Transcript Where Shall the United States Draw the Line?

How Do Undocumented
Workers Receive
Health Care in the
United States?
A Political Action Project
GNUR 590
Health Policy: Local to Global
March 23, 2009
Brian Booth, BSN, RN, CEN
Carlin Callaway, MS, RN, OCN, CHPN
Sarah White Craig, BSN, RN
Elizabeth Friberg, MSN, RN
Sarah Huffman, BSN, RN, CCRN
“On our honor as students, we have not given nor received aid on this assignment.”
The Issue
• An undocumented worker seeks health care for a
blood sugar level of 800. A nurse attempts to
intervene, but is told by other health care providers
that undocumented workers are not be able to receive
any insulin unless they privately pay for it.
• What should health care providers do?
• Does primary health care exist in the Charlottesville
area for undocumented workers?
Project and Objectives
Project:
Five graduate nursing students (who) investigated (what) the
issues related to provision of health care services for
undocumented workers in the Charlottesville area (where) and
prepared (what) a presentation for colleagues in March 2009
(when) that provides an explanation of the issue and available
resources to facilitate appropriate response and referral (why) in
addressing the health care needs of this population.
Objectives:
•
•
•
Using the Policy Problem Analysis Model (Mason, 2007),
identify the historical, political, legal, regulatory, human rights,
ethical, economic aspects and the stakeholders and their
ideological positions as it relates to the delivery of health care
for this population.
Explore health care access/availability in the Charlottesville
area for this target population.
Distribute factual information and resources to graduate nursing
students at the University of Virginia School of Nursing.
Rationale for Project
• Health care professionals encounter this type of
dilemma daily.
• Regardless of personal or political beliefs, a
framework is needed to address unmet health care
needs.
• Government and political positions may not reflect
the local realities of unmet health care needs and
provisions of health care services.
• To serve the public, communities respond locally
to resolve unmet health care needs.
• Health care providers need to be aware of resources
available within their communities to address local
health care needs.
Terminology is Key to Understanding
“If you can control the words people use , you can frame the issue” (Cindy Rodriquez,
The National Association of Hispanic Journalists, 2006).
Pro-immigration Terminology
•
Unauthorized /undocumented immigrants or workers: Refers to foreign citizens
residing in the United States illegally. It applies to two categories of immigrants:
those who enter the country without approval of the immigration process and those
who violate the terms of a temporary admission. Terms usually used in
congressional reports, by immigration supporters and in legal proceedings.
•
Undocumented immigrant is preferred by proponents of open borders while illegal
alien is used more often by persons who support stronger enforcement of
immigration laws.
Anti-immigration Terminology
•
Illegal aliens/illegal immigrants: Terms also used to describe undocumented
immigrants. Usually a negative connotation, invokes fear, often used by media and
public to emphasize violation of immigration law and threat to US.
•
The Mexican American Legal Defense and Educational fund (MALDEF) disputes
the use of the term illegal alien to define the immigration status of an individual
citing the fact that some legal immigrants lapse into illegal status while waiting for
lengthy forms to be processed.
•
The Colorado Alliance for Immigration Reform (CAIR) encourages the use of the
term “illegal alien” to define a person illegally residing in a country in violation of
immigration laws and emphasizes that other terms are misleading and “soft.”
(ProCon.org, February 14, 2008; ProCon.org, March 27, 2008)
Immigration Policy Overview
Our Collective Ambivalence
•
Immigration
• Foreign-born legal permanent residents
• Legal temporary residents
• Undocumented workers (undocumented aliens, or illegal aliens)
•
America is a nation of immigrants (Ewing, 2008).
• Native Americans came over the land bridge from Serbia.
• Successive waves of immigration came from all corners of the world.
• Northwest Europe in colonial & early US history
• Southeast Europe in late 1800s
• Latin America, Africa, & Asia in late 1900s
•
There was no “right way to enter” prior to the late 1800’s [established exclusions]
and early 1900’s [established quotas] (IPC, November 25, 2008).
