Instruct: Given a question, retrieve relevant documents that answer the question.
Query: Can undocumented immigrants get health insurance?
In the United States, while healthcare can, in theory, cost less for undocumented immigrants than for legal immigrants and other U.S. citizens, significant barriers to health care face undocumented immigrants, including low socioeconomic status, difficulty negotiating time off of work, lack of transportation and language barriers.[1] Having medical insurance coverage—whether private or through Medicaid—significantly influences the actual utilization of healthcare services.[2]
In 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. The ACA contains language that explicitly excludes undocumented immigrants from being able to purchase health insurance coverage.[1] However, the ACA also provides additional funding for community health centers and clinics, which play an integral role in implementing provisions of the ACA and are heavily relied upon by undocumented immigrants.[1] The Gruber MicroSimulation Model estimates that the rise in uninsurance rates of undocumented immigrants will be negligible nationwide with higher coverage rates for the rest of the population under the ACA.[1] At a state level though, the impacts of the ACA will vary depending on the percentage of uninsured illegal immigrants among their statewide population.
Barletta opposed the Affordable Care Act (Obamacare) and voted to repeal it. Barletta had threatened not to support Obamacare repeal because he wanted the repeal legislation to prohibit undocumented immigrants from applying for health insurance tax credits. After meeting with President Trump and House Speaker Paul Ryan, Barletta said that they had promised to bring up separate legislation to prohibit undocumented immigrants from accessing health insurance tax credits. In 2018, Barletta said that the repeal of the Affordable Care Act would not have weakened protections for individuals with preexisting conditions; experts said that the repeal would have given states the option to seek waivers whereby insurers would be allowed to raise prices for individuals with preexisting conditions who did not have continuous coverage.
Some who advocate against greater government involvement in healthcare have asserted that the difference in costs between the two nations is partially explained by the differences in their demographics. Illegal immigrants, more prevalent in the U.S. than in Canada, also add a burden to the system, as many of them do not carry health insurance and rely on emergency rooms — which are legally required to treat them under EMTALA — as a principal source of care. In Colorado, for example, an estimated 80% of undocumented immigrants do not have health insurance.
Of the 26.2 million foreign immigrants living in the US in 1998, 62.9% were non-U.S. citizens. In 1997, 34.3% of non-U.S. citizens living in America did not have health insurance coverage opposed to the 14.2% of native-born Americans who do not have health insurance coverage. Among those immigrants who became citizens, 18.5% were uninsured, as opposed to noncitizens, who are 43.6% uninsured. In each age and income group, immigrants are less likely to have health insurance. With the recent healthcare changes, many legal immigrants with various immigration statuses now are able qualify for affordable health insurance.
PPACA’s creation of subsidies to make insurance more affordable notably benefits legal immigrants, given that they comprise a large number of the uninsured population. In contrast, undocumented immigrants are denied these subsidies and further prohibited from participating in federal or state health insurance exchanges, though their lawfully present children will be eligible. Regardless of citizenship status, however, PPACA’s funding for the development of new community health centers has the potential to help both legal and undocumented immigrants who lack coverage.
Undocumented immigrants within the United States do not have access to government funded health insurance. Although The Affordable Care Act allows immigrants to receive insurance at a discounted rate, the same does not go for those without US citizenship. Undocumented immigrants in the US can seek medical help from community centers, or what is termed Safety Net Providers, and participate in fee for service medical assistance, but can only buy health insurance from privatized health insurers.
[it] protects undocumented immigrants in New York City from being reported to the INS while they are using city services that are critical for their health and safety, and for the health and safety of the entire city ... There are times when undocumented immigrants must have a substantial degree of protection.
During 2009, as Congress debated proposals for health insurance reform, Romney said that he was in favor of increased health insurance portability, coverage of pre-existing medical conditions, a cap on malpractice lawsuits, the implementation of a streamlined electronic medical records system, an emphasis on preventative care, loosening restrictions on importation of prescription drugs, and tax benefits aimed at making health insurance more affordable for the uninsured and targeted to promote universal access. He said he opposed efforts to provide non-emergency health coverage to undocumented immigrants and he supported the Hyde Amendment prohibiting government funding for elective abortion. Romney opposed a federal single-payer system, but supported state efforts to reduce the uninsured population. The Massachusetts health care law was used as an early model for Democratic health insurance reforms in 2009.
Limited access to services adds another layer of trauma and misfortune to immigrants living in the United States and more specifically to Mexican women who have the highest uninsured rate (54.6%) as compared to other immigrants (26.2%), blacks (22.5%) and non-Hispanic white (13.9%). As an alternative, Mexican women with limited access to health services seek health coverage through community health centers and are end up being provided with inadequate services. Additionally, the 2010 Affordable Care act was a health legislation passed in order to help Mexican immigrant women gain access to quality health care services when they are without employer sponsored or private health insurance. However, the Affordable Care Act does not help undocumented immigrants and legal immigrants with less than five years residence in the U.S. Mexican women are the largest female immigrant group in the United States and are also the most at risk for developing preventable health conditions. Multiple factors such as limited access to health care, legal status and income increase the risk of developing preventable health conditions because many undocumented immigrants postpone routine visits to the doctor until they become seriously ill.
