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  1. #1
    Senior Member Dixie's Avatar
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    Immigrant health care in the United States: What ails our sy

    They are blending illegal aliens and immigrants together so this study.


    Immigrant health care in the United States: What ails our system?
    Katherine G. Footracer, MS, PA-C, CMTApril 13, 2009

    Is everyone in the United States entitled to health care? If so, how much does each person deserve? If not, how should it be allocated? And, perhaps most crucially, who pays for it? These questions have been raised in presidential debates, editorial columns, and conversations around the country. The debate already bears the weight of failed proposals and personal frustrations, but it takes on additional intensity when applied to people who are in this country without documentation. The problem of undocumented immigration has broad economic, political, and cultural implications, but as health care providers, our primary concern is with the medical needs of our patients and communities.


    THE SCOPE OF THE PROBLEM

    Nearly 46 million people in the United States are currently estimated to be without health insurance, representing approximately 15% of the total population.1,2 For the native-born, the uninsured rate is 12.7%, but among noncitizens, a group that includes temporary workers, foreign students, permanent legal residents, and those here without documentation, the rate is 43.8%.1,3 This difference means that noncitizens are vastly overrepresented within the population of uninsured persons.2 Moreover, the number of immigrants without insurance, including those entering with or without documentation, is growing. Government estimates as of January 2005 place the number of undocumented immigrants at 10.5 million, representing 29% of the total foreign-born population.4,5


    IMMIGRANT USE OF HEALTH CARE

    Immigrants and the native-born use health care resources differently, with immigrants typically accessing them less frequently. Figure 1 compares health care access by citizens and noncitizens.6 The majority of health care received by undocumented immigrants comes through emergency departments (EDs), while most of the remaining care is obtained through public clinics and community health centers.3,4



    A national study comparing health care expenditures between immigrants and those born in the United States found that native-born adults and their children consume statistically significantly more dollars per capita for health care.2 The one exception is that children of immigrants have a higher per capita expenditure for ED visits than do children of the native-born when adjusted to take into account age, ethnicity, poverty level, insurance status, and patientreported health status.2

    A 2000 study uncovered additional differences between native-born and foreign-born residents regardless of their citizenship status. The study showed that immigrants were more likely to have no health insurance, report fewer medical conditions, spend less on health care, have fewer interactions with the health care system, and have lower household incomes.4 These differences were magnified when the nativeborn were compared with undocumented immigrants.7

    Interestingly, immigrants in general and the undocumented in particular report lower levels of cancer, heart disease, arthritis, depression, hypertension, and asthma than do the nativeborn. Researchers attribute lower rates of health care usage and lower reported chronic disease to several factors. The first consideration is that compared with the native-born population, immigrants are relatively young, resulting in a healthier immigrant population. The second is that the process of migration itself, especially in cases of people entering without documentation, may positively select for health since the less healthy are unable to make the often arduous journey.7

    A third possibility is that many immigrants, especially the undocumented, may avoid seeking health care for fear of being noticed by authorities. Immigrants are more likely to wait until they are acutely ill and then access emergency care rather than seek preventive care earlier in the disease process.3 Figure 2 shows a comparison of ED use by citizens versus noncitizens.6



    Other reasons may be financial. Given the low number with health insurance and an average income approximately 25% that of the native-born, undocumented immigrants may not be able to afford preventive health care and may have chronic medical conditions that have yet to be diagnosed or treated.2 One of the reasons so few immigrants have health insurance may be that lack of health insurance is associated with lower education levels, higher poverty rates, and less-skilled jobs that are less likely to provide health insurance.8 The exception to this pattern is immigrants who are in the United States with refugee or asylum status. These individuals are more likely to have insurance because they are granted immediate access to welfare and Medicaid.9


    GOVERNMENT POLICIES

    Public funding for preventive and ongoing health care for the poor occurs primarily through Medicaid, the costs of which are usually split equally between federal and state governments.10 In 1996, as part of welfare reform, the Personal Work and Responsibility Reconciliation Act reduced immigrants' access to Medicaid by delaying eligibility for federal benefits until after they had attained permanent resident status for five years and denying benefits to undocumented and nonpermanent residents. The net effect of this policy change was to shift responsibility for immigrant health care from the federal government to state and local governments.3

