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Medical care a key issue in immigration debate
Scripps Howard News Service


August 31, 2006

Illegal immigrants' use of medical care is at the white-hot center of the immigration debate.

The common refrain: Hospitals are groaning under the burden of patients who are undocumented. They flood emergency rooms and the state picks up the tab.

That drives up Medicaid costs, the argument goes, which is bankrupting states, robbing other programs and pushing U.S. citizens to the bottom of the waiting list for services.

Impact on health care of undocumented immigrants
Scripps Howard News Service

Impact on health care:

- The closest measure of the growth in immigrants' health-care costs is emergency Medicaid. The program's cost rose from $39.4 million in 2001-2002 to a projected $61.9 million this fiscal year, a 57 percent increase. Nine of the top 10 treatments are for pregnant women.

- Recent measures to prevent undocumented immigrants from accessing health care take the form of stricter documentation requirements. But immigrants get most of their care at places beyond the reach of that law: hospitals and low-cost clinics.

- An estimated 20 percent of illegal immigrants have employer-based health insurance, according to the Rand Corp. The study also found that 65 percent are uninsured and 15 percent are partially insured.

- Communities with high numbers of Hispanics and uninsured patients have lower emergency-room use than towns with many elderly and insured patients, according to a July study published in the academic journal Health Affairs.

- Further, immigrants use less care than citizens, about $1,139 a year for every $2,564 used by non-immigrants, according to Harvard Medical School researchers. They say immigrants may be more likely to forgo preventive care.

The reality is that the costs of Medicaid and hospital charity are, indeed, spiraling upward, but illegal immigrants contribute only a small share of the uninsured, underinsured and working poor who are increasingly relying on government and charity help.

It's difficult to pinpoint growth in the costs of caring for illegal immigrants, but one measure is emergency Medicaid - which has gone up 57 percent in the past six years.

This federally mandated program pays for emergency room care for anyone who would qualify for Medicaid based on income but can't prove citizenship or five years of legal residency.

Medicaid takes care of the very poor, children born into poverty and the disabled, with the state and federal government splitting expenses 50-50.

Efforts so far to limit health care for illegal immigrants have taken the form of stricter documentation requirements for some public programs.

But tighter rules on proving citizenship don't extend to most places that illegal immigrants get care - emergency rooms, federally qualified health clinics, school-based health clinics and nonprofit charity programs.

A new federal law requiring Medicaid applicants to show proof of citizenship went into effect July 1, but most people think it will have little effect.

"One of the biggest myths is that immigrants are trying to get on Medicaid," said David Adamson, executive director of the Mountain Family Health Centers in Glenwood Springs, Colo. He and others say most immigrants don't know what's available and avoid registering for government programs.

Foes of illegal immigration say free medical care lures workers to the United States.

Most immigrant advocates and immigrants themselves say that's not true. Immigrants come here to work, they say. Medical care is an afterthought.

"I don't think I've heard of anybody who has trekked through the Arizona desert to have their baby in Glenwood Springs, or to have their throat checked," said Adamson, who heads a low-cost health clinic in the booming mountain town.

But once here, immigrants take advantage of the decades-old safety net put in place under President Lyndon Johnson to help the poor.

It's widely known among undocumented workers, for instance, that hospitals can't turn away patients from the emergency room. They also know to get free exams at health fairs and immunizations at school.

Maria, who asked that her last name not be used because she is here illegally, is a patient at a nonprofit, private clinic for the needy in Denver. She's faced a series of surprises since she came to the U.S. from Jalisco, Mexico, three years ago.

She dreamed of working and saving enough to build a retirement house on her small plot of land in Mexico. But two years ago, she learned she had breast cancer. She's lived with relatives who have helped with medication costs.

"I haven't worked since I got here," she said.

She's grateful to the physicians at Denver's Clinica Tepeyac, who have arranged private funds for her chemotherapy. The clinic accepts no taxpayer money.

"I had two surgeries and treatment," she said in Spanish. She also had four sessions of chemotherapy and continues to take medicine, she said.

She's heard arguments that illegal immigrants come to this country to get benefits, but she believes most come here just to earn a living.

"I came to work, but I can't because of my illness," she said.

Public wrath about illegal immigrants puts providers in a bind. Doctors and nurses are trained to help the sick, period. Federally funded hospitals and clinics can't discriminate based on national origin. And low-cost preventive care staves off costly emergency visits down the road.

Contrary to popular belief, not all illegal immigrants are uninsured. Among the 225,000 to 275,000 estimated illegal immigrants in Colorado, for example, an estimated one in five workers has a job with a company that provides health insurance. Virtually no immigrants buy coverage on their own, experts say.

Rosa, who has been living illegally in the United States for the past four years, gets health insurance through her husband's job. She agreed to talk if she were not identified.

Not long ago she learned that the lump in her breast was not fatty tissue, as a previous doctor told her, but a cancerous tumor.

Before each chemotherapy session, her husband takes their three children to the baby sitter. Rosa is too weak to take care of them after the therapy.

"I stay alone until my husband comes home from work at 7 p.m.," she said. "I feel weak, nauseous and my body hurts."

Her husband's work insurance covers some of the cancer treatments, including chemotherapy. Her co-payments are $40. In addition, she pays $60 for three pills after chemotherapy sessions.

In July she received her fourth round of chemotherapy. She said she has four more left.

The RAND Corp. in 2005 estimated that about 70 percent of U.S. undocumented immigrant adults have no health insurance.

When they get sick, they rely on free or low-cost care in clinics and charity care at hospitals.

That leads to a common complaint - that hospital emergency rooms are overrun with illegal immigrants, adding to long wait times for citizens.

But knowing whether the person sitting in an emergency room is here legally or illegally isn't possible for a casual observer. And research on the matter has surprising conclusions.

Communities with high levels of Hispanics and uninsured patients have lower emergency room use than towns with many elderly and insured patients, according to a July study published in the academic journal Health Affairs.

Further, immigrants use less care than citizens, about $1,139 a year for every $2,564 used by non-immigrants, according to Harvard Medical School researchers. They say immigrants may be more likely to forgo preventive care.

Without preventive care, minor illnesses can turn serious, and uninsured immigrants - like uninsured citizens - wind up relying on charity.

Still, uninsured patients, whether here legally or not, increase the cost of care to everyone else.

Many hospitals are just beginning to ask for Social Security cards or other ID after care is rendered. That will allow them to take advantage of a new federal program that offers extra payments to hospitals that care for a higher-than-usual number of illegal immigrants.

But medical facilities risk being cited for discrimination if they deny care because of national origin. Many also say it goes against their mission.

"Our responsibility and our heritage is providing care regardless of ability to pay," said Kay Taylor, a spokeswoman for Exempla Health Care in Denver."


Contact Rachel Brand and Rosa Ramirez of
the Rocky Mountain News at
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Scripps Howard News Service,


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