Along with freedom, privacy is highly valued in the American culture. Take a look at just some of the many U.S. current events pertaining to privacy:
- NSA Surveillance and the U.S. Patriot Act: the Edward Snowden leak case put a spotlight on the government’s surveillance methods of U.S. citizens, especially telephone metadata.
- Workplace monitoring: some companies monitor employee’s emails in addition to work habits to combat “insider threat” (Lawrence, 2015).
- Use of drones: unmanned aircraft are used for surveillance by the FBI, U.S. Customs and Border Patrol, and by other businesses for commercial purposes with minimal regulations in place (Drones and privacy: A looming threat, 2015).
And the healthcare industry is not to be left out, despite the establishment of the Healthcare Insurance Portability and Accountability Act (HIPAA) in 1996:
- Anthem Inc. breach: a large health insurer in the U.S., where personal information for 80 million individuals was exposed. Many warn that this is just the beginning of such large security breaches in healthcare as medical identity theft is on the rise (Abelson & Creswell, 2015).
Privacy and the Undocumented
Privacy is also a top concern for undocumented immigrants for fear that exposure of their documentation status would result in immediate deportation. In the electronic age of healthcare, personal information such as social security numbers or lack thereof are readily accessed from multiple points within the system in addition to the number of individuals (i.e. clinic staff) with access to this information.
As mentioned in a previous post, undocumented individuals will often refrain from seeking needed medical care for fear of being detained and deported. In relation to this, there are U.S. citizens who have family members who are undocumented and living within their household. Again, the fear of detainment and deportation of their family members may prevent these legal residents from applying for needed health care coverage and other related assistance programs, many of whom are children (Sommers, 2013).
Legislation calling for healthcare coverage for the undocumented should also address concerns regarding privacy. If undocumented immigrants are approved for government assistance, their personal information such as documentation status would be made readily available to an increasing amount of individuals at the state and/or federal level. In order for this type of legislation to be successfully implemented, there would need to be secure measures in place to ensure that this sensitive information is not shared in a way that results in the detainment and deportation of individuals. However, undocumented immigrants may be prevented from applying for these programs due to the aforementioned fear of being “discovered.”
This issue of privacy shows the interconnection between the issue of healthcare reform for the undocumented and immigration reform. As long as these two issues remain in conflict, there will be difficulty in both proposing and implementing such legislation.
References
Abelson, R., & Creswell, J. (2015, February 6). Data breach at Anthem may forecast a trend. New York Times. Retrieved from: http://www.nytimes.com/2015/02/07/business/data-breach-at-anthem-may-lead-to-others.html?_r=0
Drones and privacy: A looming threat. (2015, March 19). The Economist. Retrieved from: http://www.economist.com/blogs/democracyinamerica/2015/03/drones-and-privacy
Lawrence, D. (2015, March 12). Companies are tracking employees to nab traitors. Bloomberg Business. Retrieved from: http://www.bloomberg.com/news/articles/2015-03-12/companies-are-tracking-employees-to-nab-traitors
Sommers, B. (2013). Stuck between health and immigration reform – care for undocumented immigrants. New England Journal of Medicine, 369: 593-595. doi:10.1056/NEJMp1306636
nm health policy: exploring health policy for the undocumented 
You bring up an important point in this discussion of policy governing access to data in this electronic age. It is true that undocumented immigrants fear “discovery” because pieces of their information may disclose their immigration status but the information that is gathered for healthcare purposes should not be used for that purpose but rather to facilitate delivery of healthcare. Thus policy should be developed and enforced to ensure that even undocumented persons can seek medical attention without fear that their privacy will be breached in any way.
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I agree that policy would need to be developed to ensure that such privacy is maintained. I think that the most difficult part, however, would be actually convincing affected individuals that their personal information including documentation status will not be accessed by any other entities than those who are required in order to provide quality care.
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I have come across several patients who are undocumented immigrants who have waited until they are very ill to be seen because of the fear of being deported. Some have tried to use family members names and birth dates who are citizens in order to receive care. Even though my clinic will not turn anyone away regardless of their status, many are still fearful.
Just this week I had a young woman who was in the process of attempting to get U.S citizenship but would not apply for Medi-Cal because she was afraid the government would find out she could not afford health care and deny her application. She needed more medical attention but I fear she will not follow up out of fear that she will be told to leave the country.
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I think the example you provided of the patient refusing to apply for assistance related to fear of being denied citizenship shows that perhaps more education should be provided explaining the privacy laws and measures that are already in place especially when it involves individuals seeking resident status or citizenship. However, I am sure that many of these individuals often live in fear and mistrust of governments, organizations, and others not solely from lack of knowledge, but also in relation to prior experience where they may have lived in a country with a corrupt government. It is unfortunate that many individuals who are eligible for assistance that would lead to improvements in their own health often shy away from even applying.
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