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45 J.L. Med. & Ethics 55 (2017)
Immigration and Health: Law, Policy, and Ethics

handle is hein.journals/medeth45 and id is 208 raw text is: Immigration and Health: Law, Policy, and Ethics Wendy E. Parmet, Lorianne Sainsbury-Wong, and Maya Prabhu Immigration poses numerous challenges for health care professionals and public health lawyers. Health professionals must care for patients with different cultural backgrounds, some of whom have experienced traumas in their country of origin, may not speak English, or lack access to health insurance. Public health lawyers must untangle the multifaceted interactions between immigration law and health law, which add complexity, inefficiency and inequity to the U.S. health care system. These challenges are apt to intensify under the Trump Administration, which has pledged to increase deportations and repeal the Affordable Care Act (ACA). This paper offers an over- view of some of these issues, as well as the arguments that are given for denying immigrants equal access to health care. Immigrants' Access to Health The anti-immigrant sentiment evident in the 2016 election was not new. American history has been marked by periodic waves of nativism. Such anger towards immigrants often focuses on health. Through- out history, immigrants have been blamed, usually erroneously, for disease outbreaks. This association between immigrants and disease can be seen in the health-based exclusions in U.S. immigration law and the disproportionate use of coercive public health powers against immigrants as when San Francisco quarantined Chinese American residents in response to a smallpox outbreak in 1900.1 Wendy E. Parmet, J.D., is the Matthews University Profes- sor of Law and Professor of Public Policy a& Urban Affairs at Northeastern University. Lorianne M. Sainsbury-Wong, J.D., is the Litigation Director and Compliance Attorney at Health Law Advocates. Maya Prabhu, M.D., LL.B., is an Assistant Professor ofPsychiatry at Yale School ofMedicine. 2016 PUBLIC HEALTH LAW CONFERENCE * SPRING 2017 The Journal ofLaw, Medicine & Ethics, 45 Si (2017): 55-59. @ 2017 The Author(s) DOI: 101177/1073110517703326 In 2015 there were 244 million people around the world living outside of their country of origin.2 In the last two years, rapid increases in immigration in Europe triggered a backlash of nationalism and xeno- phobia. The U.S. has not witnessed a similar surge in immigration, but xenophobia remains potent. The U.S. is home to the largest number of immi- grants in the world.3 In 2014, there were 42.2 million immigrants in the U.S., making up 13.2% of the popu- lation. Forty-seven percent of these immigrants are citizens; only 3.5% are undocumented.4 Immigrants are less likely to have health insurance than native-born citizens.6 This is due to many fac- tors including their disproportionate employment in low-wage sectors that tend not to provide employer- sponsored insurance. Another reason is the exclusion of many classes of immigrants from publicly-funded health insurance programs. Living in poverty is not enough to establish eligibil- ity for federal health care coverage in the U.S. Immi- gration status also matters, not because of any logical or health care-related nexus between coverage and immigration, but because federal law restricts access to federally-funded benefits to numerous classes of immigrants, including many with legal status. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) limits eligibil- ity for public insurance, including Medicare and Med- icaid, and imposes a mandatory waiting period on certain legal immigrants who must first demonstrate at least five years of continual qualified immigration status and residency in the U.S.6 PRWORA also bars aliens who are not qualified aliens from Medicaid, except for immigrants accessing emergency services7 or lawfully residing children or pregnant women in a state that has expanded Medicaid under the Chil- 55

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