    Emergency medical care is treated differently. The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1985 requires that anyone who enters a hospital with an emergency or in active labor be screened and treated until ready for discharge or stable for transfer, regardless of that individual's ability to pay. Emergency Medicaid does not require proof of citizenship or residency and thus can be used by anyone in the United States, including visitors, foreign students, and undocumented immigrants.11

    Critics of the law have argued that “emergencyâ€
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  2. #2
    Senior Member crazybird's Avatar
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    That is interesting. Personally, I guess I don't follow what they say is normal, or know many who do. I'm the low end. Poor, but not poor enough to qualify for government freebies. I pay cash. If I can't, I don't get care.

    Last tests I had were calcification of the abdominal aorta, compressed disks, cholestral issues........nothing on what to do except more tests which I can't afford and probably treatment I can't either. No blood, no pain, no broken bones....so I don't whine.

    Probably avoidable, treatable, but I'm not young, pregnant or a minority....so I loose.
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  3. #3
    Senior Member Dixie's Avatar
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    I think the number of uninsured illegal aliens is even higher.

    The study is futher distorted by the fact that illegal aleins are using other individuals insurance to receive services. They go into an office with someone's insuance card and unless the doctor's office requires ID, who knows who is being treated. I saw a person turned away at the doctors office the other day who had an exspired insurance card and no ID and a few days later, another person tried to use an exspired insurance card to pay for the $75 perscription they were trying to pick up. They were asked to pay cash and left instead.

    Insurance cards are just another form of fake document that they use.

    Dixie
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  4. #4
    ELE
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    Americans that were once Immigrants should get care.

    Illegals and their anchors should be getting their health care and all of their Social Services in Mexico and/or their home country . The political elites in this country have a lot of nerve telling the American people to go without while illegals are getting free health care. It's a good thing we are having tea-parties!
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  5. #5
    Senior Member WorriedAmerican's Avatar
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    Re: Americans that were once Immigrants should get care.

    Quote Originally Posted by ELE
    Illegals and their anchors should be getting their health care and all of their Social Services in Mexico and/or their home country . The political elites in this country have a lot of nerve telling the American people to go without while illegals are getting free health care. It's a good thing we are having tea-parties!
    I say send Mexico the illegals bills and STOP giving Mexico MONEY!
    If Palestine puts down their guns, there will be peace.
    If Israel puts down their guns there will be no more Israel.
    Dick Morris

  6. #6
    Senior Member crazybird's Avatar
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    Insurance cards are just another form of fake document that they use.

    Exactly.
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    I am so fed up with the entire illegal situation, and I may sound cruel. Any illegal that taxes our health system in any way, should be given cursory treatment and deported. Legal immigrants are another thing totally.
    When I was in Germany in 1970s, I was legal and stumbled into a work visa. I was fully insured after six hours on the job because of socialized medicine. Still got my full paycheck while I recuperated for a week after I was hospitalized for my appendix. I could have gotten full pay for six weeks had I found a doctor to "write me sick", but I never bothered.
    There were plenty of other ways to play the system, including plenty of dirty doctors you could complain to about your hair hurting and they would give you a medical excuse to miss work while still getting your paycheck.
    There are too many problems to expunge before we start spending tax dollars on medicaid for illegals, or any other insurance plan.
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  8. #8
    Senior Member butterbean's Avatar
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    I am tired of illegals receiving medical care when alot of Americans cant even afford to buy asprin. Too many of them cram hospital emergency rooms with pregnancies or petty things.
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  9. #9
    Senior Member Dixie's Avatar
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    Forty-two percent of all new tuberculosis cases are linked to immigrants, here both legally and illegally.
    Where are the legal immigrants catching it? They have to pass a chest X-Ray. They have to be picking it up from illegal aliens, if immigrants are contracting it in significant numbers.

    Dixie
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