American College of Physicians Recommends Immigrant Healthcare

ACP Calls for National Policy Backing Immigrant Healthcare

 
An Expert Interview With Virginia Hood, MBBS

April 26, 2011 (San Diego, California) — Editor’s note: Many immigrants do not have health insurance coverage and face a number of barriers to access to healthcare. The immigrant population continues to grow, even as the current system is inadequate to meet their existing needs. Here at Internal Medicine 2011: American College of Physicians (ACP) Annual Meeting, the ACP released a position paper calling for national legislation to address access to healthcare for immigrants.

To find out more about meeting the healthcare needs of immigrants, Medscape Medical News interviewed Virginia Hood, MBBS, president of the ACP.

Dr. Hood is an internist and nephrologist in Burlington, Vermont, and a professor of medicine at the University of Vermont College of Medicine, as well as an attending physician at Fletcher Allen Health Care, both also in Burlington.

Dr. Hood has been an active Fellow in the American College of Physicians since 1991. She has been a member of the Board of Regents since 2005, and has been the chair of the Ethics, Professionalism and Human Rights Committee and the International Council. She became president of ACP in April 2011.

Medscape: What prompted this position paper?

Dr. Hood: The immigrant population in the country is continuing to grow. Many immigrants are less likely to receive appropriate care, as they are less likely to have health insurance than US citizens — particularly the Latino group, who are the fastest growing ethnic group in the country. We know that those who don’t have health insurance live sicker and die younger.

Often immigrants don’t understand health insurance very well, or don’t know how to get it — or even if they need it. There are also undocumented immigrants, which make up a large group of people in this country; perhaps several millions of people who have even less access to care, except in emergencies.

One of the reasons for putting out a position paper was that these issues are nationwide, and the ACP promotes the idea that there should be a national policy on healthcare for immigrants. A patchy state approach can’t address these problems adequately. The paper was aimed at highlighting the issues that make it essential to do something now, before there is a greater crisis in healthcare, especially as there are other initiatives being proposed that many affect healthcare as part of overall immigration policy in the country. ACP has no position on general immigration policy. Our concern is that it not exclude the opportunity for all those living here to receive appropriate, cost-conscious care — and that includes the immigrant population.

Access to healthcare shouldn’t be restricted based on immigrant status.

Medscape: What specific barriers to healthcare do immigrants face?

Dr. Hood: Immigrants come to this country for economic opportunity, but tend to have low-wage employment. They often don’t get offered health insurance, and they don’t have the funds for healthcare. They may be afraid of seeking healthcare because of legal ramifications. But if they do get sick, they end up having very costly emergency care that perhaps could have been avoided with more appropriate care in the first place.

Another down side to undocumented immigrants not receiving needed care is communicable diseases, and even some noncommunicable diseases, that can have a huge impact on the health of coworkers, their families, and other members of society.

A good illustration is tuberculosis. There is more tuberculosis around now, and some of it has become drug-resistant, or even multidrug-resistant. If an undocumented immigrant is afraid to get care for a cough or a respiratory condition, and they actually have tuberculosis, it could spread to coworkers, family members, and others in the community. If they did get care, it could be taken care of, and the rest of society would not be put at risk. Children receiving vaccinations, pregnant women receiving prenatal care, some preemptive mental healthcare, and chronic disease care can prevent harm to individuals and others, as well as reduce costly complications or treatments.

Urgent care is very costly. This isn’t just a problem for undocumented immigrants, but for any group of uninsured people in the country, who receive very costly acute care when they could be getting better preventive care or care early in the onset of their disease.

We need to acknowledge that there are public health risks, and there are concerns that people may not present to get appropriate healthcare if they are afraid that doctors or other healthcare professionals may be forced to divulge their immigration status. These issues need to be addressed in any national policy.

Medscape: How does last year’s Affordable Care Act affect immigrants?

Dr. Hood: The bill has some very important provisions. It enables all legal immigrants and their children to have access to federally funded healthcare, which is a very good thing, but it doesn’t allow undocumented immigrants to be eligible for health insurance through health insurance exchanges, even if a person was to pay out of pocket. That is very concerning to ACP. Just because we don’t allow individuals to have affordable healthcare insurance doesn’t mean they won’t become ill.

ACP’s position is to encourage modification of the Affordable Care Act to allow everybody to participate in health insurance exchanges. This has a great benefit not just to the individual but to the community as a whole, because the more people who participate, the lower the cost will be for everybody. Undocumented immigrants are often younger and have fewer healthcare problems, so their participation in exchanges diffuses the risk and lowers cost for everyone. Also, if immigrants have health insurance, they’re more likely to have better and more appropriate healthcare at a critical time, and that can lower the cost of healthcare overall.

There have been some state lead initiatives that question whether children born in the United States to undocumented immigrants should be considered US citizens, and thus could be denied the same healthcare as US citizens receive. The ACP does not support such legislation. We believe that all US citizens, as defined by the Constitution, should receive the same benefits of citizenship, including healthcare benefits.

Medscape: What are the broader goals for this position paper?

Dr. Hood: ACP wants the public to know that we, as healthcare professionals, have an ethical and professional obligation to care for the sick. Immigration policy, though critical for the well-being of our country as a whole and the security of our borders, shouldn’t interfere with our ability to provide healthcare to all who need it. As part of our commitment to professionalism, the ACP fosters policies that don’t discriminate against any class or category of patients. We want to remind our members of these responsibilities, and be sure that the public knows as well. We certainly hope that our politicians will take these matters into account when they create legislation.

We know that systems that restrict care tend to have poorer outcomes and higher costs, so we need more inclusive systems of care. This has been documented in other countries, where a higher percentage of primary care services is associated with lower overall costs.

The important challenges for providing affordable accessible healthcare for immigrants are similar to those associated with providing healthcare to all residents: primary care services that emphasize prevention, early recognition of illness and coordinated care, team-based approaches to care — especially for long term care and complex conditions, and encouraging participation of the individual in healthcare. In the latter situation, immigrants may have added challenges, because they may not come from a cultural background that encourages patient participation in their care.

Dr. Hood has disclosed no relevant financial relationships.

Internal Medicine 2011: American College of Physicians (ACP) Annual Meeting. Presented April 7, 2011.

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