Introduction
Unauthorized immigration poses many questions about the allocation of societal resources, services, and opportunities. On a traditional view, membership in a community is both what subjects you to its rules and entitles you to its benefits, and for a nation, membership is generally codified by citizenship. Requirements for citizenship vary, but many nations automatically extend citizenship to children born within the nation’s border and/or have a formal naturalization process. Naturalization often involves several steps on the bureaucratic path to full citizenship (I.e., providing biometric data, having history in country of origin vetted, being interviewed by immigration officers, swearing an oath of allegiance, etc.) and this can take years to complete (18-24 months on average for naturalization in the U.S.). For a variety of reasons, many immigrants do not complete the steps required to become a full citizen prior to their arrival, leaving their rights and entitlements a point of contention.
One contention concerns the provision of healthcare. Unauthorized immigrants are not generally eligible to enroll in health care insurance within the U.S. until they acquire full citizenship (some are able to acquire healthcare through employers or private insurance plans), which leads to scenarios where individuals have lived in the U.S. for years and are socially and professionally embedded in their local community, and yet are still unable to receive healthcare. Some consider these scenarios unjust, but the reasons why are unclear—what is it about that scenario that does the heavy lifting, morally speaking? Physical presence? Time spent living somewhere? Social embeddedness? Contribution to societal productivity? All of them together, or some yet un-mentioned reason? Moreover, there are also those who argue that extending rights and entitlements to unauthorized immigrants is unfair and punitive to those who complete naturalization ‘the right way’, or that it is a prerogative of a nation state to carefully vet and decide who is allowed to become a citizen, and so disqualification from healthcare is an appropriate deterrent or consequence of failing to naturalize.
At the heart of this debate is the question: what makes a member a member? What are the necessary and sufficient conditions for membership, and what privileges or rights are appropriate to confer to members vs. non-members?
Assigned Readings
Thesis: Daniels and Ladin argue that there is a strong presumption in favor of extending healthcare to unauthorized immigrants through the PPACA. Their argument has two horns: (1) “healthcare is a benefit owed as a matter of reciprocity for contributions made by unauthorized immigrants,” and (2) “unauthorized immigrants are entrenched and contributing members of the community and all members of the community must have their health protected” (Daniels and Ladin, 2015). The authors note that most unauthorized immigrants contribute financially by paying sales and property taxes and working for employers who withhold taxes. Moreover, they contribute to the “social fabric” of their communities by embedding themselves socially and participating in religious and civic activities, and so deserve healthcare on the grounds of societal reciprocity.
Thesis: Young and Lehmann discuss medical repatriation, a process by which unauthorized immigrants in need of healthcare are involuntarily transferred to their country of origin. The authors suggest that medical repatriation is likely motivated by financial considerations on the part of hospitals, legal considerations with respect to returning unauthorized immigrants to their country of origin, and “responsible stewardship of limited resources” (Young, Lehmann, 2014). Despite this, the authors argue that healthcare providers have an ethical duty to provide care without concern for citizenship—to treat all incoming patients as having equal claim to healthcare.
Thesis: Aas puts forward a cooperation-based, egalitarian argument for extending society’s benefits equally among its [compliant] citizens. Aas refers to his position as serious distributive egalitarianism. Aas rejects reciprocity as the principle grounds for distributing society’s fruits equally, relying instead on a “brutely ‘productivist’, anti-exploitation principle, which demands returns proportional to contribution to productive enterprises” (Aas, 2017). Aas argues that any compliant citizen (I.e., someone who cooperates with society’s rules) earns some share of the worth or value of the opportunities their cooperation produces or makes possible.
Discussion Questions
- Daniels and Ladin reject “global justice” and “human rights” based arguments for inclusion, contending that states retain the final authority to decide who is entitled to benefits and who is not. What are the pros and cons of rejecting these “cosmopolitan” arguments about healthcare and preserving state powers to regulate immigration?
- Daniels and Ladin address (and dismiss) several arguments against the universal provision of care, including that there is no legal obligation to do so, not rewarding illegal activity, avoiding incentivizing illegal immigration, that providing care is too costly, that emergency care is sufficient, and that providing care hurts legal residents who are vulnerable (low skilled workers with limited education). Which of their rebuttals did you find convincing, and which issues remain a significant source of concern?
- A key premise in Aas’s argument is that “differences in contribution do not count, in justifying distributions of what is produced, if those who contribute more are responsible for the fact that others contribute less” (Aas, 2017, emphasis mine). How does Aas argue that this condition has been satisfied? How might one argue that it has notbeen satisfied?