• Biased; shaped by public fear and anxiety rather than public policy
• Contradictions between immigration laws and economic realities
• Random
• Schizophrenic
•
Despite the proliferation of biased exclusionary laws, 30 million immigrants
arrived between 1875 and 1920 (IPC, November 25, 2008).
• In 1890, 14.8% of the US population was foreign-born.
• In 2006, only 12.5% of the US population was foreign born.
Immigration Law Overview
1875-1920
1921-1964
1924
Exclusion laws created
Quota laws initiated based on national-origin
U.S. Border Patrol established
1942-1964
Five million Mexican field workers admitted under “BRACERO Program”
1954
One million Mexican immigrants deported (“Operation Wetback”)
1965
1980
Quotas eliminated; Created preference system, and “Touch Back Program”
Mexican immigrants limited to 270,000
1986
Immigration Reform & Control Act (IRCA) Undocumented workers could apply for
citizenship. Created H2A visas (temporary seasonal agriculture workers)
1990
Immigration Act . Cap increased to 700K/yr thru 1994 and then 675K thereafter;
increasing 65K/yr. H1B visas (highly skilled temporary) & 66K/yr H2B visas (temporary
non-agriculture)
1996
Illegal Immigration Reform & Immigrant Responsibility Act (IIRIRA) & Welfare Reform
Act (PRWORA). Created new rules for inadmissibility, mandatory detention, expedited
removal and legal permanent resident (LPR) – “green card.” Determined LPRs
ineligible for “means-tested public benefits” for 5-years and Medicare or SS for 10years post receipt of green card. Undocumented barred from ALL public benefit
programs despite paying payroll, property & sales taxes.
2001
Immigration control linked to National Security
2002
Registration system to identify foreign-born Muslims and Arabs
2005
REAL ID Act (required proof of citizenship for Medicaid application)
2006
Secure Fence Act (850 mile fence along the Mexican border)
(Ewing, 2008; IPC, November 25, 2008)
U.S. Approach to Date
•
Since the mid-1980s, tens of billions of dollars have been spent on
law enforcement to eliminate undocumented immigration (ALIA,
2008; Ewing, 2008).
•
Today, it is estimated that 12 million undocumented workers have
entered the U.S.
• This represents 1/3 of the 37.5 million foreign-born population.
• Our national policies have not worked.
•
Legislative attempts for comprehensive immigration reform to bring
in line the economic & social realities that actually fuel
undocumented immigration failed in 2006, 2007 & 2008 (Ewing,
2008; IPC, November 25, 2008).
•
We continue to wrestle with our own historical identity as a nation
of immigrants by changing the definitions of “legal” and “illegal”
over time (IPC, September 8, 2008 & November 25, 2008).
Undocumented Workers and the U.S. Economy
4% of the current US population
Pew Hispanic Center. Retrieved January 27, 2008 from
http://pewhispanic.org/reports/report.php?ReportID=94
Important Points to Consider
•
Despite paying payroll, property, and sales taxes, undocumented workers
are prohibited from receiving most government benefits for at least five
years after they come to America (IPC, September 8, 2008).
•
Undocumented families may receive emergency medical care and
immunizations for public health and safety concerns only (IPC, November
25, 2008).
•
U.S. Immigration Policy is costly, complicated, confusing, contradictory, and
ineffective.
•
Undocumented workers have low criminal propensities (Faruk, 2008; ALIA,
2008).
•
“Immigrants” do assimilate, learn English 2nd (91% fluency) & 3rd (97%
fluency) generations and climb the socio-economic ladder over time (Faruk,
2008; ALIA, 2008).
•
45% of undocumented workers do not sneak across the border (Faruk,
2008).
• They entered legally and overstayed their visas.
• Being unlawfully in the U.S. is a civil offense, not a criminal offense.
Some Regulatory Aspects
Medicaid
Eligibility:
•
Undocumented immigrants remain ineligible for Medicaid regardless of how long they
stay in the U.S. (Staiti, 2006).
