In the past two months it’s become even more clear how the Trump administration is committed to sabotaging the Affordable Care Act (ACA), from its refusal to defend the health-care policy against legal challenges to its move to end payments benefiting those with higher health-care costs. As advocates continue fighting for full access to affordable, quality health care, it behooves them to include the needs of undocumented people as well in these conversations.
Although Democrats were heralded by many progressives for their efforts overhauling the health-care system in 2010, the law has not helped one of most vulnerable groups in the United States: the over 11 million undocumented people currently residing here. As of 2016, the uninsured rate for undocumented, nonelderly adults was 40 percent compared to 10 percent and 18 percent for citizens and legal residents, respectively, even after the ACA’s implementation. Because of their immigration status, undocumented people are not eligible for any form of public assistance under the ACA. Only a handful of states—California, New York, Illinois, and Michigan, to name a few—offer even limited Medicaid coverage for some people regardless of immigration status. Even those who qualify for Deferred Action for Childhood Arrivals (DACA) find it nearly impossible to access timely, affordable, and much needed medical care.
For many DACA-mented young people, or “Dreamers,” DACA provides temporary relief from the threat of deportation, a permit to work legally in the United States, and sometimes eligibility for financial assistance for higher education. President Trump has tried to end the program, but the courts have ruled in its favor, allowing DACA recipients to renew their applications for this year. The program’s future, though, remains unclear. Either way, DACA does not permit recipients to receive most forms of public assistance, including Medicaid. For Dreamers who are denied health care, treatable illnesses like diabetes, asthma, or heart disease can quickly become life-threatening.
In addition to exclusion from public governmental assistance, Dreamers can also face exclusion from funding from charitable organizations, which provide aid to people with chronic illnesses or disability, claiming to work at the intersection of these issues in order to bridge accessibility gaps. Nonprofits that provide assistance and funds to people in medical emergencies are forced under federal law to exclude undocumented people from the charitable services they offer.
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The burden of being undocumented or DACA-mented and uninsured is further compounded for Black people. Young, Black, undocumented or DACA-mented people in the United States face a double-edged sword of anti-Blackness and xenophobia when trying to navigate the country’s health-care system. As of 2013, there were approximately 575,000 Black undocumented immigrants living in the United States, and today, approximately 12,000 DACA recipients are Black, according to the Black Alliance for Just Immigration. This population faces challenges in securing basic necessities, finding employment, and paying for adequate health care. These are in addition to dealing with other issues facing young Black people in the United States, documented or otherwise, including institutional racism, misogynoir, and discriminatory policing and incarceration.
The blatant denial of health care simply because of one’s immigration status has dire consequences. The human cost of this exclusionary system is made abundantly evident through the experience of Chika, a 29-year-old nursing student in Atlanta, who is currently in urgent need of a kidney transplant. While family close to her are more than willing to act as donors, she is unable to access the life-saving treatment necessary for a treatable medical condition.
Chika was brought to the United States as a child by her family, who is originally from Nigeria. Her parents were seeking a better life and more opportunities for themselves and their children and came to the United States without authorization. After Chika spent her most formative years living undocumented and in the shadows in the United States, Obama’s DACA offered her a place in the country she called home. Shortly after this, she was diagnosed with kidney failure. While she has two siblings and two parents willing to donate a kidney if they are a match, without insurance the family cannot afford the almost $150,000 procedural costs.
Unfortunately, the price of the transplant is just the tip of the iceberg in terms of the financial cost of care. Continued medical care after a kidney transplant can cost as much as $17,000 a year. This insurmountable challenge exists because our nation places an extraordinary burden on immigrants, Black working class families, and people with severe medical issues.
Chika’s story and the many others like hers tragically bring to light the inhumanity of our health-care system, which is dominated by private health insurance companies—and the lawmakers they back—whose profit-driven models drive up the cost of health care to unaffordable levels for most average citizens. Despite the passage of the ACA, according to the Kaiser Family Foundation, the cost of health care in the United States has continued to rise while nearly 28 million Americans remain uninsured. These numbers are jarring even before taking into account the current political agenda of the Trump administration and congressional Republicans’ regulatory war on the Affordable Care Act. We are living under a crisis where many people are left without the necessary resources to mitigate treatable medical emergencies such as the one Chika is experiencing.
Anti-immigrant activists argue that because Chika and her family came into the United States without authorization, they are not entitled to our country’s social safety net. There are at least two problems with this line of reasoning. The authorization that the state confers unto individuals is a designation used to demarcate who is worthy of life and who is not. Secondly, the logical conclusion of this argument is that Chika should die for having been brought to the United States as a small child without this arbitrary designation. At the core of the fight for immigration justice and for health-care equality is the basic, inalienable value of human life. Nobody should be deprived of life-saving medical care just because they have the wrong passport, or no passport at all.
When patients with Chika’s diagnosis have access to reliable medical care, they are generally able to maintain a high quality of life. Without any real way to access the ongoing care she requires, Chika lives in a state of medical limbo. Instead of continuing on with her nursing education, training that will prepare her to one day provide health care for others such as herself, Chika lives in constant wait of her next medical emergency. Her only option at the moment is emergency dialysis, every several days, when her body threatens to shut down from the swell of toxic buildup that her kidneys are unable to process.
At a time when the Trump administration is rescinding the limited social provisions afforded to immigrants and people with severe medical conditions, it’s important that people of all walks of life show up for one another. This includes demanding a health-care law that benefits everyone residing in the United States, not just U.S. citizens. It is inhumane to exclude a whole group of people from a means to obtaining life-saving care.
In addition to supporting Chika as she fights for her life right now, people interested in truly expanding medical care for all can take the following steps: 1) Share Chika’s story with your friends and family. 2) Call, email, or write to your elected officials, asking them to expand health-care access to all people and to pass a clean DREAM Act. 3) Support local grassroots organizations in your area that advocate for undocumented and DACA-mented people and/or advocate for health-care reform for all by making a donation or volunteering your time. It is up to all of us to hold our lawmakers and elected officials accountable.