Project Overview

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

Project Co-Directors

Nancy Berlinger & Michael K. Gusmano

Fun­der

Over­brook Foun­da­tion Domes­tic Human Rights Program

Time­frame

June 2011-December 2012

Efforts to address the health care needs of the 11 mil­lion undoc­u­mented immi­grants in the United States con­cern three lev­els of health care: clin­i­cal, orga­ni­za­tional, and reg­u­la­tory. Physi­cians, nurses, social work­ers, and other health care pro­fes­sion­als who serve com­mu­ni­ties with sig­nif­i­cant year-round or sea­sonal pop­u­la­tions of undoc­u­mented immi­grants need clear guid­ance, sup­ported by orga­ni­za­tional pol­icy, to help them address an unre­solved soci­etal ques­tion: what share of social goods is owed to undoc­u­mented immi­grants as per­sons and as mem­bers of soci­ety, and how should the deliv­ery of health-related goods, in par­tic­u­lar, be autho­rized and paid for? Fail­ure to address 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 pol­i­cy­mak­ers face hard bud­getary choices affect­ing safety net providers, this 18-month project is explor­ing the val­ues that can sus­tain or imperil the domes­tic health care safety net

The roll-out of the Patient Pro­tec­tion and Afford­able Care Act (PPACA) of 2010 offers a timely oppor­tu­nity to address the health-related rights and needs of undoc­u­mented immi­grants 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. This project aims to take advan­tage of this opportunity.

The audi­ences for this project include:

  • health care pro­fes­sion­als, includ­ing clin­i­cians and orga­ni­za­tional leaders
  • human rights advo­cates work­ing on health care access and on immi­gra­tion reform
  • schol­ars work­ing at the inter­sec­tion of domes­tic human rights, health care ethics, and health policy
  • jour­nal­ists and oth­ers who fol­low these issues.

Prod­ucts of this project will include:

  • a spe­cial report pub­lished online by The Hast­ings Cen­ter, tar­geted to health care pro­fes­sion­als and to human rights advocates
  • jour­nal articles
  • this pub­lic web­site, which will chron­i­cle the course of the project through short essays, videos, links, and citations.