Emergency Medicaid:
•
Covers only emergency stabilization (including childbirth) for individuals not eligible for
regular Medicaid because of their immigration status but does not include coverage for
ANY preventative or routine care (Fremstad, 2004).
SCHIP
Eligibility:
•
Federal regulations allow some flexibility, so states have the option to use SCHIP funds
for prenatal care regardless of immigration status (National Immigration Law Center,
2003) . CHIPRA 2009 retains this option through the "unborn child” provision.
•
Seven states (AR, IL, MA, MI, MN, NE, RI) use federal SCHIP funds to provide prenatal
care coverage regardless of the mother’s immigration status (not Virginia). This “unborn
child” option essentially extends eligibility to unborn child, which is not considered to have
any immigration status (Kaiser Commission, 2008).
WIC
Eligibility:
•
Undocumented immigrants are eligible for Women, Infants, and Children program (WIC)
including supplemental nutritious foods, nutrition education and counseling at WIC clinics,
screening and referrals to other health, welfare and social services (USDA Food and
Nutrition Service, 2008).
Regulatory Aspects (continued)
EMTALA (Emergency Medical Treatment & Active Labor Act of 1986 Consolidated Omnibus
Budget Reconciliation Act (COBRA)
•
Primarily a non-discrimination statute to prevent “patient dumping” (Fosmire, 2006)
– Applies to ALL patients regardless of immigrant status or ability to pay
– Requires that EDs provide appropriate “medical” screening exam to determine if an
emergency medical condition exists
• If so, the hospital is obligated to provide stabilizing treatment or initiate
appropriate transfer to another facility.
•
A pregnant woman who presents in active labor must be admitted and treated until delivery
is completed or appropriately transferred (Fosmire, 2006).
•
A triage evaluation does not satisfy the requirement for a “medical” screening exam
(Naradzay, 2006).
•
Violation can yield significant penalties (Naradzay, 2006):
– Hospitals and/or physicians may be fined up to $50k per violation and face civil
lawsuits.
– Hospital Medicare participation may be terminated.
Medicare Prescription Drug, Improvement and Modernization Act of 2003, section 1011
•
Reimburses hospitals, physicians, ambulance providers for emergency care to
undocumented immigrants (CMS, 2008)
•
$250 million per year is set aside for these payments. Divided among states based on
relative percentages of undocumented immigrants. Hospitals must document immigration
status to obtain reimbursement (Spencer, 2007).
•
Information collected by hospital for this purpose can not be used to enforce immigration
laws (CMS, 2008).
Criticisms (Spencer, 2007):
•
Providers are encouraged not to directly ask patients about legal status. Process requires
providers to ask indirect questions such as: “Are you eligible for Medicaid?” or “Do you have
a social security number?”
•
Gathering this information in emergency situations may be very cumbersome.
•
Undocumented families may refuse or avoid care out of fear of deportation.
Federal Medicaid and SCHIP Eligibility
Immigrant Status
Eligible for Eligible for SCHIP
Medicaid
Lawful Permanent resident
(LPR ) > 5 yrs
√
N/A
NO commonly
referred to as
“five-year
bar”
NO - However, CHIPRA
2009 will allow states to
cover children and
pregnant woman during
first 5 yrs in country
√
Refugees/Humanitarian
immigrants
√
√
N/A
Pregnant Immigrants (both
LPRs < 5 yr and
undocumented)
NO
Only in a few states
√
Undocumented immigrants
who are not pregnant
NO
LPRs residing in US
5yrs
<
√
Eligible for
Emergency
Medicaid
NO - However, a few
states offer state-funded
coverage to
undocumented immigrant
children
√
(Fremstad, 2004)
Stakeholder: Taxpayer/Citizen
Anti
Public funds/Fiscal impact/Taxpayers:
•
State, local governments are required
to provide emergency services to
individuals regardless of immigration
status and bear much of the cost of
providing public services. Under federal
budget, undocumented workers are
only eligible for emergency services
through Medicaid. Burden falls to local
and state funds (Merrell, 2007).
