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Academic Health Centers and Care of Undocumented Immigrants in the United States: Servant Leaders or Uncourageous Followers?

Acosta, David A. MD; Aguilar-Gaxiola, Sergio MD, PhD

doi: 10.1097/ACM.0000000000000182

Public dialogue and debate about the health care overhaul in the United States is centered on one contentious question: Is there a moral obligation to ensure that all people (including undocumented immigrants) within its borders have access to affordable health care? For academic health centers (AHCs), which often provide safety-net care to the uninsured, this question has moral and social implications. An estimated 11 million undocumented immigrants living in the United States (80% of whom are Latino) are uninsured and currently prohibited from purchasing exchange coverage under the Patient Protection and Affordable Care Act, even at full cost. The authors attempt to dispel the many misconceptions and distorted assumptions surrounding the use of health services by this vulnerable population. The authors also suggest that AHCs need to recalibrate their mission to focus on social accountability as well as the ethical and humanistic practice of medicine for all people, recognizing the significance of inclusion over exclusion in making progress on population health and health care. AHCs play a crucial role, both in educational policy and as a safety-net provider, in reducing health disparities that negatively impact vulnerable populations. Better health for all is possible through better alignment, collaboration, and partnering with other AHCs and safety-net providers. Through servant leadership, AHCs can be the leaders that this change imperative demands.

Dr. Acosta is associate vice chancellor of diversity and inclusion, Office for Equity, Diversity and Inclusion, University of California, Davis Health System, Sacramento, California.

Dr. Aguilar-Gaxiola is professor of clinical internal medicine and director, UC Davis Center for Reducing Health Disparities, Sacramento, California.

Editor’s Note: This is a commentary on Cacari Stone L, Steimel L, Vasquez-Guzman E, Kaufman A. The potential conflict between policy and ethics in caring for undocumented immigrants at academic health centers. Acad Med. 2014;89:536–539.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Dr. Acosta, Office for Equity, Diversity and Inclusion, UC Davis Health System, 4800 2nd Ave., Suite 2300, Sacramento, CA 95817; telephone: (916) 734-2926; e-mail:

© 2014 by the Association of American Medical Colleges