The topic of undocumented immigrants is heavily debated across the United States. Furthermore, the concept of these undocumented immigrants receiving subsidized healthcare is an even more highly controversial matter. The conflicting sides are significantly divided even though the United States of America was founded upon the notion of freedom and the melting pot ideology. This paper will examine the dilemma of undocumented immigrants and access to subsidized health care; yield a few attainable solutions in addition to some recommendations for the future on how this issue may be solved. Immigration has been around in the United States of America since the colonial times. Along with those immigrants come many other issues, including healthcare. Many of the millions of immigrants presently in the United States are without insurance. This paper will discuss how important it is for us as Americans to provide those who are uninsured and here illegally with some form of subsidized care. Additionally, this article will inform readers on reasons why this should derive from an ethical standpoint and due to the associated health risk that can come about for those who are here legally. The multiplying constituency base includes healthcare providers, consumers, and buyers. There is a great importance to these individuals regarding the assurance of a more equitable and accountable system of healthcare (Kaiser Family Foundation). The terms “illegal immigration” and “undocumented immigration” are often used in an interchangeable manner. “Illegal immigration is the movement of a person from his native country to foreign country, with an intent to find a lively hood and settle down without the permission of the government. Illegal immigration is an offense with legal consequences from the state’s criminal code.” (Buzzle.com) Undocumented immigrants are not all settled into the United States of America under the same circumstances. In the vicinity of 55% of the undocumented immigrant population are people who made an entrance into the United States without permission. The other 45% of the population are people that originally had permission to be a part of the United States. However, these individuals remained in the country past the amount of time they were given according to their visa (Theadvocatesforhumanrights.org). Immigration in the United States dates back to colonial times circa 1607 and still occurs today (ProCon.org, “Historical Timeline”). Along with the long history of immigration in the United States, healthcare has always been viewed as a right and not a privilege here. The adoption of a system of social insurance for American use proved that healthcare and well being should be a right of the people. Today, the United States has a very diverse population of people, many of them being immigrants from other countries. “Immigrants are a large and rapidly growing segment of the United States population, and they disproportionately lack health insurance.” (Goldman, Smith, and Sood 1640) The people that come to the United States legally are not the significance of the issue. However, those that come illegally have brought about numerous issues of concern to the citizens of the United States. The United States of America has a reputation for being a land of freedom, and immigrants mainly come here looking to have a better life for themselves and their families. Opposed to what many may believe, immigrants, come to America because of the greater economic opportunities, to move away from a lower socioeconomic status, for a better quality of life, and to escape poverty. Often times, there is the overpopulation in their home country. Furthermore, many are seeking family reunification, fleeing war, or looking for asylum. Citizens in other countries do not always have all of the freedom and liberties offered here in the United States so they come here looking for that opportunity of living the American dream of living in a free land. An issue of Immigrants and Healthcare: The refusal to provide millions of undocumented immigrants with subsidized health care is unethical and will only ensure the American citizens will have a more significant problem in the future. Denying these people accessible healthcare will only force them to utilize emergency services more and drive up the cost of care. According to some research conducted by the Kaiser Family Foundation, “when compared with the insured, the uninsured are less likely to have a regular doctor or to get timely and routine care, and are more likely to be hospitalized for preventable conditions.” (3) Furthermore, this issue will soon threaten the health of the public because of the risk that is associated with communicable diseases that go untreated. Along with the previous issues at hand, there will be the, the ethical dilemmas that nurses may face if they have to use the citizenship status of the patients to determine his or her eligibility for emergency medical care, and violation of EMTALA Laws (Grim and Wells). The stigma that immigrants may soon face will most likely have an effect on the well being of children who are United States citizens but live in immigrant households. Many immigrants who come here to the United States come with nothing and have no health coverage. Studies show that the majority of undocumented immigrants that live in the United States are from Mexico and Latinos have the highest rate of uninsurance. Latinos are at a greater risk of developing health complications later in life, such as diabetes and obesity. These conditions will only worsen without access to healthcare. Though many Americans are against undocumented immigrants receiving subsidized healthcare, many fail to see the many contributions that immigrants make to our society (Theadvocatesforhumanrights.org). Immigrants are net contributors to economy and treasury, and play an essential role in maintaining the Social Security system via their employment deductions. Despite these contributions, the Social Security system is a program that they have no access to. Unauthorized immigrants pay taxes and also represent 5% of the United States labor force (www.ProCon.org, “Is Illegal Immigration an Economic Burden to America?”). United States employers benefit from the cheap labor that immigrants provide and they help fuel the United States economy through hard work and entrepreneurship (Theadvocatesforhumanrights.org). Ethical Dilemmas: Nurses and other hospital workers may encounter ethical dilemmas if they have to use the citizenship status of the patients to determine his or her eligibility for emergency medical care. Often times, the status of the immigrants are used in investigations to differentiate immigrants and the other patients. The researchers, in addition to the physicians, are held accountable to disconnect their personal and political opinions and their professional obligations. (Achkar and Macklin) Unfortunately, the political climate of the United States increasingly holds a negative stigmatization upon the population of undocumented immigrants. Ethically, an individual may question if the publication of these inquisitions would cause the population at large to have a stronger reaction towards these undocumented immigrants. Additionally, the immigrants involved may wonder if their information would be given to the authorities for their removal from the country. (Achkar and Macklin) The possible violation of EMTALA laws is a constant struggle for medical facilities that receive federal funding. “Congress enacted the Emergency Medical Treatment and Active Labor Act (“EMTALA”) in 1986″ due