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Here’s how it works if you’re undocumented and need health care

Andy Uhler Jul 9, 2019
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Medical students give a check-up to a Jamaican migrant worker on a H2A visa at a Connecticut apple orchard and farm on October 11, 2017 in Middlefield, Connecticut.
Spencer Platt/Getty Images

Many of the candidates competing for the 2020 Democratic presidential nomination support the provision of health coverage to undocumented immigrants.

On Twitter, President Donald Trump said he’s happy his opponents are in favor of it because he thinks it’s going to prove unpopular with voters.

“All Democrats just raised their hands for giving millions of illegal aliens unlimited healthcare,” he wrote. “How about taking care of American Citizens first!? That’s the end of that race!”

Politics aside, navigating the health care system is difficult for more than 10 million undocumented people living and working in the U.S.

Here’s how it works

People in the country illegally are, for the most part, barred from enrolling in Medicaid or Medicare. They can’t buy insurance through the Affordable Care Act marketplace because that would be publicly subsidized.

But if an undocumented person can afford it, they can purchase their own, unsubsidized insurance.

“There is nothing illegal about selling private health insurance to people who are not in the country with authorization,” said Steven Wallace, professor of community health sciences at UCLA. 

Most people who are in the U.S. illegally work jobs that don’t pay well enough to buy health insurance. Wallace said those who do access health care tend to do so at federally funded health care centers, which are required to treat anyone, charge on a sliding scale and don’t ask for citizenship documentation.

Undocumented people also often use emergency rooms for nonemergency care because they tend not to have a family doctor.

“When you ask them ‘Where do you usually go for health care?’ They say, ‘Well, nowhere in particular,’” Wallace said. “So then when you have a need, or your baby has the flu and you’re worried because she’s getting dehydrated, where do you go? You don’t have an established relationship with any provider, so you head off to the emergency room.”

More often than not, undocumented people will simply avoid going to the doctor rather than coming home with a big hospital bill.

Samantha Artiga, director of the Disparities Policy Project at the Kaiser Family Foundation, pointed out another important deterrent: the assumption they’ll be asked about their citizenship status.

“We’ve seen a growing level of fear and uncertainty, broadly, across immigrant families, that is also making them less willing to access services and programs for which they might be eligible,” Artiga said. “The majority of their children are United States-born citizens who may qualify for Medicaid and CHIP coverage.”

Some states and cities have tried to make access for undocumented people more available. California is providing subsidized medical insurance for low-income undocumented adults aged between 19 and 25, a $100 million state budget item. And there’s talk of expanding the coverage to elderly undocumented immigrants.

“There really is a movement of trying to expand coverage to as many people as you can,” said Shannon McConville, health care policy researcher at the Public Policy Institute of California.

Opponents to increased access to insurance argue that costs will skyrocket if people are covered regardless of citizenship status. 

Of the Democratic candidates running for president who support providing health coverage to undocumented immigrants, none have offered a comprehensive blueprint of how to do it. Or, perhaps more importantly, how to pay for it.