This issue is relevant to nursing and to the nation's health care delivery system for a number of interrelated reasons. First, the number of undocumented aliens residing in the United States continues to grow (Berger, 1992, p. B3). The need for health care services among the undocumented alien component of the American population, thus, is also increasing. Second, the overwhelming majority of the undocumented aliens in the United States arrive here nearly destitute and largely tend to remain in need (Capan, Beard, and Mashburn, 1993, pp. 5355). Thus, the great majority of undocumented aliens are not going to be able to gain access to health care services by paying for such services. Third, the provision of free or subsidized health care services

to undocumented aliens restricts the funds available to provide free or subsidized health care services to indigent citizens and legal aliens in the country (Gelfand and BialikGilad, 1989, pp. 2327). Funds to provide free or subsidized health care services to citizens and legal aliens in the United States are already scarce.

As costs associated with the delivery of health care services soared in the 1980s, third party funders, health care providers, and users of health care service

Fullerton, Judith T., Palinkas, Lawrence, & Cavero, Carmela. (1991, Fall). Nursemidwife services. Journal of Health Care for the Poor and Underserved, 2(2), 293306.

Health and Human Services Secretary Donna Shalala has proposed that undocumented aliens be guaranteed the right to access to free or subsidized preventive health care services (Brownstein, 1993, p. A11). This proposed solution will not shift the funding burden from the states to the federal government, but, if the policy is a success, it might lead to reduced costs for the states through the promotion of health among undocumented aliens in the United States (Downey, 1993, pp. 5051).

Chavez, Leo R. (1984). Undocumented aliens and access to health services: A game of pass the buck. Migration Today, 12(45), 2024.

Shah, M. A. (1993, JulyAugust). The nursemidwife as primary care provider. Journal of Nurse Midwifery, 38(4), 185187.

Kindel, Stephen. (1993, 19 January). Disease control. Financial World, 162(2), 48.

Medicaid must also be prepared to deal with the approximately 30 million persons who are without any formal health care insurance coverage, and are not in a financial position to fund such services as required. The working poor without health care insurance tend to postpone medical consultation and treatment to avoid incurring costs they cannot afford. As a consequence, when they do receive health care services those services are typically more extensive and more costly than would have been the case had consultation and treatment been sought earlier. The higher cost of these deferred services often results in charges to the Medicaid program.