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Undocumented Immigrants

By Dr. Nilesh Kalyanaraman
. 2 Comment(s)

At Health Care for the Homeless, where I work, we’re gearing up for Medicaid expansion coming in 2014 thanks to the Affordable Care Act. The ACA expands health insurance coverage to over 30 million more people. Unfortunately, that still leaves about 19 million people uninsured amongst them an estimated 11 million undocumented immigrants.

Undocumented immigrants need health care. They sprain their ankles, develop asthma and suffer heart attacks just like everybody else. Yet we keep them in the shadows, pretending they don't exist in our health care system. But they do exist. They get care at Community Health Centers, like the one where I work, where they pay based on a sliding fee scale. If they need radiology studies or referrals we try to get them through charity programs but it takes a long time and isn’t guaranteed to come through. And if things get too bad they use the emergency room which is a far more expensive option and where the ER often eats the cost. If they get hospitalized it’s even worse because they can get stuck in the hospital for far longer than necessary because on discharge they wouldn’t be able to get the mediations, rehab services or follow up care that would be needed to go home.

Providing access to affordable health care to undocumented immigrants is the moral thing to do. There’s no reason a country with the resources we have needs to look into the eyes of an undocumented person and tell them that they are a second class human, that somehow their basic human needs are less worthy than others. It demeans them and more so it demands us as a people. We should be better and we should be able to provide to those in need in our country regardless of how they got here.

And yes, we can afford it. Our current system of subsidizing CHCs and hospitals simply hides the costs associated with care while costing more because of the high cost of hospital care. Currently, Medicaid pays hospitals about $2 billion a year to compensate for care to the undocumented. Having undocumented immigrants pay for subsidized insurance would give them access to lower cost primary care while simultaneously having them contribute to the cost of their care. Additionally, access to quality primary care and preventive services decreases overall costs. As a bonus, immigrants tend to be younger than the population as a whole which means that they tend to utilize health care less. Add it all up and including undocumented immigrants to our insurance and Medicaid pool would lower costs for everyone and would likely be a net savings for the government through the payment of insurance premiums, income taxes and Medicare taxes.

Though it may feel like justice to deny undocumented immigrants access to our health care system, the reality is that they do access our system but that it’s done in the most inefficient and expensive way possible. When the opportunity presents itself to do something that’s both moral and cost-effective, we should jump at the chance to do so. The freedom our country fought for that we celebrate this July 4th is worth very little if we’re not able to share it with others.

Share Your Comments


  1. amber

    i am undocumented and need a health insurance, can you please help me/ Thank you and God bless
  2. john

    do i need a license to see undocumented individual sin T



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