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Posted on January 7, 2021 at 4:48 PM

by Mark G. Kuczewski, PhD

Another day, another headline to stoke fear in the minds and hearts of immigrants. This one did not come from the federal government but was based on the statements of Governor Pete Ricketts of Nebraska. His response to a reporter’s question led many to believe that undocumented immigrants working at the state’s meatpacking plants would not be eligible to receive vaccination for COVID-19. However, a spokesperson for the governor later clarified that proof of citizenship was not required for COVID-19 vaccination but nevertheless added that  “… while the federal government is expected to eventually make enough vaccine available for everyone in the country, Nebraska is going to prioritize citizens and legal residents ahead of illegal immigrants.”

As is often the case, these cruel-sounding statements mean little operationally. While they may be meant to express the posture of a politician toward undocumented immigrants, they also express an exclusionary sentiment toward undocumented immigrants and likely spread fear that seeking vaccination could cause problems.  Because even casual brushes with the law can lead to being detained and deported, such statements add to a climate of fear and likely will make it more difficult to vaccinate this population.

This incident illustrates deeply ingrained flaws in the way we think about healthcare in general and immigration in particular. Healthcare, in the form of a vaccine in this instance, is seen only as a benefit to the recipient. An undocumented immigrant is seen as unworthy of the benefit or at best, as occupying the lowest possible rung on the latter of human worth, i.e., a low priority. It is this framework that has led to the exclusion of undocumented immigrants from federal “benefits” such as federal student loans, social security, and from the full-cost purchase of health insurance on the exchanges created by the Affordable Care Act. Similarly, most states will not grant the “benefit” of a driver’s license to an undocumented immigrant.

When we conceive of health insurance and educational opportunity as … something that may be limited based on [individual] merit and worth, we undermine and limit the systems that are meant to serve us all.

The current pandemic should lay to rest the idea that healthcare is a benefit only to the recipient. Vaccines have long been considered public health measures because they can prevent an inoculated person from becoming sick and spreading disease to their neighbors, especially those for whom the vaccine may be medically contraindicated. States are developing their vaccination priorities based on considerations such as enabling workers who serve functions related to critical infrastructure to be able to continue at their work. Even the prioritizing of high-risk patient groups benefits the community by preserving hospital capacity. When we discourage the vaccination of a person who is an undocumented immigrant, we place in jeopardy other members of our society and the society’s efficient functioning.

The benefits to society are so clear in this instance that even Governor Rickett’s spokesperson seemed to acknowledge that after all other residents of the state got theirs, undocumented immigrants should also be vaccinated. Moreover, we can generalize from this lesson. Enabling all to participate in our healthcare, education, and public safety systems generally benefits society, not just the individual. I have argued elsewhere that enabling undocumented immigrants to purchase health insurance on the state exchanges adds a younger, healthier population who pay premiums and are then also covered rather than rely on uncompensated care in the event of a calamity. Similarly, providing the conditions that enable undocumented youth to finance their educations contributes significantly to a motivated and culturally diverse physicianand healthcare workforce. When we conceive of health insurance and educational opportunity as only an individual benefit and therefore something that may be limited based on merit and worth, we undermine and limit the systems that are meant to serve us all.

I hope that in this pandemic we might find the seeds of a moral transformation of our perspective. The fact the Governor and his spokesman were quickly on the defensive may indicate that people intuitively grasped that our fates in the pandemic are tied together. We are not utopian idealists or socialists by acknowledging that fostering inclusiveness in the systems that serve our communities creates a return for all. To jeopardize the well-being of the community because of a exaggerated focus on individual worth or merit is not only morally suspect, it is self-defeating. Only a politician seeking to stir up resentment and division could possibly benefit.

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