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Undocumented Patients: Human Rights, Access to Health Care, and the Ethics of the Safety Net

Project launched in June 2011

Project co-directors: Nancy Berlinger and Michael K. Gusmano

Funder: Overbrook Foundation Domestic Human Rights Program

Project Web site:

Efforts to address the health care needs of the 11 million undocumented residents of the United States concern three levels of health care: clinical, organizational, and regulatory. Physicians, nurse-practitioners, and other health care professionals who serve communities with significant year-round or seasonal populations of undocumented residents need clear guidance, supported by organizational policy, to help them answer an unresolved societal question: what share of social goods is owed to undocumented residents as persons and as members of society, and how should the delivery of health care be authorized and paid for? Failure to meet this foreseeable challenge can result in ad hoc remedies that can be unfair to patients, inefficient as resource allocation processes, and ineffective as reform efforts.

Supporting systemic change that can ensure access to high quality and affordable health care for all residents of the U.S. requires close attention to difficult questions of resource allocation. In the U.S. visions of health care as a right and as a privilege have long competed. Both health care and immigration are likely to remain fragmented as systems, and contentious with respect to political debate. As federal and state policy makers face hard budgetary choices affecting the safety net providers who serve undocumented residents, including Federally Qualified Health Centers and hospital emergency departments, this 18-month project will explore the values that can sustain or imperil the domestic health care safety net

As the roll-out of the Patient Protection and Affordable Care Act of 2010 proceeds, the project will help clarify the health-related rights and needs of undocumented residents and, through careful analysis and concrete recommendations, to promote the development and implementation of equitable and sustainable public policy that can help providers who serve this population.

The audiences for the information that comes out of the project include: health care providers serving undocumented residents; human rights advocates working on health care access and on immigration reform; and scholars working at the intersection of domestic human rights, health care ethics, and health policy; as well as journalists and others who follow these issues.

Planned products include a special report published online by The Hastings Center, targeted to health care professionals and human rights advocates; journal articles for medical and health policy journals; and a Web site that will offer a multimedia chronicle of the project.

Advisory Group:

Howard Berliner, ScD, director of health policy,Service Employees International Union

Michael Birnbaum, MA, vice president,United Hospital Fund

Francesca Gany, MD, MS, chief, Immigrant Health and Cancer Disparities Service,Sloan-Kettering Institute,Memorial Sloan-Kettering Cancer Center

Allen S. Keller, MD, director, Bellevue/NYU Program for Survivors of Torture and director, NYU School of Medicine Center for Health and Human Rights, Bellevue Hospital Center

Jonathan H.Marks, BCL, MA, director, Bioethics and Medical Humanities Program,Pennsylvania State University

Tia Powell, MD, director, Montefiore-Einstein Center for Bioethics

Rajeev Raghavan, MD, assistant professor, Baylor College of Medicine

Rina Ramirez, MD, FACP, chief medical officer, Zufall Health Center

Pamela Riley, MD, MPH, program officer, vulnerable populations, The Commonwealth Fund

Sara Rosenbaum, JD, Hirsh Professor and chair, Department of Health Policy, School of Public Health and Health Services,  George Washington University Medical Center

Bobbi Ryder, president and CEO, National Center for Farmworker Health

James E.Sabin, MD, director, ethics program, Harvard Pilgrim Health Care; clinical professor, Harvard Medical School

Anthony Shih, MD, MPH, executive vice president for programs, The Commonwealth Fund

Eva Turbiner, president and CEO, Zufall Health Center

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