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

Project CodirectorsNancy Berlinger and Michael K. Gusmano
Funders: Overbrook Foundation Domestic Human Rights Program, The Robert Sterling Clark Foundation
Project Website: www.undocumentedpatients.org

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

The project aims to 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.