations. Many for prenatal care but have involved payments for a prenatal package which included payment for labs and ultrasounds. The only payment from Medicaid was for the delivery to the hospital and doctor or midwife who delivered them. I can certainly see how this does affect hospitals and physicians or midwives who deliver these babies as far as reimbursement.
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Thank you for your insight on the needs of the undocumented given your experience working in the public health setting. Where have you worked (region/state)? Although I would assume that the needs of the undocumented in, say, California would mirror the needs of the undocumented in New Mexico, I would be curious to see if there are any differences in the care sought and coverage needed.
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I have worked in Texas and Arizona with the undocumented, and yes, I agree that public health needs are very similar. In reality these are a matter of humanity, since these are basic needs in public health.
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This is definitely a hot topic and a major public health risk. I’ve tried to understand the opportunities for health care coverage under the Development, Relief, and Education for Alien Minors (DREAM) Act but it appears very limited. There was a report in the National Law Review that due to Governor Brewer’s executive order, the state of Arizona is prevented from issuing driver’s licenses and public benefits to young undocumented immigrants who qualify for the Deferred Action for Childhood Arrivals (DACA) programs provisions (Binshteyn, 2012). Any idea what the case is in New Mexico?
Reference
Binshteyn, N. (2012). Arizona Responds to Deferred Action Program by Blocking Privileges for DREAMers. Retrieved from http://www.natlawreview.com/article/arizona-responds-to-deferred-action-program-blocking-privileges-dreamers
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In 2003, a law was passed here in New Mexico that allows all undocumented immigrants to obtain driver’s licenses and the law still stands today. Since then, there have been multiple attempts with no success thus far to have this law repealed. It’s interesting that you bring this up right now because this week there is a bill advancing in the New Mexico state legislature that would ban driver’s licenses for undocumented immigrants.
As far as healthcare coverage in the state for such undocumented/DREAM individuals – stay tuned to this blog because I will explore this in further detail. 🙂
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