Definition and Description of the Issue Health policy and immigration policy are interconnected, as attitudes towards immigrants—especially those who are undocumented—have impacted the substantive content of healthcare policies like the Affordable Care Act. Similarly, immigration policies have been influenced by real or imaginary threats immigrants may pose to public health or public health spending. Political and economic expediency guides both health and immigration policy, whereas frontline healthcare workers including nurses have a direct ethical and professional responsibility to patients regardless of immigration status. Effective public policy blends the ethic of duty to care with an honest evaluation of budgetary constraints and evidence-based practice. As much as possible, immigrant-related health policy ignores emotionally laden and fallacious rhetorical arguments.

Background

Since the nineteenth century, healthcare and immigration policy have been inextricably linked. New immigrants have been blamed for public health problems and for burdening the public health budget, and have also been labeled as being undeserving of health benefits (Mitchell, 2018). As a result, health policy in the United States has veered towards being anti-immigrant and exclusionary, culminating in a series of executive orders issued by President Trump that “fanned the flames of that anti-immigrant narrative, raising it into the country’s national consciousness,” (Center for Health Progress, 2018). The Affordable Care Act had only offered provisions for permanent residents, opening the healthcare insurance marketplace to green card holders and other documented immigrants—with strident provisions such as a mandatory five year residency period prior to eligibility (National Conference of State Legislatures, 2017). Therefore, even documented immigrants struggle to access essential services, and suffer from a wide range of mental and physical health problems as a result of denial of coverage. Undocumented immigrants are systematically excluded from accessing the healthcare insurance marketplace, but in some cases may be able to receive some emergency treatments, immunizations, and some disaster relief programs (National Conference of State Legislatures, 2014). The current state of immigrant health policy remains in flux, bogged down by inconsistencies among various states and rapidly changing rhetoric. The way forward is through a clarification of federal healthcare and immigration policy that aligns healthcare ethics with the principles of social justice.

Stakeholders

While the most vulnerable population, undocumented immigrants are also part of a broader social network. Therefore, American citizens and permanent residents are also primary stakeholders in immigrant healthcare policy. Immigrant healthcare policy also has a strong bearing on public health outcomes. Punitive immigration policies and irregular immigration policy enforcement leads to “profound mistrust of health services, avoiding health services, and sacrificing their health and the health of their family members,” (Rhodes, Mann, Siman, et al., 2014, p. 329). Fear of deportation also compounds mental health issues among immigrant communities—undocumented or not—with measurable increase in diagnosed cases of depression, anxiety, and post-traumatic stress disorder (Martinez, Wu, Sandfort, et al., 2015). Likewise, research shows that individuals living in states with “a more exclusionary immigration policy climate had higher rates of poor mental health days than participants in states with a less exclusionary policy climate,” (Hatzenbuehler, Prins, Flake, et al., 2017, p. 169). Both legal permanent residents and undocumented residents are underinsured; and about 28% of foreign-born residents in the United States are undocumented (Messias, McEwen & Clark, 2015). Undocumented immigrants and legal permanent residents can be considered primary stakeholders, but because healthcare policy ultimately affects all Americans, the stakeholder base should be expanded to include all taxpayers and all healthcare workers who daily meet with the struggle between the ethical duty to care and the financial barriers to providing care to individuals who need it.
Issue Statement

Immigration policy and health policy must converge to undermine the stranglehold insurers have on healthcare and allow for a single payer option that efficiently allocates funding for essential services. Anti-immigrant policy is not only unethical and impossible to align with healthcare ethics, but also impractical and ultimately, financially untenable. Boosting immigrant health promotes improved public health services for all.

Possible Methods of Addressing the Issue

Addressing the issue through policy change allows for an entrenchment of moral values that undergird the healthcare system. Furthermore, changes to immigrant health policy can spill over into other areas of concern including general immigration policy and economic policy. “When the…