NR 506 Your Policy-Priority Issue Assignment
NR 506 Your Policy-Priority Issue Assignment
With an estimated 400,000 illegal or undocumented immigrants in Georgia, Georgia is on record as one of the states with the most stringent immigration healthcare laws (Ridder, 2015). Under federal law, Georgia’s undocumented immigrants are prohibited from receiving public or private healthcare services, purchasing private health insurance, or receiving public healthcare insurance; however, they can receive emergency healthcare services at a hospital ER. Undocumented immigrants can also receive limited healthcare services from state approved community health centers or safety net hospitals. Georgia adheres to federal laws governing healthcare services, but state law enforcement agencies have begun to enforce the “show me your papers” clause under Georgia’s central immigration law (Yee, 2017). This clause places severe restrictions on undocumented immigrants’ ability to travel. Undocumented immigrants are less likely to seek health services because they may be deported after receiving treatment (Sconyers & Tate, 2016). My public policy focuses on making healthcare services more accessible to Georgia’s undocumented immigrant population. The health policy will focus on providing a standard delivery of equitable health care services (to include low cost vaccinations for school age children and six-month health checkups) for all undocumented immigrants in Georgia. The policy will also include a provision that blocks medical deportation while receiving any of the medical services listed within the conditions of this new public health policy.
My public policy issue impacts Georgia’s nurses because the law restricts the type of healthcare services nurses can offer to undocumented immigrants. This raises ethical issues as nurses are both the central health providers for patient care and information resources who drive patient safety and quality. There is no specific Georgia legislator in charge of immigration legislation. Each immigration bill, and there are many of them, is authored by one or several state representatives or senators and sponsored by various committees. In that my policy is healthcare based, I will contact State Representative Sharon Cooper. I think she would be interested in my policy issue for several reasons: Rep. Cooper is the chairperson over the Health and Human Services Committee; she has an MSN in Nursing; she is a member of the Special Committee on Saving Grady Memorial Hospital (Atlanta’s largest “safety net” hospital). She is a noted conservative, but I believe her experiences in nursing and education make her a compassionate and knowledgeable ally for my public health policy. Rep. Copper can be reached at the State Capitol in Atlanta, GA (404-656-5069) or at the district office in Marietta, GA (770- 956- 8357. Her email address is [email protected]., and her Facebook link is https://www.facebook.com/State-Rep-Sharon-Cooper-133816235514/.
The context of the public healthcare policies aimed at undocumented immigrants living in Georgia starts with laws passed on the federal level. Georgia must follow federal guidelines regarding healthcare services for undocumented immigrants, the type of medical services provided, and the location healthcare services can be received (Ballotpedia, 2018). However, the state can also create its own immigration laws that do not conflict with federal provisions. Instead of passing a public health policy that benefits undocumented immigrants and legal residents, for the greater good of society, state legislators have chosen to pass laws that limit the scope of care undocumented immigrants can receive outside of the ER if they do not present a valid ID. Georgia’s public healthcare policy is so restrictive that as of October 2016 enacted legislation does not even allow lawfully residing immigrants to enroll in Medicaid or CHIP (Ballotpedia, 2018). Georgia legislators are conservative and want to provide as little healthcare services to immigrants as possible, which is evident by many of the state laws that have been passed regarding this population.
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One of the identified need for changes is Georgia’s legislators’ ideas about undocumented immigrants and their connection with spreading diseases. For example, Rep. Phil Gingrey, R-Ga. wrote an impassioned letter to the CDC in July of 2014 advocating for stricter federal immigration polices because he feels undocumented immigrant children carry all types of diseases, such as dengue fever and tuberculosis that place other school age children at risk (Poon, 2014). In response, the CDC released a statement that there is little evidence that undocumented immigrants are to blame for diseases outbreaks of measles, pertussis, hepatitis C, and other diseases (Tani, 2015). This is also a key point that I will have to overcome when presenting my public healthcare policy to Rep. Cooper. Another identified need for change is that both Georgia and the federal government’s public healthcare policies allow for the deportation of sick undocumented immigrants. In Georgia, hospitals are no longer “sensitive locations” protected from enforcement actions. This poses ethical issues for nurses and doctors, as they are legally forced to stop treatment on sick patients under arrest.
The goal is to provide undocumented immigrants access to a better and varied set of healthcare services. Another goal is to eliminate medical deportations and re-establish Georgia’s hospitals as “safe locations,” to include all medical facilities. My solution is to pass a socially and ethically appropriate public health policy that benefits legal residents and undocumented immigrants. The policy will eliminate medical deportations from “safe locations,” approve low cost preventative care checkups every six months with no ID required, and support low cost childhood vaccines for school age children. My rationale is to make healthcare services more accessible to undocumented immigrants and remove the threat of deportation to help them make a better informed decision about going to the doctor; therefore, minimizing the concerns of Georgia legislators about disease outbreaks. Providing a standard delivery of equitable health care services is a more noble use of Georgia’s economic resources. The low cost paid by undocumented immigrants will help offset some of the medical costs absorbed by the state, which will be offset by some of the $67 million in federal funds Georgia receives for healthcare.
