The topic is ( Improving access and/or quality of dental insurance) .1.Prepare a 7-minute presentation for the class in PowerPoint based on your final paper. Since you'll still be working on your pape
1“Cancer is a major public health problem worldwide and is the second leading cause of
death in the United States”. 1 Treatment for cancer is very expensive and health care expenditures
have increased for cancer treatment over the past two decades. “According to the Agency for
Healthcare Research and Quality, a total of $57 billion was sp ent on cancer care in 2001,
compared with $88.3 billion in 2011, and the National Cancer Institute reported that national
estimates of cancer care costs are expected to rise to as high as $173 billion by 2020 ”.2 The
burden of cancer affects patients and fa milies, regardless of race, ethnicity, age and regardless of
immigration status as cancer does not disc riminate. In 2017, there were an estimated 10.5 million
undocumented immigrants in the United States, representing 3.2% of the total U.S. population in
2017. 3 Most undocumented immigrants in the U.S. are either uninsured or at an increased risk of
being uninsured due to limited health insurances available to them. 4 Undocumented immigrants
have limited access to coverage options as there are strict eligibil ity restrictions for them from
Medicaid, Medicare, the Affordable Care Act also referred as the ACA and the Children’s Health
Insurance Program referred to as CHIP in addition to very limited employer -sponsored
insurances .5 Restrictions and/or limitations cause many undocumented immigrants to not receive
immediate healthcare they need or have delays in receiving care thus, leading to undesired
consequences. Cancer is a disease in which abnormal cells divide without control and can invade
nearby tissues in o ne’s body. When a person is diagnosed with cancer, they need to be treated
before the cancer spreads and becomes untreatable, or in other words, before it becomes fatal.
Because cancer is a disease that is unpredictable and does not have a guaranteed treat ment
success result, it needs to be treated as early as it is d iagnosed . Undocumented Immigrants have
limited access to healthcare, however it is crucial to think about the burden cancer has on
undocumented immigrants. There needs to be a program that addresses cancer treatment, post 2
treatment resource costs and allocate fund s for cancer treatment state by state.
Cancer does not discriminate. A study conducted in 2011 discusses that of the 11.1
undocumented immigrants in the United States at the time, the majority were Latinos. Cancer
was found to be the lea ding cause of dea th in Latinos. 6 Un documented cancer patients face many
challenges such as delayed diagnosis, limited social support, financial issues, fear of deportation,
and language and cultural barriers, which result in significant physical and psychological distress
as they navigate through the U.S. healthcare system. 7 Health care access should be a basic human
right regardless of immigration status yet access to healthcare and treatment for cancer, a
terminal illness isn’t a right but a financial burden for most undoc umented and uninsured
immigrants. In efforts to guarantee nondiscriminatory access to emergency medical care, the
U.S. Congress passed The Emergency Medical Treatment & Labor Act of 1986 (EMTALA)
which required all hospitals to treat and provide emergency services to patients regardless of
whether they have the ability to pay. 8 Despite initiatives like this, cancer treatment still has
barriers for undocumented immigrants. It is considered an emergency condition for those who
are uninsured and/or undocumente d as they face strict eligibility restrictions from being covered
under Medicaid. States such as California and NY work to provide treatment and resources to
cancer patients through emergency Medicaid and other funding and financial support resources.
“Undocumented immigrants are not eligible to enroll in Medicaid or CHIP or to purchase
coverage through the ACA Marketplaces ”.9 The option of Emergency Medicaid allows for
payments to reimburse emergency services for anyone regardless of their immigration status.
