Central American migrants walk during their journey towards the United States in Villa Comaltitlan, Mexico, April 18, 2019. (Jose Cabezas/Reuters)

Some notes to the candidates who raised their hands last week when asked if they would support health insurance for undocumented immigrants:

First, there are already clinics and emergency rooms across the U.S. that provide a safety net for many millions of patients, including those in the country illegally, whether or not they have health insurance.


The clinics are known as Federally Qualified Health Centers. They received grants under Obamacare from 2010 to 2015, and as they expanded they began to receive more income from patients coming in with their new Medicaid cards. I traveled to one of the clinics a few years ago on the shores of Lake Erie, in Dunkirk, N.Y., and was told by the medical director there that 85 percent of their patients now have insurance and the main problem is a shortage of doctors.

Emergency rooms across the country have the same problem. They are bound by law to see patients in an emergency whether they have insurance or not. Most of our ERs have too many patients, but too few physicians and nurses. Illegal immigrants are able to use these facilities and they do, whether they can pay for the care they receive or not.

Second, health insurance doesn’t automatically improve access to actual care. In fact, by further clogging our ERs and clinics, insuring illegal immigrants could reduce access to care for Americans who already have insurance yet suffer from long waits, overcrowding, and health-care worker shortages.



I interviewed a patient at that clinic in Dunkirk who praised the doctors and nurses for being available 24/7 as he tried and succeeded in defeating his addiction to opioids. Medicaid paid his bill, but with the clinic stretched thin and suffering from a perpetual doctor shortage, I had to wonder who would have been available to return his late-night phone call and guide him through withdrawal if the clinic had been overwhelmed with even more patients.



Democrats might consider my position heartless, but I consider it practical. It’s too easy for a politician not to factor in real-world math before putting his hand up. It’s too easy for him to forget the difference between health coverage and health care.

But down in the medical trenches of an ER or community clinic, where we don’t distinguish between citizens and non-citizens or even insured and uninsured, we must focus on providing high-quality health care for all comers. We already have the safety net to provide for those without insurance, whether they are immigrants or not. We need to expand it. We need more doctors, more nurses, and more supplies to accomplish that, not more insurance.