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Uninsured Immigrants and Healthcare in the United States

SDSU COLLEGE OF NURSING

N495: DIRECTED STUDIES IN NURSING

SOCIAL JUSTICE PAPER

BY: JENNIFER AMPONSAH

February 27th, 2012

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Uninsured Immigrants and Healthcare in the United States

Introduction

Imagine walking into a healthcare setting or facility and receiving no care because you

have no health insurance and the healthcare facility cannot afford to treat without any cost.

United States as one of the major immigrant-accepting countries, has observed a rapid increase

in its foreign-born population. There are several barriers that affect immigrants or foreign born

individuals. These barriers include but not limited to unfamiliarity with the United States health

care system, language barriers (limited English or English not as primary language). In additions

to theses barriers, foreign-born individuals face greater difficulties in obtaining the necessary

financial means to cover health care costs than do naturalized or native-born citizens. Most

importantly, non-citizen immigrants are much less likely to have employment-based private

health insurance, as many are not allowed to work in the United States and, even if they have

employment, are less likely to have jobs with benefits. This leads to uninsured among the

immigrants population. Uninsured contribute to a large portion of inadequate care, which causes

a major issue in social justice. Many healthcare settings do not have adequate funds to treat a

patient free of charge which makes it makes difficult to give patients the best care possible.

Therefore the purpose of this paper is to discuss the social justice issues that arise with

inadequate healthcare among uninsured immigrants, the consequences, possible outcomes, and

interventions to improve this problem.

Antecedents and Historical context

Immigrants are one of the fastest growing populations in the United States for the past

decade. In 2005, about 12% of the US population (36 million) consisted of foreign-born

individuals, and that figure had doubled since 1970 (Sungkyu & Sunha, 2009). The United States

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receives an average of 104,000 foreigners a day, and about 1.2 million new immigrants each year

(Lebrun & Dubay, 2010). As the immigrant population continues to grow, the uninsured

populations also continue to increase in the United States. Forty-eight million people or one-sixth

of United States population is uninsured (Becker, 2007). Fourteen million of those uninsured are

below the poverty threshold level. These individuals are eligible for Medicaid, but they have

failed to apply for Medicaid, which might be due to lack of knowledge regarding available

resources. Eleven million of these uninsured populations have declined health insurance offered

to them by their employers because they elected not to spend the portion of their pay required to

cover the employee contribution. In addition, eighteen million of the uninsured have a household

income of more than $50,000 per year; and, interestingly, 9 million of those have a household

income of greater than $75,000 per year. Moreover, 9.7 million of the uninsured are illegal

immigrants (Sataloff, 2010). Healthcare is one of the most important needs of humans, and due

to this everyone deserves the right to equal healthcare no matter their origin, age, race, religion,

or economic status, which then creates a social justice issue.

Potential or actual consequences

“The uninsured in the United States are systematically less likely than the insured to

receive effective, safe, and timely care” (Becker, 2007). Inadequate healthcare among uninsured

immigrant violate many issues of social justice, causing many ethical dilemmas. This issue is

on the rise as healthcare cost continues to rise and the immigrant population continues to grow in

the United States. Due to this the uninsured does not receive safe and effective care. For

example, healthcare providers will spend more time providing effective care to their insured

patient so that patients will come back to them when are having any problems. Also, healthcare

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providers are more likely to see their insured patients first during the day because this is where

their source of income comes from

The United States health system fosters a structured approach of containment toward the

uninsured, that’s not only marginalizes them but it keeps the problem of the uninsured in check

by discouraging people from using health care services(Becker, 2007). I personally, find this to

be absolutely true, because the cost of care for uninsured population in the United States is

higher than the care of insured populations. For example, the cost of colonoscopy for insured

person is around $1700 to 2000, but the cost of the same procedure for uninsured person is

around $3,000. Due to this, most immigrants fail to seek healthcare when necessary and wait till

the illness get worst because they cannot afford the cost.

The uninsured immigrants are also more likely to delay needed care (Becker, 2007). For

example, uninsured immigrants’ pregnant women will not seek prenatal care until they are far

along during their pregnancy because they cannot afford the care and might not see the

importance of prenatal care. Cost of healthcare being one of the biggest issues affecting many

people; discourages most individuals including uninsured immigrants not to seek health when

needed.

Research also proves that the uninsured are also less likely to receive timely preventive

and outpatient care and are more likely to be hospitalizing for avoidable health problems

(Rowland & Shartzer, 2008). This means uninsured immigrants are less likely to receive

preventative care such as cholesterol testing and cancer screening, Pap smear, annual breast

exams, colonoscopy, and etc. For example, one might have Pap smear all her life until she

experiences the symptoms of cervical cancer. Or one might not check their cholesterol levels

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until he or she experience chest pain, but due to uninsured and the cost of emergency room

service, he or she might delay care until they code.