Analysis of Empirical Evidence:
The CDC has acknowledged there is a risk of high levels of disease spreading but that risk does not stem from undocumented immigrants alone (Jacobson, 2015). Surveyed medical experts all agree that there is “no hard data” to prove that undocumented immigrants have spread unusually high levels disease; a disease outbreak can come from legal immigrants, refugees, international travelers, and yes even from a U.S. citizen (Jacobson, 2015). Therefore, continuing to pass Georgia legislation that limits undocumented immigrants access to healthcare based upon these grounds is counterproductive. The success of my public health policy hangs on my ability to show that undocumented immigrants do not pose a strain on Georgia’s healthcare system and that undocumented immigrants will not trigger a disease outbreak. I must also show that medical deportations pose more risk, as scrutiny and lawsuits from anti-immigrations coalitions and civil liberties organizations like the ACLU will grow.
I plan to convey this message to Rep. Cooper. I know her schedule is busy, so getting a meeting may be challenging. My contingency plan is to set up a meeting with another member of the Health and Human Services Committee, Kim Schofield (D – Atlanta). Before I present my public policy, I must develop a solid objective, clear plan of delivery, and a written proposal of my public policy. My aim is to evoke empathy and compassion for undocumented immigrants and familiarity with the nursing profession and its goals. I would also like to bring some charts and graphs that validate the details of my proposal. I must give Rep. Cooper a chance to present her point of view but be able to provide counterpoints that open the floor to meaningful discourse and hopefully some resolution. It is critical that I present with confidence and stick to my presentation. Communication skills are critical, such as maintaining eye contact, steadying my tone of voice, and using visual aids.
Importance and Impact to Nursing:
Under current Georgia law, nurses are under no obligation to report undocumented patients, but they are also under no obligation to provide treatment outside of an ER setting. Some nurses may feel obligated to call immigration enforcement on foreign patients who present fake IDs or who they suspect are undocumented immigrants. Nurses who report illegal immigrants raise ethical concerns within the nursing profession: nonmalfeasance, beneficence, confidentiality, fidelity (Sconyers & Tate, 2016). If nurses exercise their legal rights not to disclose any personal information about a suspected undocumented patient to immigration enforcement officials, their silence is often the nail in the coffin that causes undocumented patients to be carted off in cuffs. The ethical dilemma for nurses raises questions about whether nurses have a higher ethical responsibility to the government or to the professional code. (Sconyers & Tate, 2016).
Georgia’s public health policy regarding access and type of healthcare for undocumented immigrants is in dire need of reform.The policy approves medical deportation and offers limited access to healthcare services, which restricts 400,000 people from seeking necessary healthcare services. My policy calls for comprehensive policy reform that expands access to health care for undocumented immigrants based on an analysis of their impact on health care expenditures, public health, and the role of health care providers. Nurses can advocate this reform on ethical grounds, maintaining the goal is to improve the health of everyone in Georgia.
Ballotpedia. (2018). Immigration in Georgia: Public policy in Georgia. Retrieved from https://ballotpedia.org/Immigration_in_Georgia
Jacobson, L. (2105, July 23). Are illegal immigrants bringing ‘tremendous’ disease across the border, as Trump says? Unlikely. POLITIFACT. Retrieved from http://www.politifact.com/truth-o-meter/article/2015/jul/23/are-illegal-immigrants-bringing-tremendous-diseas/
Poon, L. (2014, July 22). The immigrant kids have health issues — but not the ones you’d think. National Public Radio (NPR). Retrieved from https://www.npr.org/sections/goatsandsoda/2014/07/22/332598798/the-immigrant-kids-have-health-issues-but-not-the-ones-youd-think
Ridder, K. (2105, September 14). Illegal immigration population in Georgia. NewsMax. Retrieved from https://www.newsmax.com/fastfeatures/illegal-immigration-georgia/2015/09/14/id/691510/
Sconyers, J., & Tate, T. (2016). How should clinicians treat patients who might be undocumented? AMA Journal of Ethics, 18(3), 229-236. doi: 10.1001/journalofethics.2016.18.03.ecas4-1603
Tani, M. (2015, February 24). CDC official dismisses claim that undocumented immigrants bring measles into the U.S. Huffington Post. Retrieved from https://www.huffingtonpost.com/2015/02/23/undocumented-immigrants-measles-outbreak_n_6737102.html
Yee, A. (2017, May 31). Feds, states target southern ‘sanctuary cities’. Savannah Now[Savannah]. Retrieved from http://www.savannahnow.com/lavozlatinaonline/noticias/2017-05-31/feds-states-target-southern-sanctuary-cities