Helen Farnham

29 February 2024

Californian legislatures made headlines in early January when they implemented an expansion of health insurance to include undocumented immigrant adults (1). As of January 1st, 2024, undocumented adults between the ages of 26 and 49 living in California are able to register for Medi-Cal (Medicaid’s name in California) (1). Prior expansions in California have given other demographics of immigrants access to Medi-Cal, meaning all undocumented immigrants in the state who meet income requirements are now eligible to receive government-funded healthcare. These requirements vary based on the person’s income, household size, and proximity to the Federal Poverty Level (2). While universal healthcare has not been achieved in California, making care available for all undocumented immigrants regardless of their age brings California much closer to current Governor Gavin Newsom’s goal of ensuring all residents have access to healthcare (1). 

While other states, including Minnesota and Oregon, are in the process of implementing similar plans, California is one of the first, and largest states to make healthcare available to all income-eligible undocumented immigrants (3). Subsequently, there is sizable pushback, particularly from Republican lawmakers and politicians (1, 3). Many detractors cite the added cost to taxpayers and alleged unfairness towards American citizens as reasons to deny immigrants health coverage (1, 4). However, many of these arguments fall flat and ignore the fact that everyone, regardless of citizenship status, deserves access to healthcare. It is imperative that more states, Pennsylvania in particular, follow California’s lead in providing care for all, including non-citizens.

Lack of healthcare access is a huge threat to immigrant populations within the United States. In 2021, 20.8 million non-citizen migrants were living in the United States, making up 6% of the population (3). Undocumented immigrants are not eligible to receive any federally funded healthcare coverage, meaning the vast majority of them lack access to Medicaid and Marketplace tax credits (the latter of which helps people afford private insurance) (5). According to KFF, “In 2018, noncitizens were more than twice as likely as citizens to be uninsured. Among noncitizens, undocumented immigrants were much more likely to be uninsured” (6). In fact, 55% of likely undocumented Hispanic immigrants lack insurance, a staggering number (6). This means undocumented immigrants are more likely to avoid getting needed treatment for health problems, end up in the hospital for avoidable health issues, and not get recommended preventative care (5). Furthermore, those without health insurance who are hospitalized have a higher mortality rate than those with insurance (5). 

Undocumented immigrants have contributed their money both to the American economy and to help pay for government funded healthcare for decades, yet they have not been able to partake in any of the benefits. Despite rampant claims that undocumented immigrants harm the United States economy and American citizens themselves, they contribute a significant amount of money to the economy (7). According to the Immigration Forum, “in 2018 undocumented immigrants contributed 20.1 billion in federal taxes and 11.8 billion in state and local taxes” (7). These taxes that undocumented immigrants have been paying directly contribute to Medicare funding (8). Furthermore, they created a $35.1 billion dollar surplus in the Medicare Trust Fund during the period of 2000 to 2011 as they paid taxes funding Medicare without using or receiving the majority of benefits provided (7). They also strengthen the economy by fulfilling needs of the labor market, particularly in agriculture, and creating jobs by starting their own businesses (9). Not only have undocumented immigrants made extensive contributions to America’s economy, they have contributed their income to Medicare for decades without receiving any benefits. Therefore, it is only fair that they be granted the same access to health insurance afforded to American citizens. 

While there is more work to be done to ensure immigrants utilize the services available to them beyond just implementing more extensive coverage, expanding access is still a crucial step in the process. A 2023 KFF and the Los Angeles Times survey found that 27% of likely undocumented immigrants refuse to apply to public assistance programs due to fears that doing so could jeopardize their ability to remain in the United States (10). Fear and stigma prevent them from utilizing those programs to their full extent. However, The KFF has found that immigrants in states with expanded Medicaid have higher insured rates than those without (6). Despite potential distrust there may be between immigrants and the healthcare system, more immigrants do enroll if it is available to them(6). Therefore, the passage of legislation to provide them with access to healthcare is an important first step in increasing insurance rates among undocumented immigrants and building trust between them and the healthcare system.

In Pennsylvania, there are approximately 170,000 undocumented immigrants (11). In 2018, they contributed 238.3 million dollars in just state and local taxes, and another 418.1 million dollars in federal taxes (11). However, the only medical assistance available for undocumented adults is Emergency Medical Assistance, which requires proof of a serious medical issue (12). That means there is a massive gap in healthcare status, and Pennsylvanian undocumented immigrants are much more vulnerable than Pennsylvanian citizens.

Pennsylvania should adopt California’s policy of allowing all undocumented immigrants whose income is within a certain proximity of the Federal Policy Level to qualify for Medicare. While this program is not the perfect way to ensure people receive care regardless of their immigration status, it is an option that can make healthcare much more accessible to over a hundred thousand Pennsylvania residents.

