A South Carolina bill that would make it illegal to transport undocumented persons to a hospital and other legislative efforts to deny medical services to immigrants have prompted calls from the American College of Physicians (ACP) for a national policy to override such state rules.
"We need to have some way to make sure everybody gets healthcare," said Virginia Hood, MD, president of the ACP and an internist with Fletcher Allen Health Care in Burlington, VT. "There [are] all kinds of legislation and regulations coming out at the state level which could have an effect on the provision of healthcare for immigrants, and we think this isn't something that can be dealt with on a state-by-state basis. There needs to be a national strategy."
The South Carolina bill, she says, "would make it illegal to transport immigrants to a hospital anywhere."
Other legislation introduced in several other states, she says, would dictate that "before someone could be treated in an emergency room, or even after they're treated, immigration status should be documented or reported," she says. This inappropriately turns doctors and paramedics into immigration officials.
There are efforts to deny healthcare to children born in this country if their parents are undocumented as well, she says.
In a lengthy position paper the ACP, which represents 126,000 internal medicine practitioners, calls for seven steps to assure the 12 million undocumented immigrants can get care they need:
1. Adopt a national policy. Individual state laws will not be adequate and will result in a patchwork solution.
2. Do not restrict healthcare on the basis of immigration status. Do not restrict immigrants from paying out-of-pocket for health insurance coverage.
3. U.S.-born children of parents who lack legal residency should have the same access to health coverage and government-subsidized healthcare as any other U.S. citizen.
4. a) National immigration policy should recognize there are risks to the overall public when undocumented persons do not receive medical care. They should not be denied comprehensive primary care, prenatal care, injury prevention initiatives, toxic exposure prevention and chronic disease management, which alleviate the need for costly emergency care.
b) Encourage all residents to receive vaccinations and screening for prevalent infectious diseases.
5. The federal government should develop innovative strategies to support safety-net providers including community health centers, public health agencies and hospitals with a disproportionate share of patients who are uninsured, indigent, or covered by Medicaid and should continue to offset costs of uncompensated care and emergency services.
6. Immigration policy should not interfere with the ethical obligation to provide care for all.
7. Immigration policies should not foster discrimination against a class or category of patients.
The ACP acknowledges that the policy needs to be one that balances the nation's need to control who it admits within its borders. But the organization says that the U.S. needs to recognize that people "who delay obtaining care because they cannot document legal residency are likely to generate higher healthcare costs that are passed onto legal residents and taxpayers through higher premiums and higher taxes."
Hood says the U.S. population of immigrants has less access to healthcare not just because it is afraid to try to access it. Often immigrants don't know about it or don't know they need it.
While the Emergency Medical Treatment and Active Labor Act requires a hospital to provide a medical screening exam and stabilizing treatment for people with emergency medical conditions regardless of their ability to pay and to transfer them to another facility if the hospital is incapable of providing appropriate care. But EMTALA doesn't go far enough, Hood says.
"We would like it to include provisions for blood pressure checks, appropriate blood glucose levels for those with diabetes, and other conditions" that become much more expensive when people go without primary care, she says. "We need a coherent national strategy to deal with these issues.