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The JAMA Forum
October 15, 2019

Is Affording Undocumented Immigrants Health Coverage a Radical Proposal?

Author Affiliations
  • 1University Professor and Faculty Director, O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC
JAMA. 2019;322(15):1438-1439. doi:10.1001/jama.2019.15806

During the Democratic presidential debate on July 31, all 10 candidates raised their hands when asked if they would provide health insurance to undocumented immigrants. Among all Democratic ideas for health reform, this is least popular. A recent poll found that only 38% of respondents approve. The idea drew extensive criticism, which is understandable: Why should the United States provide health coverage for people who don’t have a legal right to be here? Extending coverage could be seen as rewarding individuals who have violated the law.

There are, however, strong reasons to afford health coverage for this population: modest economic costs, safeguarding the public’s health by curbing the spread of infectious diseases, and complying with international law that requires health coverage for migrants. Many countries fail to afford migrants equitable access to health coverage, so adopting a policy of providing undocumented immigrants on par with other residents—integrated into existing federal health insurance programs—would help the United States regain moral leadership, in line with World Health Organization (WHO) and United Nations (UN) guidelines, and potentially save money (discussed below).