The United States has a very long and often complicated relationship with immigration. Although Ellis Island is lauded as a uniquely American symbol of freedom and hope, those moving to this country seeking better economic opportunities or to escape oppression and violence have not always received a warm welcome. Even today, several studies show that immigration status is often associated with health care disparities.1
The American Society of Clinical Oncology, the American Society for Hematology, and the American Association for Cancer Research, among other industry groups, have all established initiatives aimed at improving cultural competency among practitioners and diversity in clinical trials. As physicians at the beginning of their careers, fellows are singularly positioned to make cancer care more inclusive for all patients.
According to findings from the Center for Immigration Studies published in December 2021, the immigrant population includes 46.2 million documented and undocumented people, the highest total in US history. Overall, 14.2% of people in the United States come from somewhere else.2
Undocumented immigrants are foreign-born individuals who have migrated to the United States without authorization.2 Contrary to conventional wisdom and anti-immigration policies, approximately 50% to 70% of the undocumented immigrant population pays federal and state taxes. Despite their contributions to the American economy, the undocumented population continues to face discriminatory policies.1 Those who have been diagnosed with cancer and their loved ones, in particular, feel the sting of those disparities. These policies affect undocumented immigrants with cancer on emotional, financial, physical, and social levels.
Disparities Within the Health Care System
The Affordable Care Act is a federally funded initiative implemented in 2010 to allow more affordable health care options for millions of Americans. However, this initiative excludes many in the undocumented population.
Research shows that those who are undocumented are rarely able to attain full insurance coverage, whether it is private insurance from the marketplace or Medicaid. Multiple states have expanded Medicaid policies to cover service gaps for undocumented individuals (Emergency Medical Treatment and Active Labor Act), but this extended policy varies by state and solely covers emergency services. This affects individuals who are diagnosed with cancer for any type of treatment. Individuals who seek emergency services due to a diagnosis may receive emergency medical attention; however, it typically does not cover cancer treatment costs.