However, despite emergency Medicaid to cover services for cancer treatment, it isn’t enough to
reduce the burden of cancer. California is a state that has more undocumented immigrants than
any other state in the U.S. and it has introduced a health policy initiative called Medi -Cal, a 3
program which if expanded to undocumented immigrants, would give health care access to them
with standard eligibility requirements in order to make sure undocumented immigrants aren’t
exclu ded from these health services .10 The idea to expand California’s Med -Cal initiative to
undocumented immigrants emphasizes that although there are safety net providers such as
community clinics and hospital emergency rooms that serve and provide free or reduced -price
care to patients, these resources although essential, they are not equivalent to having
comprehensive health insurance. 11 Similarly, in New York State emergency Medicaid policy
requires that chemotherapy and radiation treatment associated with a cancer diagnosis, receives
coverage and that coverage should also include prescription medications that are meant for
stabilization and treatment of the cancer diagnosed. 12 Safety net providers such as community
clinics and hospital emergency rooms should be for emergencies. W ithout comprehensive health
insurance, available to undocumented cancer patients, they are more reliant on these safety net
providers. Cancer is a life -threatening condition and without adequate care and treatment, it can
take lives. Everyone should have access t o healthcare for a medical condition such as cancer
regardless of what their immigration status is. Although emergency medicine covers
chemotherapy and radiation therapy, cancers such as leukemia often require a stem cell
transplant, a treatment not mentioned as an emergency form of treatment. U ndocumented
immigrants are not only limited to cancer treatments but are also limited to receiving post
treatment resources such as medical equipment, disposable medical supplies, nutritional supplies
and outpa tient care such as at home nurse visit which are crucial to the health and recovery of a
cancer patient. T hus, all individuals regardless of their immigration status deserve to have access
to cancer treatments and post -treatment resources. State by state M edicaid expansion would
allow for undocumented immigrants to not only have access to treatments for cancer and post 4
treatment resources but also access to primary care and screenings.
Medicaid expansion to undocumented immigrants is one of the most debated policies. In
recent Democratic debates, the 19 candidates contending for the 2020 Democratic presidential
nomination all raised their hands to give millions of undocumented immigrants unlimited
healthcare or in si mple terms, “Medicare for all” .13 Medicare for all would be a comprehensive
health plan to not only dismantle set f ederal policies that limit healthcare coverage for
undocumented immigrants to safety net providers but to also give patients and families with
cancer, coverage without worrying about ineligibility because of their immigration status. Cancer
is a n unpredictable terminal disease that can become fatal and take lives. Recent studies have
shown that cancer death rates dropped more in states that expanded Medicaid under the ACA
also commonly referred to as Obamacare. 14 The expansion of Medicaid to undocumented
immigrants would not only help them but would also allow for state governments, local
governments and hospitals to manage cancer patients ’ medical care costs. More federal fundi ng
would not only allow for primary care that can include screenings but will allow for affordability
of cancer treatments such as chemotherapy, radiation therapy, bone marrow transplants as well
as for post treatment care. The expansion of Medicaid to und ocumented immigrants or in simple
terms, a federally -financed Medicaid eligibility standard with disregard to immigration status
requires a change to federal law and very a lengthy process. However, a state by state approach
to adopt and implement a progra m that would identify and allocate resources for und ocumented
immigrants could be implemented quicker to address and respond to the needs of undocume nted
immigrants who have cancer.
It is pivotal to adopt and implement a policy that would work to give canc er patients
coverage for not only inpatient cancer treatments but also for outpatient and at -home medical 5
equipment, disposable supplies, and nutritional supplies. A state by state approach in which each
state identifies and allocates their own resources t o offer Medicaid to the undocumented, with
state dollars. A state can either identify resources and reimburse hospitals for the services they
provide to cancer patients or can allocate and give funding to hospitals to cover the needs of
undocumented immigr ants who have cancer. 15 This state by state approach if implemented,
wou ld be similar to how emergency M edicaid works, but rather treatments for cancer would be
accessible without the status of an “emergency condition”. The first approach states can take t o
provide cancer treatment and cancer care to patients is to expand emergency Medicaid to cover
cancer treatment more broadly. This would be implemented through giving cancer treatment
coverage to undocumented immigrants. The other approach states can take to address cancer
treatment coverage for undocumented immigrants is by creati ng a cancer specific Medicaid
coverage carve out. States may choose the first approach as expanding emergency Medicaid to
cover cancer treatment more broadly on a state basis wou ld be both politically and/or
administratively simpler than carving out a cancer specific Medicaid coverage as it would
require incorporating a change in Medicaid which already bars undocumented immigrants from
being insured under it. States may also choos e the first approach as the second approach to carve
out a cancer specific Medicaid coverage would require changes in eligibility for Medicaid
overall. Thus, in order to carve out a cancer specific Medicaid coverage, it would require a
change in state stat ute of existing Medicaid guidelines.
