title: The potential conflict between policy and ethics in caring for undocumented immigrants at academic health centers.
abstract: Academic health centers (AHCs) are at the forefront of delivering care to the diverse medically underserved and uninsured populations in the United States, as well as training the majority of the health care workforce, who are professionally obligated to serve all patients regardless of race or immigration status. Despite AHCs' central leadership role in these endeavors, few consolidated efforts have emerged to resolve potential conflicts between national, state, and local policies that exclude certain classifications of immigrants from receiving federal public assistance and health professionals' social missions and ethical oath to serve humanity. For instance, whereas the 2010 Patient Protection and Affordable Care Act provides a pathway to insurance coverage for more than 30 million Americans, undocumented immigrants and legally documented immigrants residing in the United States for less than five years are ineligible for Medicaid and excluded from purchasing any type of coverage through state exchanges. To inform this debate, the authors describe their experience at the University of New Mexico Hospital (UNMH) and discuss how the UNMH has responded to this challenge and overcome barriers. They offer three recommendations for aligning AHCs' social missions and professional ethics with organizational policies: (1) that AHCs determine eligibility for financial assistance based on residency rather than citizenship, (2) that models of medical education and health professions training provide students with service-learning opportunities and applied community experience, and (3) that frontline staff and health care professionals receive standardized training on eligibility policies to minimize discrimination towards immigrant patients.
authors.affiliation: Dr. Cacari Stone is assistant professor, Department of Family and Community Medicine, and senior fellow, Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico, Albuquerque, New Mexico. Ms. Steimel is director, Office of Community Affairs, University of New Mexico, Albuquerque, New Mexico. Ms. Vasquez-Guzman is Robert Wood Johnson Foundation Doctoral Fellow and a graduate student in the Department of Sociology, Albuquerque, New Mexico. Dr. Kaufman is Distinguished Professor of Family and Community Medicine and vice chancellor for community health, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cacari Stone
authors.forename: Leah
authors.initials: L
authors.lastname: Steimel
authors.forename: Estela
authors.initials: E
authors.lastname: Vasquez-Guzman
authors.forename: Arthur
authors.initials: A
authors.lastname: Kaufman
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D003220:Conflict, Psychological; D003695:Delivery of Health Care / Q000458:organization & administration; D004503:Education, Medical, Graduate / Q000458:organization & administration; D054242:Emigrants and Immigrants / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D005260:Female; D006282:Health Personnel / Q000193:education; D006291:Health Policy; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D020380:Needs Assessment; D009516:New Mexico; D058991:Patient Protection and Affordable Care Act / Q000941:ethics*; D011050:Policy Making; D035862:Vulnerable Populations / Q000706:statistics & numerical data