Health Justice for Immigrants

4 University of Pennsylvania Journal of Law & Public Affairs 235 (2019)

78 Pages Posted: 20 Jan 2019

Date Written: January 9, 2019


Should universal health coverage include immigrants within the “universe?” Should federal taxpayers subsidize health insurance coverage for immigrants, even those who are undocumented? Should all immigrants be required to purchase health insurance? Although the Affordable Care Act (ACA) is conceived as a progressive project to expand access to coverage and promote equity in health care, it intentionally left out the 10.7 million undocumented immigrants living in the United States and preserved the existing restrictions on subsidized coverage for lawfully present noncitizens. In fact, it increased the disparity in access to health care between U.S. citizens and immigrants. As a result, immigrants suffer disproportionately from delayed treatment, unnecessary pain and suffering, and stress.

Understanding how and why immigrants have been left out of progressive efforts to subsidize health insurance coverage can help to illuminate the fundamental defects in our health care system that perpetuate these and other inequities. This Article introduces a new paradigm for analyzing the issue of immigrant access to the health care safety net, arguing that Health Justice requires that immigrants receive equitable access to subsidized health coverage. It demonstrates that the ethical norms underlying access to health care — the principle of need, which directs health care providers to offer care to those in need, and the principle of mutual aid, which dictates that health care resources should be distributed based on medical need — support the inclusion of immigrants in the community entitled to health care.

Keywords: Health Policy, Immigration Policy, Health Care Access, Health Insurance, Health Reform, Affordable Care Act, Communitarian, Social Justice, Health Justice, Health Equity

Suggested Citation

Makhlouf, Medha, Health Justice for Immigrants (January 9, 2019). 4 University of Pennsylvania Journal of Law & Public Affairs 235 (2019). Available at SSRN:

Medha Makhlouf (Contact Author)

Penn State Dickinson Law ( email )

150 S College St
Carlisle, PA 17013
United States

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