According to some state legislators, the answer is yes. Lawmakers in South Carolina are pushing legislation that would “make it illegal to transport immigrants anywhere, including a hospital” reports the New York Times. Fox News Phoenix reports that in Arizona, a bill has been introduced to “require hospitals, when admitting nonemergency cases, to confirm that a person seeking care is a U.S. citizen or in the country legally. In emergency cases where the patient isn't here legally, the hospital would be required to call immigration authorities after the treatment is done. Hospitals in non-emergency situations would also be required to contact federal immigration authorities, but they would have more apparent discretion about whether to treat illegal immigrants.”
Such ill-advised efforts by states to criminalize health care for undocumented persons has led the American College of Physicians, the nation’s second largest physician organization, to speak out against “Any law that might require physicians to share confidential information, such as citizenship status to the authorities, that was gained through the patient–physician relationship conflicts with the ethical and professional duties of physicians.” ACP made this statement in a new position paper on immigrants’ access to health care released yesterday at its annual scientific meeting in San Diego, California.
Moreover, ACP argues that, “Access to health care for immigrants is a national issue and needs to be addressed with a national policy. Individual state laws will not be adequate to address this national problem and will result in a patchwork solution.” A national policy on immigrants’ access to health care should include the following elements, says ACP:
- Taxpayers should not be required to subsidize health insurance coverage for persons who are not legal residents of the United States and people should not be prevented from paying out-of-pocket for health insurance based on immigration status.
- The same access to health coverage and government-subsidized health care for U.S.-born children of parents who lack legal residency should be the same as any other U.S. citizen.
- Acknowledgement of the public health risks associated with undocumented persons not receiving medical care because of concerns about criminal or civil prosecution or deportation.
- Immigration policy should include increased access to comprehensive primary and preventive care, and vaccinations and screening for prevalent infectious diseases. This will make better use of public health dollars by improving the health status of this population and alleviating the need for costly emergency care.
- Federal government support for safety-net health care facilities and offsets for costs of uncompensated care provided by these facilities.
- Acknowledgment that physicians and other health care professionals have an ethical and professional obligation to care for the sick. Immigration policy should not interfere with the ethical obligation to provide care for all.
- Policies that do not foster discrimination against a class or category of patients in the provision of health care.
ACP concluded with a “call to action” for a national policy that recognizes the need for the country to control whom it admits within its borders and to differentiate its treatment of those who comply with the law in establishing legal residency from those who do not, while recognizing that hospitals and physicians have an ethical obligation to provide care for residents lacking legal documentation.
Some readers of this blog might question why ACP is wading into the complex, controversial, and polarizing debate over immigrants’ access to health care. (ACP’s paper addresses only questions relating to immigrants’ access to health care, not broader immigration policy.) But in my opinion, ACP should be praised for confronting an issue that affects health care for tens of millions of persons in the United States, documented and undocumented alike. As ACP President Fred Ralston, MD, MACP remarked at yesterday’s press event, “Access to health care for immigrants is crucial to the overall population of the U.S. We all have a vested interest in ensuring that all residents have access to necessary care.”
If physicians don’t speak up for their patients, even those who lack legal residency, who will? Not federal and state politicians, that’s for sure.
Today’s question: What is your reaction to ACP’s call for a national policy on access to care for immigrants that is in accord with physicians’ ethical obligation to care for the sick?