This piece was written by Dr. Mary McDonough. Dr. McDonough is the author of Can a Health Care Market Be Moral?: A Catholic Vision.
In Galatians 3:28 St. Paul declares: “There is neither Jew nor Greek, there is neither slave nor free, there is neither male nor female; for you are all one in Christ Jesus.” I would add to this list “there is neither citizen nor undocumented” because, in the eyes of the Lord, there are no labels, no categories with which to define us. We are all the same—human beings who are created in God’s image and, therefore, have inherent and undeniable dignity. We are also equally valuable. Regardless of race, religion, gender, sexual orientation, ethnicity, citizenship, or legal status, each one of us has certain human rights that must be met in order to maintain our intrinsic dignity. Rights that were beautifully articulated in Pope John XXIII’s encyclical Pacem in Terris (“Peace on Earth”) issued in 1963. These rights include political rights, religious rights, economic rights (such as the right to work, to a just wage, and to humane working conditions), and the right to health care (nos. 11-27).
Not only did John XXIII recognize the right to health care but in 1981 the US Catholic bishops also addressed the issue in their Pastoral Letter called “Health and Health Care.” Here, they expressly call for society “to provide adequate health care which is a basic human right” because health care is “so important for full human dignity and so necessary for the proper development of life that it is a fundamental right of every human being” (p. 5). Later in the document, the bishops state that access to health care must be provided for all people “regardless of economic, social or legal status” (p. 18).
One of the poorest and most vulnerable groups of people living in the US today is undocumented immigrants. Defined as those who entered the US without valid documents and those who are living outside the terms of their entry visas, there are approximately 11 million undocumented immigrants living in the US with about two-thirds of them residing in California, Texas, New York, and Florida. Eighty percent are Hispanic with over half of them having been born in Mexico. Many live in mixed-status families. In fact, some 4.5 million US residents are children born in the US to undocumented immigrants.
Undocumented immigrants work very hard. Most are employed in food production, construction, maintenance, and other unskilled, physically demanding, low-wage jobs that many American citizens would not consider doing. They also pay taxes at local, state, and federal levels. Yet, except for emergency medical care, undocumented immigrants are not eligible for federally funded public health insurance programs, including Medicare, Medicaid, and the Child Health Insurance Program (CHIP). They are also not eligible for coverage under the Affordable Care Act (ACA) even if they can pay for their coverage. As a result, over 50 percent of undocumented immigrants between the ages of 18-64 and 68 percent of their citizen children have no health insurance.
Lack of access to health care has many devastating consequences to health outcomes. Take, for example, prenatal care. A 2013 UCLA study concluded that while most undocumented pregnant women actually engage in fewer risky behaviors during pregnancy, their healthy lifestyles are often counteracted by a lack of prenatal care. Undocumented women were 4 times more likely to have a low birth weight baby and were more than 7 times as likely to deliver a baby prematurely. They were also more likely to be anemic, to gain insufficient weight during pregnancy, and to have complications during delivery. California-based studies also show that children of undocumented immigrants are 50 percent more likely to have developmental delays probably due to living with poverty, a lack of prenatal and pediatric care, and the relentless stress of possible family deportation.
While the ACA has brought health care coverage to millions of Americans who, prior to the law’s enactment could either not afford it or had a preexisting medical condition, one of the unfortunate consequences of the law is its negative effect on access to health care for undocumented immigrants. The ACA drastically restricts one of the few health care safety nets undocumented immigrants have: the Disproportionate Share Hospital (DSH) program. DSH provides funding to hospitals that treat poor patients. Regrettably, with the passage of the ACA, the funding of DSH has been greatly reduced—by five hundred million dollars in 2014. In 2016, a $600 million reduction is scheduled with continued incremental reductions until 2020 when $3 billion will be slashed from the DSH budget. The reason for these reductions is that the ACA is estimated to expand public and private health care coverage to millions more Americans by 2019 so Congress deemed it appropriate to cut DSH payments to hospitals thinking that hospitals would have to care for fewer uninsured patients as health coverage is expanded. These reductions particularly affect safety-net hospitals in those states, such as California and Texas, where undocumented residents are concentrated.
So, one of the costs of expanding health care coverage to millions more Americans comes at the expense of a marginalized and vulnerable group of people. Even if president Obama’s executive action on immigration which would temporarily delay the deportation of certain undocumented immigrants without granting them permanent legal immigration status is found constitutional, those who are allowed to stay will still not be able to access public health programs or apply for health care coverage through the ACA because of their immigration status.
We cannot leave undocumented immigrants behind. We have the opportunity to alleviate suffering of the sick, improve the health of citizen children whose access to health care depends on their parents, and improve health outcomes affecting one of the most vulnerable populations. Our Congress and state legislatures need to expand Medicaid and DHS safety net funding beyond the current emergency Medicaid for undocumented immigrants and their citizen children. Funding for access to prenatal and pediatric care is particularly essential.
As Catholics we should listen to Pope Francis, someone who continually reminds us of our duty to help the poor and vulnerable regardless of how they might be labeled or characterized. Following his example and heeding his words, we should joyously serve as “an instrument of God for the liberation and promotion of the poor, and for enabling them to be fully a part of society.”