•
Most estimates over the past 20 years
conclude that tax revenues of all types
generated by immigrants (legal and
unauthorized) exceed the cost of the
services they use (education, law
enforcement and health care). They
have lower paying jobs, so they pay
less taxes and have less disposable
income to spend/sales taxes (Merrell,
2007).
Anti-immigrant ideology include:
 Respect and enforce existing
immigration laws/close borders
 Preserve the scarcity of
economical resources and health
services for American citizens
only
Pro
•
•
The U.S. needs immigrant labor for
jobs that the American workforce is
not willing to fill, especially at lower
wages and in poor working
conditions. Immigrants are cheap
labor—immigrants are welcome as a
source to work, but they are
excluded from services and benefits
(Paral, 2005).
Undocumented workers have been
providing labor foundations for
American for decades, yet health
care is mostly nonexistent for these
workers (Blewett , 2005).
Pro-immigrant ideology include:
 Reform immigration laws &
policy/provide access to legal
citizenship
 Health care reform for the
“uninsured” should provide
preventative care and
affordable accessible
healthcare options.
Stakeholder: Medical Community
Anti
Public health/ Potential communicable
disease (tuberculosis, HIV, hepatitis):
•
•
•
No screening for undocumented
immigrants/unknown risk
Expense of contagious disease outbreaks
Tuberculosis was almost absent in VA until it
spiked in 2002 with a rise of 188 % in Prince
William County which public health officials
related to “immigrants” (Cosman, 2005).
Financial burden/Uncompensated health
care/Uninsured:
•
•
•
•
Study by Pew Hispanic Center (2004) estimated
that 50% of children and 60% of adult
undocumented immigrants were uninsured.
Health care facilities who receive funds from the
federal government are required to provide a
certain level of services (emergency
stabilization, childbirth) regardless of immigration
status/uncompensated care (Cunningham,
2006).
Do not seek preventative care due to expense
and fear of deportation/ results in inappropriate
use of EDs (Goertz, 2007)
Children born to illegal immigrants become
citizens/eligible for Medicaid benefits (14th
Amendment to the US constitution)
Pro
•
Undocumented immigrants are
ineligible for most state and
federal benefits—health care
spending is approximately half
that of citizens .
•
Fear of deportation keeps
majority from seeking
healthcare and enrolling eligible
citizen children for benefits
such as Medicaid
•
Often communicable diseases
are identified during routine
visits so allowing
undocumented workers access
to health care increases the
chances of early identification
and treatment before others are
exposed (DeMaria, 2005).
What Are the Associated Costs?
•
According to the Agency for Healthcare Research and Quality’s Medical
Expenditure Panel Survey, “immigrant” health care cost $39.5 billion in 1998.
This was approximately 8% of the total amount spent on health care.
•
When stratified by age, the health care expenditures for “immigrants” (in
every age group except 65 and over) were 30% to 75% lower than those for
American citizens.
• After multivariate adjustments were made, the per capita total health
care expenditures of “immigrants” were 55% lower than those of
Americans ($1139 vs. $2546).
• Health care costs for uninsured and publicly insured “immigrants” were
approximately half those of Americans.
• “Immigrant” children had 74% lower per capita health expenditures than
American children.
• However, “immigrant” children received emergency care at a of cost
triple to those of American children. When “immigrant” children
developed emergencies, their emergencies were rather costly.
• “Immigrants” are not consuming large amounts of scarce health care
resources.
•
Teenagers (ages 12-17) had difficulties accessing routine care. Yet,
these children will likely enter the U.S. work force.
(Mohanty, 2005)
The Costs According to Texas
•
It was estimated that there were 11.1 million undocumented immigrants in
America in 2005.
• 1.4 to 1.6 million (14%) undocumented immigrants lived in Texas.
•
Undocumented immigrants comprise 7% of the Texas population.
• Texas paid $58 million in health-related expenses for them in 2005.
• Texas collected $500 million in revenue from undocumented workers.
•
In 2005, undocumented workers generated $17.7 billion worth of the Texas
gross state product.
