Healthcare for Undocumented Latinx Migrants: A Medical and Human Rights Issue
Dana Garibaldi
Introduction
In 2023, the number of undocumented immigrants, or UIs, crossing the U.S.-Mexico border was at an all-time high, with 250,000 border crossings in December alone.1 Upon arriving in the United States, however, many migrants are met with a harsh reality: they have little to no access to medical care. Despite the Biden administration’s recent plan to expand health insurance access to DACA immigrants — or individuals protected from deportation because they immigrated to the United States as children — insurance programs like Medicare and Medicaid remain off-access to non-DACA UIs.2 The medical services that these individuals are able to receive in the United States are extremely limited, with the only covered medical treatments being emergency room visits.3
If a UI does not have a DACA status, the only other way they can receive private insurance is through their employer, a rare circumstance given that undocumented immigrants are more likely to report working low-wage jobs that do not offer coverage.4 Otherwise, they have no way of paying these services with their own money, as dictated by the Affordable Care Act of 2010.5
Although the Biden administration’s recent legislation is a step in the right direction, both national and state coverage for UIs remains sparse.6 Further, in the political sphere, providing healthcare to UIs is a contested subject. Right-wing politicians and/or media outlets often portray UIs as taking funds away from the government, and therefore view the expansion of Medicaid to include UIs to be no exception. In this paper, I will address and refute these objections, arguing for the need to pursue more healthcare options for UIs.
Existing Health Services for Non-DACA UIs Are Insufficient
While some may argue that non-DACA UIs can receive some form of care — namely by using the emergency rooms of hospitals when faced with a health condition that places their health in “serious jeopardy” — this extremely limited access to care is simply not enough for the increased health risks that undocumented Mexican immigrants may face before, during, and after their migration journey. UIs face an array of mental health disorders such as depression and anxiety, which affect 14.4% and 6.6% of Latinx immigrants respectively, as well as addiction.7,8,9
For instance, UIs who once lived in extreme poverty and then migrated to the United States in hopes of a better socioeconomic status may still carry some depressive symptoms following their migrant journey. One study found that immigrants who were motivated to migrate to the United States to flee political violence in their country were also at increased risk of long-term post-traumatic stress disorder (PTSD). These same individuals are less likely to leave the United States and return to their country of origin for fear of being exposed to the same violence and triggers.10
Furthermore, the journey of migrating to the United States as an undocumented immigrant can be filled with traumatic events that may cause mental health issues, especially as many migrants crossing the border are led by coyotes, migrant guides who are paid large sums of money and often exploit the migrants they lead. Migrants often face abandonment, robbery, and abuse at the hands of coyotes. Even for those not directly involved in the exploitation, the chronic stress from bearing witness to these events can cause mental health conditions, such as anxiety and depression, to arise. In addition to these tragic experiences, the fear of deportation and the social discrimination that UIs may face after their journeys have been shown to lead to heightened rates of depression.11
These mental health conditions cannot be treated by the extremely limited healthcare coverage provided to UIs. By failing to expand healthcare coverage for UIs, the current healthcare system is playing a role in prolonging the trauma and mental health difficulties that these migrants are facing, going against its cardinal principle of doing no harm.
The extent to which these traumatic events can impact UIs not only affects their mental but also their physical wellbeing. In particular, Latinx UIs who have faced traumatic events often turn to substance abuse, especially as they are separated from support systems like their family members who can help them cope through their anxious and depressive symptoms.12 Local studies of Latino migrant laborers have identified prevalence rates as high as 80% for binge drinking, 39% for alcohol addiction, and 25% for methamphetamine and cocaine use.13 Excessive alcohol abuse is a risk factor for multiple health conditions, making up 1.8% of cardiovascular disease patients and accounting for 6% of all cancers in the United States.14,15 Thus, prohibiting UIs from accessing the services they need to improve their physical health without fear is an action that actively places these individuals at risk.
To properly address the physical and mental health issues that UIs are at risk of, we must expand public healthcare coverage to non-DACA UIs beyond the emergency room. The medical services offered in the emergency room are not only expensive, with the average ER visit costing $2,200 without insurance, but also inadequate in serving the medical needs of the Latinx UI population. While healthcare coverage remains off-limited to non-DACA UIs in many states, twelve states have taken measures to provide comprehensive and state-funded coverage for children regardless of their immigration status, with only six doing the same for adults.16
These comprehensive insurance plans cover a wide range of inpatient and outpatient services, including mental health consultations and rehabilitative services. These expansions in coverage have proven to be effective. Research has shown that only 11% of immigrants living in states with expansive health coverage policies are uninsured, compared to 22% of immigrants living in states with less expansive health coverage policies.17
Additionally, if implementing expanded or full healthcare coverage to UIs is too much of a financial barrier for a state to consider, an alternative, but perhaps less impactful, solution would be to implement free mental health centers for the public who do not ask or penalize individuals who are of undocumented immigration status. These community health centers would include mental health counseling for issues that are known to affect migrants, including depression, anxiety, post-traumatic stress disorder, and substance use. While there are online directories that list mental health professionals willing to provide services at a low cost to undocumented immigrants across the country, a centralized mental health location within a border community could better address the specific needs of a particular immigrant community.18
Economic Concerns
Others argue that expanding healthcare coverage to undocumented Mexican migrants would be destructive to the American economy, as they claim that UIs thrive off of American tax money. Some continue that higher taxes to support healthcare access options will only exacerbate the supposed exploitation of the American healthcare system. Contrary to naysayers, Mexican immigrants consume a minuscule fraction of total health expenditures while contributing billions of tax dollars in return.
In 2016, the federal government spent $974 million on emergency services for UIs, including payments to healthcare workers. This constituted only 0.2% of Medicaid expenditures and 0.03% of all national health expenditures during that year. By contrast, in 2018, UIs contributed $20.1 billion in federal taxes and $11.8 billion in state and local taxes, contributing to the very systems that they cannot access like Medicare and Medicaid. The states with the largest population of UIs, such as California, Texas, and New York, each receive over $1 billion from UI tax contributions.19
It is imperative to address the unjust structures that exploit UIs while simultaneously neglecting them of needed healthcare services.
Conclusion
Although some may argue that expanding healthcare coverage to UIs is not necessary due to their ability to utilize emergency room services, UIs struggle through mental and physical health issues and face financial barriers that cannot be properly addressed within the confines of the emergency rooms. Additionally, UIs contribute far more to the American economy through their tax dollars than they are credited for. The further we delay expanding healthcare coverage to undocumented Latinx immigrants, the further we delay providing basic medical coverage to support the health and well-being of thousands of families. It is therefore crucial for us to not only shift our political narrative of UIs to recognize their contributions to the American economy, but also expand the healthcare coverage for these individuals as they seek to make a better life for themselves.
References
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In 2023, the number of undocumented immigrants, or UIs, crossing the U.S.-Mexico border was at an all-time high, with 250,000 border crossings in December alone. Upon arriving in the United States, however, many migrants are met with a harsh reality: they have little to no access to medical care.