Denying Care To Illegal Immigrants Raises Ethical Concerns

The Senate’s Christmas Eve vote makes historic legislation to transform our health care system likely. Politicians, who rightly note that this legislation would affect nearly all Americans, could also point out that the people least affected may not be Americans at all, but those in the country illegally. Under the House bill, illegal immigrants could buy coverage in the bill’s insurance exchange but would be ineligible for federal subsidies; under the Senate version, even that would not be not permitted. The implications are staggering. While the Senate bill would extend insurance coverage to 31 million people, the Congressional Budget Office projects that as many as 23 million people would still be uninsured in 2019, about 8 million of whom would be illegal immigrants.

We don’t need to wait until 2019, however, to witness the human tragedies and policy nightmares at the heart of health care for undocumented immigrants. The closing of the outpatient dialysis unit at Grady Memorial Hospital in October 2009 captures it all.

Grady Memorial, a public hospital and fixture in Atlanta for over 100 years, provides care to the poor and essential services to the whole community, including a Level 1 trauma center and ambulance fleet. It has been seriously in the red for over a decade. Major steps have been taken recently to keep Grady’s doors open, most controversially the decision to close the outpatient dialysis unit. At the time of the decision, the unit, which was using outdated equipment that needed to be replaced, was losing between $2 million and $4 million annually. Two-thirds of its then remaining patients were undocumented immigrants. When the dialysis unit finally closed, there were about 50 patients left, almost all undocumented.

That undocumented immigrants were left behind is hardly surprising. End stage renal disease is the one and only area of medicine where most Americans already have guaranteed coverage. The Social Security Amendment of 1972 ensures access to kidney dialysis, but applies only to U.S. citizens. Another law requires hospitals that receive federal funds to provide emergency care, including dialysis, to any patient regardless of immigration status who presents with a life-threatening condition. At the same time, special federal funds that are used to offset this emergency care cannot be used to provide illegal immigrants with "maintenance dialysis"—regular dialysis treatments that prevent the life-threatening complications of renal failure and keep patients out of emergency rooms. Against this incoherent federal backdrop, a few states fund maintenance dialysis for undocumented immigrants, but a majority, including Georgia, do not.

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