• Produced $1.58 billion in state revenues, yet received $1.16 billion in
state services
• Local governments paid $1.44 billion in uncompensated health care
costs and local law enforcement costs not covered by the State.
•
Undocumented workers and their families are transient. It is estimated that
2/3 of undocumented immigrants have been in the U.S. for less than
10 years.
• 40% less than 5 years
• Mostly adult males (58%)
•
The majority of undocumented workers come from Mexico (56%), Latin
America (22%), and Asia (12%).
(Keeton Strayhorn, 2006)
The Costs According to New Jersey
•
Undocumented workers and their families represent 4.3% of New Jersey’s
overall population. The nation’s ninth largest concentration of
undocumented workers live in New Jersey (3.4% of the estimated total).
•
In 2005, New Jersey spent $2.1 billion on 372,000 undocumented workers
and their families.
• Education, $1.85 billion
• Health care, $200 million
• Incarceration, $50 million
•
The Centers for Medicare and Medicaid Services (CMS) paid for $5.3 million
worth of health care expenses (11% of the total spent) delivered in New
Jersey.
•
It is estimated that each household (headed by a native-born resident) in
New Jersey paid $800/year in taxes for undocumented workers and their
families.
•
Although New Jersey received $488 million in sales, income, and property
taxes from undocumented workers, it is estimated that the New Jersey
taxpayers ultimately paid $1.6 billion for undocumented workers and their
families.
(Martin, 2007)
Some Human Rights and Ethical
Dilemmas
•
Many believe that health care should be a universal human right, yet
undocumented workers are denied access to health care.
•
Children become American citizens when they are born in the United
States. As they grow, these children also face barriers to health
care. Their (non-citizen) parents are ineligible for care, and are often
reluctant to seek care for fear of being “identified” to immigration
officials. Children are innocent bystanders.
•
Although Medicaid Emergency Fund pays for childbirth,
undocumented immigrants do not receive funded prenatal care or
family planning.
•
If an undocumented immigrant is seen in a “free” clinic, their
screening mammograms and pap smears may be covered.
However, follow-up care for abnormal findings is most likely not
covered.
Relationship to Nursing Theory
Complex Adaptive Systems Theory
All of our actions are interconnected. Systems theorist refer to this
concept as the “butterfly effect” (Holden, 2005).
“A complex adaptive system is a collection of individual agents with
freedom to act in ways that are not always totally predictable, and
whose actions are interconnected so that one agent’s actions
changes the context for other agents (Plsek, 2001).”
Concerning primary healthcare for undocumented aliens, nursing must
consider the consequences of acting versus not-acting.
“The application of the understanding of health care as a complex
adaptive system involves cultivating an environment of listening to
people, enhancing relationships, and allowing creative ideas to
emerge by creating small non-threatening changes that attract
people (Holden, 2005).”
This theory is a framework that may help nurses look at ways to
develop an arena in which policy for primary health care of
undocumented immigrants may be created.
Relationship to Health Policy
Theory
Incrementalism Model
Enacting small changes on the margins of a dysfunctional or failing
system:
• This is the concept currently used to treat undocumented
immigrants. EMTALA requires that anyone must be treated in an
emergency.
• If patients were offered primary care, these emergencies might be
avoided as well as associated financial and emotional burdens.
Stage-Sequential Model
Stages in which the functions of problem solving occur (issue
identification, agenda setting, formulation, implementation,
evaluation):
• This model is a structured way to develop reform and a better
system to provide primary care.
• More extensive change may be possible under the Obama
Administration.
(Mason, 2007)
Principles of Distributive Justice
The first two principles of distributive justice may be
used as a framework to help establish primary
healthcare for undocumented workers (Mason,
2007).
1.
To each the same thing  strict equality for all
Lawmakers must determine what services are basic
necessities to all and the logistics of providing these
services.
2.
To each according to his need  everyone deserves basic
rights and liberties
How Do We Enact Change?
Anticipatory change is the best method of enacting new policy.
The financial and social impact of poor healthcare in
undocumented aliens must be studied and understood to
emphasize the need for providing healthcare (Mason, 2007).