Present day, 2020, there is a global pandemic known as COVID -19. COVID -19 has
impacted countries all over the world, including the United States. “ Undocumented immigrants
and low -income immigrants historically have wor ked in a variety of important jobs, ranging
from field farmworker to retail clerk to registered nurse. These jobs, many of which now don the 6
“essential” label that allows businesses to continue operating, disproportionately employ low -
income and undocument ed individuals, exposing them to COVID -19 on a daily basis” .16 The
fiscal reality of the policy frameworks to address and implement expansion of emergency
Medicaid to cover cancer treatment more broadly for undocumented immigrants is very difficult
in the wake of COVID -19. With the focus shifted to what is needed for the majority of the
general public, to lower the not only the risk of contracting COVID but also to reduce the
amount of hospitalizations and deaths, it is of concern if funds that would’ve been allocated for
cancer treatment coverage would be cut back to address the health concerns related to COVID
since it imp acts the entire population. In relation to the fiscal realities with COVID -19 right now,
it doesn’t seem feasible for s tate governments to identify and allocate resources/state dollars for
undocumented immigrants but cancer is also a disease unlike other diseases, it can’t be put on
hold or kept stable without treatment.
Despite policy frameworks to give cancer specific M edicaid coverage to undocumented
immigrants there is still opposing viewpoints . California’s Medi -Cal program if extended to
undocumented immigrants, serves as a model for other states; it is a counter to federal health and
immigration policies. The depart ment of homeland security (DHS) proposed a goal to make sure
“foreign nationals do not become dependent on public benefits for support”. 17 In other words, the
Trump Administration believes that giving health care to undocumented immigrants would
encourage future illegal immigration. However, in a 2018 study by the Pew Research Center, it
was found that the number of unauthorized immigrants living in the U.S. went down from a peak
of 12.2 million in 2007 to 10.7 million in 2016. 18 This peak decreased over th e years when the
Affordable Care Act also commonly referred to as Obamacare gave many who were uninsured,
coverage. Another opposing view is that if hospitals take initiative to take care of undocumented 7
cancer patients by waiving fees, they won’t have fun ds to support other patient needs and can
become financially unstable. The cost of most cancer treatment procedures such as MRI’s,
surgeries, chemotherapy, radiation therapy, stem cell transplant which are very expensive. Many
hospitals would be unable to waive such high cost procedures and treatments for all
undocumented cancer patients, with no reimbursement for these high cost treatments to hospitals,
they would be compromising their financially stability, leading to reduced or ineffective care and
resou rces to other patients and medical needs. However, if emergency Medicaid to cover cancer
treatment more broadly were to be adopted and implemented, hospitals would be reimbursed
from Medicaid and could continue to serve undocumented cancer patients regardl ess of their
immigration status and without becoming financially unstable or having reduced or ineffective
treatment for other patients and medical needs.
In the United States, many undocumented immigrants are uninsured and face barriers to
health insuran ce and coverage options. Cancer is a terminal disease that is unpredictable and can
become fatal very quickly if left untreated. Data collected by the National Cancer Institute from
2010 to 2016 shows t hat of all cancer cases, there is a 67.4% 5 -year relative survival rate for
patients who receive d adequate and timely cancer treatment. 19 Lack of healthcare access has
shown to have detrimental impacts on undocumented cancer patients who already have barri ers
and challenges due to their immigration status. Cancer does not discriminate thus; it is crucial to
expand emergency Medicaid to cover cancer treatment more broadly to include access for
undocumented cancer patients .
8
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