A recent World Health Organization ranking of the world’s health systems puts the United States at number 37 between Costa Rica at 36 and Slovenia, first lady Melania Trump’s birth country at number 38. This situation is all the more surprising since the United States spends more than twice as much per capita for health care as 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, however some of the health indices that drag the United States down on WHO rankings are high maternal mortality rates, health equity and unequal access to health.
Whilst Obamacare has potential to improve some of these indices a rule currently being developed by the Trump Administration in addition to its incessant attacks on the Affordable Care Act (ACA) could potentially make things even worse than it is now. 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 and would likely affect the health of all Americans especially children. Current immunization rates in the US tend to be lower than other developed nations on account of a significant proportion of US citizens who decline immunizations for various reasons. In a situation with high overall immunization rates the risk of non-vaccinated individuals is significantly reduced on account of the higher level of population immunity. This has been described as herd immunity meaning that once a large proportion of individuals have received the vaccine the few who object are protected due to the protection of the whole group. 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 all make it a point to look out for this rule and voice out our views during the public comment period which would be required for a rule which does not require congressional approval. The rule is expected to be published in the Federal Register in the coming weeks 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