to various hospitals refusing treatment on patients without insurance (Smith 310). EMTALA forces hospitals to treat any individual that becomes a patient through the emergency department that is experiencing medical conditions of an emergency nature until they have stabilized in their status. Furthermore, EMTALA is referred to the Patient Anti-Dumping Act. Therefore, this order prohibits hospitals from “denying treatment to emergency patients or inappropriately transferring (including discharging) patients in unstable conditions to other hospitals.” (Smith 310) Despite this movement, hospitals use their own funding to fly the patients back to their native lands of Guatemala, Honduras, and Mexico where they eventually passed away due to their inability to pay for healthcare services. (Smith 310) Currently, there are no legislative guidelines to enforce upon the hospitals that privately fly patients to their native homelands. “Congress must enact federal legislation to ensure that American hospitals are not engaging in international patient dumping.” (Smith 311) Even though EMTALA is federally mandated, the movement is not federally funded. “The funding should come from the billions of dollars in taxes that undocumented immigrants pay yearly for services and benefits that they will never recoup.” (Smith 311) Moreover, the “Patient Protection and Affordability Act” became law under the rule of President Barack Obama. (Smith 311) This act is seen as a move of great importance. However, undocumented immigrants are not entitled to the benefits of this legislative move. (Smith) According to the Kaiser Family Foundation, eliminating the ethnic and racial disparities in regards to health care are “politically sensitive and challenging in part because their causes are intertwined with a contentious history of race relations in America” (1). The conflicts surrounding the racial tensions and ethnic disparities extend to the formation of the United States of America. “Undocumented immigrants are a voiceless people, and thus, Americans easily find fault with their presence in the United States while simultaneously overlooking their overwhelming contributions to the country.” (Smith 333) The healthcare system of the United States has an abundance of problems due to the lack of a universal health policy. Therefore, the blame of the obstacles faced by the various hospitals and the emergency departments can easily be placed on undocumented immigrants. (Smith) Policymakers have increased the amount of attention given to the disparities in health care on how to resolve these differences. The Congress of the United States “…provided leadership on the issue by legislatively mandating the Institute of Medicine study on health care disparities and creating in the statute, the National Center on Minority Health and Health Disparities at the National Institutes of Health” (Kaiser Family Foundation 2). The Institute of Medicine study was a review of inquisitions that have taken place between the years of 1984 to 2001. According to these investigations, evidence of difference has been found in the quality of care for individuals that have equivalent insurance and the same illness (Kaiser Family Foundation). Furthermore, there are costly ramifications to the citizens of a population on a social level in addition to the health-related consequences when there is a specific group of people to become ill and unable to receive health care services. These issues include the decrease in productivity in the services they provide. According to Francine J. Lipman, “Unauthorized workers are a critical component of our micro and macro economies today and in the projected next several decades as almost 78 million boomers prepare to retire and leave the workforce” (ProCon.org, “Illegal Immigration”). Additionally, the costs of emergency care can be more expensive for serious illness than if the patient had been seen for preventative care. The multiplying constituency base includes healthcare providers, consumers, and buyers. There is a great importance to these individuals regarding the assurance of a more equitable and accountable system of healthcare (Kaiser Family Foundation). The American Civil Liberties Union has addressed the controversy of immigrants being criminalized by state and local government. An Issue Brief was released by the Immigrants’ Right Project due to the increasing amounts of criminal charges being imposed on undocumented immigrants. Even though the federal government has progressively selected to use criminal charges to prosecute undocumented immigrants instead of the civil procedures used to enforce the federal laws on immigration, the localities, and the states are not permitted to execute these federal laws to manage immigration. (American Civil Liberties Union) Resources in the law enforcement and judicial system have been taken away from the significant crimes involving property and violence in the state and other local agencies due to the majority of the resources being utilized to prosecute immigration violations. This may impact their effectiveness on public safety. “As federal prosecutions for immigration law crimes such as illegal entry have increased dramatically, with prosecutors choosing to pursue 97 percent of all such crimes referred to them, federal prosecutors have had less time for prosecutions for gun trafficking, public corruption, organized crime, and white-collar crimes” (American Civil Liberties Union). Government leaders from both the Democratic and the Republican sides are in agreement there needs to be more focus placed on the ethnic disparities in healthcare. Despite the topic of racial differences in medical coverage becoming a political agenda, other circumstances may have an effect on the ability to accomplish this goal. “Issues of national security, the federal deficit, and rising health care costs appear to be deferring prospects for a major federal role on this issue.” (Kaiser Family Foundation). Legislators of the United States attempted to ensure they would be re-elected in the next election. Therefore, these officials made the decision to exclude the undocumented immigrants in the healthcare legislation they passed in an effort to seek their vote for re-election. (Smith) The United States of America is presently in a state of controversy as the citizens and interest groups debate whether Undocumented Immigrants should receive subsidized healthcare. Despite the United States being established surrounding the melting pot ideology, and being the land of the free, there are conflicting sides on this matter. This paper explored the predicament of access to subsidized healthcare if you are an undocumented immigrant. Furthermore, there is a discussion on possible resolutions and suggestions for solving this issue for the future. Immigration began in the United States of America since the colonial times. There are a number of issues, including healthcare, surrounding the immigrants that migrate here. A number of the immigrants currently living in the United States are with no insurance. This paper discussed how important it is for us as Americans to provide those who are uninsured and here illegally with some form of subsidized care. In addition, this article informed the readers on causes for why this should derive from an ethical standpoint and due to the associated health risk that can come about for those who are here legally. The increasing constituency base includes healthcare buyers, consumers, and providers. The assurance of a more equal and responsible healthcare system is important to these individuals.