Healthcare access is recognized by the United Nations as a human right, and it is inhumane to deprive anyone of necessary and potentially lifesaving care (13). According to the Office of the United Nations High Commissioner for Human Rights (OHCHR), health services “must be available, accessible, acceptable, and of good quality” for all people (13). The lack of affordable private healthcare in the United States means that government-funded healthcare programs are a lifeline for lower-income individuals, and should be available for all, including undocumented immigrants. The concept of medical care as something to be earned rather than essential for the well-being of all is a uniquely cruel way to treat people, especially from a nation with the wealth and resources of America. Expanding healthcare services in all states to include undocumented immigrants, who have already been contributing their money to the public health system and economy, is crucial for America to live up both to international standards and to its dream of being a truly great nation.

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Image via Pexels Free Photos .

Works Cited 

1. Kekatos, Mary. “California Becomes First State to Offer Health Insurance to All Undocumented Immigrants.” ABC News, ABC News Network, 29 Dec. 2023, abcnews.go.com/Health/california-1st-state-offer-health-insurance-undocumented-immigrants/story?id=105986377. 

2. Covered California. “Program Eligibility by Federal Poverty Level for 2024.” Department of Health Care Services, 2023.  https://www.coveredca.com/pdfs/FPL-chart.pdf

3. Published: Jul 26, 2023. “State-Funded Health Coverage for Immigrants as of July 2023.” KFF, 27 July 2023, http://www.kff.org/racial-equity-and-health-policy/fact-sheet/state-funded-health-coverage-for-immigrants-as-of-july-2023/. 

4. “Remarks by President Trump on the America First Healthcare Plan.” National Archives and Records Administration, National Archives and Records Administration, 24 Sept. 2020, trumpwhitehouse.archives.gov/briefings-statements/remarks-president-trump-america-first-healthcare-plan/#:~:text=And%20coverage%20for%20illegal%20immigrants,your%20healthcare%20system%20totally%20insolvent. 

5. Drake, Patrick, and Tolbert, Jennifer. “Key Facts about the Uninsured Population.” KFF, 18 Dec. 2023, http://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/. 

6. Schumacher, Shannon, et al. “Most Hispanic Immigrants Say Their Lives Are Better in the U.S.. but Face Financial and Health Care Challenges: The 2023 KFF/LA Times Survey of Immigrants.” KFF, 18 Jan. 2024, http://www.kff.org/racial-equity-and-health-policy/poll-finding/most-hispanic-immigrants-say-lives-are-better-in-the-us/. 

7. “Fact Sheet: Undocumented Immigrants and Federal Health Care Benefits.” National Immigration Forum, 21 Sept. 2022, immigrationforum.org/article/fact-sheet-undocumented-immigrants-and-federal-health-care-benefits/. 

8. Ommerborn, M. J., Ranker, L. R., Touw, S., Himmelstein, D. U., Himmelstein, J., & Woolhandler, S. (2022). Assessment of Immigrants’ Premium and Tax Payments for Health Care and the Costs of Their Care. JAMA network open, 5(11), e2241166. https://doi.org/10.1001/jamanetworkopen.2022.41166

9. Pillai, Drishti, and Artiga, Samantha. “Employment among Immigrants and Implications for Health and Health Care.” KFF, 12 June 2023, http://www.kff.org/racial-equity-and-health-policy/issue-brief/employment-among-immigrants-and-implications-for-health-and-health-care/. 

10. Palosky, Craig. “Immigrants Overwhelmingly Say They and Their Children Are Better off in the US, but Many Also Report Substantial Discrimination and Challenges, a New KFF/Los Angeles Times Survey Reveals.” KFF, 18 Sept. 2023, http://www.kff.org/racial-equity-and-health-policy/press-release/immigrants-overwhelmingly-say-they-and-their-children-are-better-off-in-the-us-but-many-also-report-substantial-discrimination-and-challenges-a-new-kff-los-angeles-times-survey-reveals/. 

11. “Immigrants in Pennsylvania.” American Immigration Council, 2020, http://www.americanimmigrationcouncil.org/sites/default/files/research/immigrants_in_pennsylvania.pdf. 

12. Casserly, Danna. “Health Care for Immigrants .” Pennsylvania Health Law Project, June 2017, http://www.phlp.org/uploads/attachments/ckdhout757n4vy8u8bw8ak92x-immigrant-health-care-manual-for-advocates-june-2017-update.pdf. 

13. “The Right to Health – UN Human Rights Office.” Office of the United Nations High Commissioner for Human Rights, June 2008, www.ohchr.org/sites/default/files/Documents/Publications/Factsheet31.pdf.