During his 2008 presidential campaign, Barack Obama promised to support a path to citizenship for undocumented immigrants, whereby such immigrants, if they were in good standing, could pay a fine in return for gaining the opportunity to become citizens. In 2013, Obama called on Congress to include a path to citizenship in any immigration reform bill it passed. The Border Security, Economic Opportunity, and Immigration Modernization Act of 2013, passed by the United States Senate on June 27, 2013, would create a 13-year path to citizenship for millions of undocumented immigrants, a path that would require them to pass several security checks before they can get a green card.
According to analysis of a CASEN survey in 2006, undocumented immigrants to Chile live in more deprived socioeconomic conditions than legal immigrants and tend to have poorer health outcomes, although a large proportion of immigrants in general do not have health insurance. For the illegal immigrant, this is a result of lacking work papers.
Findings on the use of specific healthcare services by undocumented immigrants have been more varied. For example, this same California 2004 study found that undocumented immigrants are significantly less likely than naturalized citizens and U.S.-born-citizens to visit the emergency department.[1] These findings are supported by a study conducted in 2000 using data from a 1996 survey of undocumented Latino immigrants in four U.S. cities: Houston and El Paso, Texas and Fresno and Los Angeles, California.[5] This study found that undocumented immigrants obtain fewer ambulatory physician visits than other Latinos or the rest of the U.S. population collectively.[5] Additionally, for those undocumented immigrants who did regularly visit a physician, their rates at three or four visits per year were still lower than those of Latinos at six visits per year.[5] In regards to Medicaid, this study found that “With approximately 2 million undocumented immigrants in California, even 10 to 15 percent of them on Medicaid would represent only 4% of total Medicaid eligible statewide.”[5] On the other hand, findings from the 2009 California Health Interview Survey indicate that no significant differences have been found in the diagnoses of undocumented immigrants for diabetes, heart disease, or high blood pressure compared to documented immigrants, naturalized citizens or U.S.-born citizens.[1]
Many immigrant families cannot enjoy doing everyday activities without exercising caution because they fear encountering immigration officers which limits their involvement in community events. Immigrant families also do not trust government institutions and services. Because of their of encountering immigration officers, immigrants often feel ostracized and isolated which can lead to the development of mental health issues such as depression and anxiety. The harmful effects of being ostracized from the rest of society aren’t limited to just that of undocumented immigrants but it affects the entire family even if some of the members are of legal status. Children often reported having been victims of bullying in school by classmates because their parents are undocumented. This can cause them to feel isolated and develop a sense of inferiority which can negatively impact their academic performance.
Undocumented youth are young people living in the United States without U.S. citizenship or other legal immigration status. Undocumented immigrants are sometimes referred to as being unauthorized, out of status, or unlawfully present; the term "illegal" when applied to people is considered a slur. An estimated 1.1 million undocumented minors resided in the U.S. as of 2010. Undocumented youth make up sixteen percent of the undocumented population as a whole. Undocumented students are school-aged immigrants who entered the United States without inspection or overstayed their visas and are present in the United States with or without their parents. They face unique legal uncertainties and limitations within the United States educational system. These students are often called the 1.5 generation, as they have spent a majority of their lives in the United States. Although some undocumented 1.5 generation students find their way to legal status, many remain undocumented. 
As children, youth are granted access to public K–12 education and benefits regardless of citizenship or immigration status. After navigating through primary education, undocumented youth transition into an adulthood that does not grant them those provisions. Without need to prove their legality within the country until they come of age, undocumented youth can live their childhood years without knowing that they do not have a legal status. 
Another study done in Los Angeles County in 2000 shows how children's immigration status is associated with access to insurance as well as their health status. The study found that children under undocumented parents had many obstacles when trying to access and utilize healthcare.
Wilson said afterwards that his outburst reflected his view that Obama's bill would have provided government subsidized benefits to illegal immigrants. Several fact-checking organizations wrote that Wilson's views were inaccurate because HR 3200 expressly excludes undocumented aliens from receiving government-subsidized "affordability credits". The non-partisan Congressional Research Service agreed that people would need to be lawfully present in the U.S. in order to be eligible for the credits, but noted that the bill did not bar non-citizens from buying their own health insurance coverage through the health insurance exchange. The Obama administration said that, in the final bill, undocumented immigrants would not be able to participate in the Exchange. Such language was included in the Senate Finance Committee's version of the bill, America's Healthy Future Act.
