A recent WHO ranking of health systems puts the US at number 37 between Costa Rica and Slovenia. This is more surprising since US heath expenditure per capita is twice that of the number one country France. The question that most people ask is why we rank so low if we spend so much on healthcare? The answer to this question is not that simple. The indices that drag the United States down on rankings are high maternal mortality rates, health equity and unequal access.
Obamacare can potentially improve these indices however a new Trump Administration rule could make things worse. The Trump administrations incessant attacks on the Affordable Care Act (ACA) cause a lot of uncertainty. In addition to that White House Senior Advisor Stephen Miller is currently working on a proposal that would limit access to citizenship to legal immigrants who utilize public welfare programs including State Child Health Insurance Program (SCHIP) and Obamacare.
This rule goes further than prior regulations that restricted access to Social Security Insurance to immigrants. The public health repercussions of such a rule if passed would go far beyond immigrants. The rule would likely affect the health of all Americans especially children. Current immunization rates in the US tend to be lower than other developed nations. US low immunization rates is due to significant proportion of US citizens declining immunizations for various reasons.
When populations have high immunization rates, risk of disease risk in unvaccinated individuals is minimized by high levels of population immunity. This is called herd immunity. When a large proportion of a population are vaccinated those who object also get the benefit of this protection. This new rule could force immigrants who cannot afford healthcare outside of Obamacare or pay for it out of pocket to elect to opt out of essential preventive health care services like immunization.
To protect the health of all Americans we must make it a point to look out for this rule and voice out our concerns during the public comment period. All such rules require a comment period since they do not require congressional approval. The administration would need to published the rule in the Federal Register followed by a 60 day comment period. Supporting healthcare for all our residents, US citizens, non-citizens and legal and illegal immigrant is important to ensure good health for all of us. As long as we share this land our lives and futures would remain intertwined and interdependent. We must all work together to protect the health of all US residents.
By Dr. Leonard Sowah, an internal medicine physician in Baltimore, Maryland