Also insured immigrants are more like to be incompliance with medication regimens.

This is because for instance, if you were not treated fairly at the healthcare facility, would you

like to follow that persons instructions? I know I wouldn’t because the person did not treat me

well, how like do they care about my wellbeing, and how beneficial will their prescribed

medication help me. Due to these consequences, uninsured immigrant has decrease in life

expectancy than insured US citizens.

Professional behaviors and Outcomes

One issue of social justice that is violated is beneficence. Beneficence is action that is

done for the benefit of others. Beneficent actions can be taken to help prevent or remove harms

or to simply improve the situation of others. Medical personnel need to refrain from causing

harm and do the best to help patients (Patronis Jones, 2007). Uninsured do not benefit patients,

and in fact, can do more harm to the patient. Patient’s cares are being denied because the patient

cannot afford the care, and hospitals or healthcare facilities cannot afford to treat patients for no

cost. A way to improve beneficence when it comes to uninsured immigrants and healthcare or

an outcome would be health promotion, and education. Community nurses or all nurses can teach

the immigrants or the community regarding importance of health insurance, and how it benefits

them. Also all healthcare facilities can provide a teaching session for nurses on how to provide

equal care to patients regardless their status, nationality, and status. Also facilities can put signs

on units regarding nurses advocating for their uninsured patient to facilitate equality in

healthcare.

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Non-maleficence can be another ethical dilemma related to uninsured and healthcare.

Non-maleficence means to “do no harm.” Physicians and nurses must refrain from providing

ineffective treatments or acting with malice toward patients.  There are many factors of insured

which violate the “do not harm” definition (Patronis Jones, 2007). This ethical dilemma is

violated when healthcare providers do not provide adequate care for their patients, or when a

nurse fails to advocate for the uninsured patients. To do no harm to patients, a physician or nurse

should equal and quality care at all times even if the patient is uninsured. A possible outcome for

this ethical dilemma would be all nursing schools should introduce their student to other cultures

or other people from different countries. For example, SDSU gives its students an opportunity to

work with the refugee population in Sioux Falls. I think this provides great opportunity for the

students to learn and understand people with other backgrounds so that if they come across such

population in their work force, they will be able to provide them with adequate care. This is

something that I personally have learned and will put this into practice.

To do justice is another ethical dilemma that is violated greatly when dealing with

uninsured. Every patient is to be treated fairly whether white or colored, citizen or immigrant,

uninsured or insured. Not only are patients who are uninsured have disadvantaged when

receiving care in the US, but also inadequate healthcare appears to be one of the social justice

issues facing many uninsured immigrants in the United States. To ensure justice in healthcare, a

possible outcome should be that, all healthcare providers must provide equal and adequate care

to all their patients, even if they are uninsured and foreign born citizens. This can be done by

providing them with a translator if language is a barrier, spend quality time with them, and treat

them like you would treat your insured U.S citizen patients. Providing equality care among

uninsured immigrant will lead to positive health outcomes, such as compliance with medication

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regimens, lower levels of disability, decreases in health care costs, improved control of chronic

conditions, and increases in patient satisfaction with care (Sungkyu & Sunha, 2009).

Conclusion

In conclusion, inadequate healthcare appears to be one of the social justice issues facing

many Uninsured immigrants in the United States today. Providing equality care among

uninsured immigrant by all healthcare providers will lead to positive health outcomes, such as

compliance with medication regimens, lower levels of disability, decreases in health care costs,

improved control of chronic conditions, and increases in patient satisfaction with care which will

help eliminate this social justice issue.

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References

Becker, G. (2007). The Uninsured and the Politics of Containment in U.S. Health Care. Medical

Anthropology, 26(4), 299-321. doi:10.1080/01459740701619806

Lebrun, L. A., & Dubay, L. C. (2010). Access to Primary and Preventive Care among Foreign-

Born Adults in Canada and the United States Access to Primary and Preventive Care.

Health Services Research, 45(6p1), 1693-1719. doi:10.1111/j.1475-6773.2010.01163.x

Patronis Jones, R.A. (2007). Nursing leadership and management: Theories, Processes and

Practice. Philadelphia, PA: F.A. Davis Company.

Rowland, D., & Shartzer, A. (2008). America's Uninsured: The Statistics and Back Story.

Journal Of Law, Medicine & Ethics, 36(4), 618-628. doi:10.1111/j.1748-

720X.2008.00316.x

Sataloff, R. T. (2010, February). Healthcare for the uninsured: A simpler, cheaper, faster, better

solution. ENT: Ear, Nose & Throat Journal. pp. 52-55.

Sungkyu, L., & Sunha, C. (2009). Disparities in access to health care among non-citizens in the

United States. Health Sociology Review, 18(3), 307-320