Although the ACA led to many people becoming insured, there were still millions who were left without health coverage. Today in San Francisco, these patients are still eligible for Healthy San Francisco. These remaining patients include undocumented immigrants, prisoners, people who have lived in the city for less than 5 years and are thus ineligible for Covered California, and people whose incomes are too high above the Federal Poverty Line to qualify for Medi-Cal but not enough to afford private health insurance.
From an economic standpoint, undocumented immigrants in the United States are often employed in jobs in either the secondary or informal sectors of the labor market.[2] Subject to influences of the larger international economic system, firms in the secondary sector often offer undocumented immigrants a sense of ethnic solidarity and opportunities for upward economic mobility in exchange for few social benefits and lower pay.[2] Similarly, undocumented immigrants employed in the informal sector after often provided scarce health benefits, if given medical insurance at all while simultaneously relying on temporary contract work or other self-employment or small-business employment opportunities.[2] Given their wages, these limited employment options also limit the ability of undocumented immigrants to meet financial requirements for accessing private healthcare coverage. All of these factors combined result in the unlikelihood that illegal immigrants will have government-funded health insurance, have private medical insurance, or be able to cover medical costs through their own financial resources.[2] In fact, even for work-related injuries, it is often difficult for illegal immigrants to receive or gain access to treatment.[2]
Efforts at reforming the health care system in regards to immigrants have varied in terms of success in the past decade. In 2003, the federal government proposed funding hospitals over a four-year period to cover emergency treatment for uninsured and undocumented immigrants, but required asking for patients’ citizenship statuses. It was ultimately withdrawn due to the belief that such a policy would delay immigrants from actively seeking care unless in extreme need, thereby contributing to overall higher incidences of medical problems in a community. In 2005 and 2006, proposed Senate and House of Representatives bills sought to decrease illegal immigration but additionally made it a felony for health care providers to service undocumented immigrants. Though the bills did not pass, much discourse erupted from health care organizations in response to them. The American Medical Association notably passed a policy called “Opposition to Criminalization of Medical Care Provided to Undocumented Immigrant Patients” in response.
While there is less information available on illegal immigrants, research shows that immigrants have substantially lower overall healthcare expenditures than U.S.-born persons. In 1998, the per capita total health care expenditure amount spent on immigrants was 55% lower than that spent on their U.S.-born counterparts and 74% lower for their children.[6] Moreover, immigrant healthcare expenditure totaled $39.5 billion that year constituting only 7.9% of the U.S. total.[6] These lower expenditures have raised a number of questions about the accessibility of health care services and insurance to both documented and undocumented immigrants.[6]
Health care usage of undocumented immigrants is mostly not understood, little research has been done since the implementation of the Affordable Care Act.[1] According to study conducted using data from the 2003 California Health Interview Survey, of the Mexicans and other Latinos surveyed, undocumented immigrants had the lowest rates of health insurance and healthcare usage and were the youngest in age overall.[3] In fact, the study found that overall undocumented Mexicans had 1.6 fewer physician visits and undocumented Latinos had 2.1 fewer physician visits compared to their U.S.-born counterparts.[3] Some scholars have attributed this lower usage of healthcare services to the “Hispanic Epidemiological Paradox” where the health outcomes of Hispanic and Latino Americans have been found to be comparable or better than white Americans, paradoxical to their lower socioeconomic status.[4] However, others point to the negative experiences of undocumented groups when seeking medical treatment or other forms of healthcare service.[3] For example, this same study from the 2003 California Health Interview Survey found that both illegal groups—Mexican and Other Latino—were more likely to report negative experiences with healthcare providers and less likely to have a regular source of care because of such experiences.[3] Meanwhile, US-born Latinos with U.S. citizenship were more likely to self-report their health as good or excellent and more likely to have visited a physician in the last year.[3]
Health: Most immigrant women do not have access to health care services and health insurance due to their undocumented status and/or low income status.
Only a handful of municipalities in the United States offer health care coverage for undocumented immigrants, including Los Angeles County's My Health LA program, and San Francisco's Healthy San Francisco.
The use of public services by undocumented immigrants, including healthcare has been tied into the larger national debate over immigration [3] while simultaneously lying the intersection of two contentious debates involving health reform and immigration reform.[8] Proponents of more restrictive service use policies have argued that lax immigration policies will encourage more undocumented immigrants to relocate to the United States.[3] They also argue healthcare policies which make insurance, coverage, and treatment more accessible to all populations will encourage undocumented immigrants to overuse services without contributing their fair share to the tax base, ultimately placing an unjust burden on the general public[3] Meanwhile, both taxpayers and politicians point to state welfare and Medicaid programs as specific areas of concern when it comes to such healthcare use by illegal populations.[6]