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Invited Commentary
April 2017

Undocumented Immigrants and Access to Health Care

Author Affiliations
  • 1Division of General Internal Medicine, San Francisco General Hospital, San Francisco, California
  • 2Department of Medicine, University of California at San Francisco, San Francisco
  • 3Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
  • 4Division of Nephrology, Department of Medicine, University of Washington, Seattle
JAMA Intern Med. 2017;177(4):536-537. doi:10.1001/jamainternmed.2016.9209

But the stranger that dwelleth with you shall be unto you as one born among you, and thou shalt love him as thyself; for ye were strangers in the land of Egypt.

Leviticus 19:34

The United States has increased access to insurance for millions of people through the implementation of the Affordable Care Act (ACA). But one group is still firmly outside the insurance coverage wall: the ACA states that an undocumented immigrant “shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.” In 2014, the Pew Research Center1 estimated that about 11.1 million undocumented immigrants lived in the United States, and nationally, undocumented immigrants now make up about 15% of the uninsured who are younger than 65 years, a proportion that varies greatly by state: from 7% in Pennsylvania, to 24% in California and Texas, and 28% in New Jersey. As the country debates whether to dismantle the existing ACA health reform expansion, prospects for a federal expansion that encompasses the undocumented seem dim in the short term.