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Ideas and Opinions |5 March 2013

Coverage for Undocumented Migrants Becomes More Urgent

Ewout van Ginneken, PhD; Bradford H. Gray, PhD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From Berlin University of Technology, Berlin, Germany, and The Urban Institute, Washington, DC.

    Disclaimer: The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.

    Grant Support: By The Commonwealth Fund (grant 20110310) to The Urban Institute. Dr. van Ginneken was a recipient of a 2011–12 Commonwealth Fund Harkness Fellowship in Health Care Policy and Practice.

    Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2596.

    Requests for Single Reprints: Ewout van Ginneken, PhD, Berlin University of Technology, Straße des 17, Juni 135, 10623 Berlin, Germany; e-mail, ewout.vanginneken@tu-berlin.de.

    Current Author Addresses: Dr. van Ginneken: Berlin University of Technology, Straße des 17, Juni 135, 10623 Berlin, Germany.

    Dr. Gray: The Urban Institute, 2100 M Street NW, Washington, DC 20037.

    Author Contributions: Conception and design: E. van Ginneken, B. Gray.

    Drafting of the article: E. van Ginneken, B. Gray.

    Final approval of the article: E. van Ginneken, B. Gray.

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The outcome of the presidential election has put immigration reform back on the national agenda. Assuring access to care for undocumented migrants (UDMs) should be prominent in the discussion. Once the coverage expansions of the Patient Protection and Affordable Care Act (ACA) take effect in the states that implement the law's Medicaid provisions, UDMs will be the only large group without coverage. Ironically, some provisions in the ACA will hurt UDMs and the clinicians who provide services to them. We will share some policy options based on experiences from Europe, where provisions to provide access to care for UDMs are in place in some countries.
Not all UDMs in the United States lack health insurance. An estimated 5.1 million (43%) of the 11.8 million UDMs had coverage in 2007 (1). Even so, these persons accounted for 14.6% of the uninsured population (46 million) that year. The number of UDMs without coverage seems likely to increase as the ACA is implemented. They will not be eligible for the expanded Medicaid coverage, and the ACA specifically makes UDMs ineligible to purchase insurance through the insurance exchanges that aim to facilitate coverage in the individual and small-group markets. Moreover, an estimated 31% of adult UDMs have employer-sponsored insurance, often in small firms (2). They may lose coverage if their employers decide to let their employees seek coverage through the exchanges, where legal status is expected to be scrutinized (3).
Hospitals in some states are already expressing concern, particularly regarding additional...
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van Ginneken E, Gray BH. Coverage for Undocumented Migrants Becomes More Urgent. Ann Intern Med. 2013;158:347–348. doi: 10.7326/0003-4819-158-5-201303050-00008

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Published: Ann Intern Med. 2013;158(5_Part_1):347-348.

DOI: 10.7326/0003-4819-158-5-201303050-00008

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