The Federal Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) restricts undocumented immigrants’ access to publicly funded health services. Kullgren’s (2003) six arguments against these restrictions includes: it limits state and local governments; endangers services to children; creates ethical and professional conflict for providers; increases administrative costs; restricts preventative services that are more cost-efficient; and reduces effectiveness in dealing with communicable diseases, which support his claim that these restrictions create ethical and professional conflict for health care providers and endanger the general publics’ health, are identified, discussed, and explained with background and additional supporting information. In my opinion, these six arguments in Kullgren’s essay can also be used to support the claim that the new health care reform law, The Patient Protection and Affordable Care Act (PPACA) of 2010, still does not end health care restrictions for illegal immigrants and continues to create ethical and professional conflict for health care providers and endanger the general public’s health.
Keywords: PRWORA, PPACA, undocumented immigrants, restrictions on health services, public health
Current Reform Law and Kullgren’s Arguments against Restrictions on Health Care
Undocumented immigrants’ access to health services in the United States has been greatly restricted by the Federal Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. Although there are many philosophical arguments that could be made in regard to this complex issue, this focus is on the arguments presented in Jeffery T. Kullgren’s (2003) essay, “Restrictions on Undocumented Immigrants’ Access to Health Services: The Public Health Implications of Welfare Reform” (pp. 183-187). Kullgren (2003) claims that, “Instead of serving their intended purpose of reducing illegal immigration and conserving public resources, PRWORA’S restrictions on undocumented immigrants’ access to publicly financed health services unduly burden health care providers and threaten the health of the community at large” (p.183). In my opinion, these six arguments in Kullgren’s essay can also be used to support the claim that the new health care reform law, The Patient Protection and Affordable Care Act (PPACA) of 2010, still does not end health care restrictions for illegal immigrants and continues to create ethical and professional conflict for health care providers and endanger the general public’s health.
The magnitude and scope of undocumented illegal workers in the United States needs to be understood in order to comprehend Kullgren’s claims and how these claims relate to the new health care law. Kullgren (2003) observes that 300,000 to 500,000 undocumented immigrants enter the United States each year. United States Immigration Support estimates that there are 12 million illegal immigrants in the U.S. In the past, undocumented workers have been men employed in construction, agricultural, and food service settings. However, there is a rising trend in female undocumented immigrants who are employed in service areas as housekeepers, nannies, and health care aides. Understanding the sheer number of undocumented workers and the work they do is necessary for fully appreciating how the community is directly affected by the restrictions placed on health services for undocumented workers. Illegal immigrants do not constitute a separate population but are an integral part of our community and neglecting their needs puts the whole community at risk.
Another important consideration in analyzing Kullgren’s claims is to understand the specific effect PRWORA and its restrictions have on access to health care for undocumented workers, health care providers, and the U.S. health care system. The Emergency Medical Treatment and Active Labor Act of 1985 (EMTALA) obliges...
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