Why Undocumented Immigrants Are Turning To Underground, Cash-Only Clinics To Get Health Care

Obamacare seeks to extend health coverage to millions of previously uninsured Americans, but that doesn’t include the nation’s estimated 12 million undocumented immigrants. And as Kaiser Health News reports, that oversight — along with the historical difficulty that undocumented immigrants face when trying to obtain coverage — has led to the proliferation of underground, cash-only “bodega clinicas” in Los Angeles migrant communities.

The clinicas aim to serve Latino immigrants who do not have public or private health insurance. Strictly speaking, they are closer to private primary care doctors’ offices than public clinics that are subject to much tighter regulations. But while the community clinics provide immigrants with a much needed service, their off-the-grid nature has some health officials worried about the quality of care that they provide.

Still, care providers also see in the clinicas the potential to ease the burden of America’s primary care doctor shortage:

Health officials see in the clinicas the tantalizing opportunity to fill persistent and profound gaps in the county’s strained safety net, including a chronic shortage of primary care physicians. By January 2014, up to 2 million currently uninsured Angelenos will need to enroll in Medicaid or buy insurance and find primary care. And the clinicas, public health officials note, are already well established in the county’s poorest neighborhoods where they are meeting the needs of Spanish-speaking residents. The clinicas also could continue to serve a market that the Affordable Care Act does not touch: undocumented immigrants who are prohibited from getting health insurance under the law.

Dr. Mark Ghaly, deputy director for Community Health at the Los Angeles County Department of Health Services, said bodega clinicas, a term he seems to have coined, that agree to some scrutiny could be a good way of addressing the physician shortage in these neighborhoods.

“Where are we going to find those providers?” he said. “One logical place to consider looking is these clinics.”

The clinicas are obviously not a perfect solution. While the clinicas could make for an effective source of cost-effective primary care, their cash-only model does pose some risks for the people who may need more specialized and expensive care — after all, paying $120 in cash for antibiotics is one thing, but $5,000 for a surgery is another story entirely. For more extensive care, these immigrants will require some sort of public or private insurance coverage.


But barring comprehensive immigration reform or additional measures to extend health benefits to America’s undocumented immigrants, Los Angeles’ clinicas are many people’s realities.