Political action project plan and timeline:
• Study the literature & other resources (research)
January 31 - February 14, 2009
• Develop an understanding of the policy issue at the national &
state level (analysis)
February 14 – February 28, 2009
• Investigate current non-governmental strategies to address
the issue in the Charlottesville community & schedule
interviews (agency/organizational interviews)
February 16 – February 28, 2009
• Compile our findings for peer dissemination (presentation)
January 31 – March 14, 2009
• Clarify misconceptions re: what services are/are-not available
to this population and how services are utilized/provided
March 23 – 29, 2009
Political Action Findings
We identified local resources that serve undocumented
workers in the Charlottesville area and conducted
interviews with their organizational leaders:
•
•
•
•
•
Creciendo Juntos-Growing Together (February 11, 2009)
Social Services (February 11, 2009)
Church of the Incarnation (February 11, 2009)
Southwood Trailer Park (February 11, 2009)
Legal Aid Justice Center (February 20, 2009)
Interviews were conducted in person by one or two group
members.
Interviewees were eager to discuss their local initiatives,
the scope of this issue, their strategies, and their
encountered barriers.
Creciendo Juntos
Creciendo Juntos-Growing Together (CJGT)
• http://www.cj-network.org/index.html
• “an inter-agency and inter-community network for issues
related to the Latino/Hispanic community in Charlottesville
City, Albemarle County and surrounding areas.”
• Organized in Spring 2005 under the leadership of the
Piedmont Housing Alliance (PHA), CJGT now involves over
100 agencies/institutions and 200+ staff and individuals
dedicated to building knowledge, sharing information, and
seeking ways to collaborate and integrate across the cultural
divide.
• Participating organizations include health, housing,
communication media, business, legal, UVA, local & regional
planning, public safety, education, transportation, social
services, churches, chambers of commerce, and real estate
among others.
• Executive committee meets monthly with designated social,
health, legal, and housing workgroups.
• CJGT works with similar networks in Richmond, Harrisonburg,
and elsewhere.
Social Services
Pam Benton, Benefit Programs Supervisor
City Hall Annex, 120 7th Street N.E., Charlottesville, VA 22902
Interviewed on February 11, 2009
•
Undocumented families are not eligible for food stamps, temporary
assistance to needy families (TANF), WIC or other federal/state funded
programs. (Our research indicated that WIC is available.)
•
To be eligible for programs, applicants must live in Virginia, be American
citizens, or be legal immigrants.
•
Undocumented families may only receive emergency stabilization to
include childbirth.
•
Because it may take 45 days to process the claim and receive payment,
the hospital is paid well after the undocumented family member is
discharged from the hospital.
•
Children born to Illegal immigrants are citizens. Therefore, they are
eligible for all state and federal programs. Most of the Agency’s
encounters with undocumented families occur through their eligible
children.
•
The University of Virginia Patient Financial Assistance Office helps when
undocumented workers require hospitalization.
Legal Aid Justice Center
Tom Freilich – Director of the Immigrant Advocacy Program
1000 Preston Ave, Charlottesville, VA
Interviewed on February 20, 2009
•
•
•
•
•
•
•
•
•
Four offices: Charlottesville, Richmond, Petersburg, and Falls Church- over 40 lawyers &
public policy experts
Interviewed Tim Freilich - Director of the Immigrant Advocacy Program
Program offers free legal assistance and representation to low-income immigrants (including
undocumented immigrants)
Main goal is to eliminate abuse and exploitation of immigrants “
“Can You Pay Me Now” Campaign- Helped low-income immigrants recover over $300K in
unpaid wages from Verizon
Promote public policies and systemic reforms that recognize the contributions of hardworking
immigrants
Carefully monitor proposed legislation (both at the federal and state level)
Because their organization represents undocumented immigrants, current law prevents them
from receiving any federal funding
Mostly funded by private organizations and individuals, some funding from city and county
governments
“Many undocumented immigrants do not seek care or outright refuse care even when faced with
severe illness or workplace injury out of fear of deportation or profound mistrust of
government agencies.”
