Harvard Public Health Review

Reforming both U.S. immigration law and our health care system have been key domestic issues in the 2008 presidential campaign. Yet there is little recognition of the fact that these two problems overlap. Immigrants in this country and their children-about 18% of the U.S. population, about 53 million people-are caught at the intersection of these two broken systems.

So far, much of the debate surrounding immigration reform has focused on the pros and cons of an earned-legalization or "amnesty" program for an estimated 12 to 13 million who are undocumented. Clearly, legalizing their status would do much to improve these workers' wages, safety, and working conditions while bringing them into compliance with federal law. But we must not forget that, since 1996, when the Clinton Administration passed welfare reforms, even recently arrived legal immigrants have been denied access to social and health safety-net programs, including Medicaid. This restriction remains in place for at least five years.

There is an erroneous perception by the general public that current policies aim to penalize only "illegal" immigrants. In the heat of debate, the idea of easing access to health services for the 12 million living here legally has yet to be addressed.

Similarly, discussions of universal health care-whether publicly or privately insured-have tended to ignore immigrants' limited access to health insurance. This is shortsighted, since for many immigrant families, low socioeconomic status and limited English proficiency, among other factors, pose major barriers to getting care. As of now, most of us in the U.S.-about 60 percent-get health insurance through an employer. But many immigrants work in the low-wage sector for firms that offer no health insurance at all.

Your administration can restore access to health and social safety-net programs for all legal immigrants, including an estimated 5.1 million who arrived in the last five years. Any realistic discussion of "universal" health care must explicitly address the question of their eligibility for publicly subsidized health insurance, not to mention affordable alternatives to employer-based plans. As we strive to widen the safety net, consider that policies to integrate or exclude adult immigrants will affect their children. Surely these young people-one-fifth of all U.S. children, nearly all of whom are citizens by birthright-deserve quality health care, too. 

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