Tim Freilich (personal communication, February 20, 2009)
“We are beginning to see a shift in public policy at both the state and national level…taking a turn
away from the anti-immigrant policies that have imposed barriers to adequate health care for
immigrants.”
Tim Freilich (personal communication, February 20, 2009)
Coalition: A Local Non-Governmental
Solution to a Local Problem
•
Church of the Incarnation
• http://www.incarnationparish.org/index.php
•
Southwood, Inc.
• (434) 979-0856
•
Habitat for Humanity of Greater Charlottesville
• http://cvillehabitat.org/southwood.shtml
•
Blue Ridge Medical Center/Rural Health Outreach
• Health Promoter/Promotor de Salud Group
• http://www.cj-network.org/cjwgm/health.html
• [email protected]
Political Interest Groups
• American Immigration Lawyers Association
•
http://www.aila.org/
• Mexican American Legal Defense and Education
Fund (Ford Foundation)
•
http://www.maldef.org/
• Migration Policy Institute
•
http://www.migrationpolicy.org/
• National Council of La Raza
•
http://www.nclr.org/
• National Immigration Law Center
•
http://www.nilc.org/
• National Network for Immigration and Refugee Rights
•
http://www.nnirr.org/
• Open Society Institute: Soros Foundation
•
http://www.soros.org/initiatives/regions/usa
• Southern Poverty Law Center
•
http://www.splcenter.org/center/about.jsp
Group Reactions
•
In spite of considerable contradictory information and misinformation, there are extreme views on all sides. There is no
perfect way to identify correct information.
•
American economic and social realities are not reflected in
American immigration policies.
•
This is a very emotional topic. Ultimately, people will believe the
perspective that best matches their personal/political ideology.
•
Because undocumented families remain in our communities, the
group consensus was to provide basic primary care services to
ensure public safety and basic human dignity.
•
Charlottesville has responded with non-governmental approaches
to provide some primary health care to undocumented workers.
•
Nurses need to be aware of these efforts and how to access
services for their patients independent of their own political or
personal views.
References
American Immigration Lawyers Association (AILA). (March 10, 2008) ALIA Top 5 Immigration
Myths of This Campaign Season. Retrieved January 27, 2009 from
http://www.immigrationpolicy.org/images/File/onpoint/AILAcampaignmyths01-08.pdf
Blewett, L.A., Davern, M., & Rodin, H. (2005). Employment and health insurance coverage for
rural Latino populations. Journal of Community Health, 30(3), 181-195.
Centers for Medicare and Medicaid Services. (2008). Fact Sheet: Federal Reimbursement of
Emergency Health Services Furnished to Undocumented Aliens. Retrieved January 15,
2009 from: www.cms.hhs.gov/MLNProducts/downloads/Section_1011_Fact_Sheet.pdf
Cosman, P. M. (2005). Illegal Aliens and American Medicine. Journal of American Physicans
and Surgeons, 10 (1).
Creciendo Juntos-Growing Together: Immigration myths and facts. (n.d.). Retrieved January
23, 2009 from http://www.cj-network.org/myths_facts.html
Ewing, W. A. (November 25, 2008). Opportunities and exclusions: A Brief History of U.S.
Immigration Policy. Retrieved January 23, 2009 from
http://www.immigrationpolicy.org/images/File/factcheck/OpportunityExclusion11-2508.pdf
Fosmire, S. M. (2006). Frequently Asked Questions about the Emergency Medical Treatment
and Active Labor Act. Retrieved February 1, 2009 from: http://www.emtala.com/faq.htm
Grever, M. (2007, July 23). Immigration debate continues: Who should get health care?
National Conference of State Legislatures State Health Notes, 28, Issue 496. Retrieved
January 23, 2009 from http://www.ncsl.org/programs/health/shn/2007/sn496c.htm
Faruk, A. ( October 2008). Virginia Interfaith Center: immigration fact sheet. Retrieved January
23, 2008 from
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