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  1. #1
    Senior Member lorrie's Avatar
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    Jan 2006
    Redondo Beach, California

    Affordable Care Act excludes illegal immigrants; 20 of 25 top counties treat them an

    Affordable Care Act excludes illegal immigrants;
    20 of 25 top counties treat them anyway

    Published: Mar 24, 2016 5:10 p.m. ET

    County governments figure it is cheaper, safer and easier to
    give basic health services to immigrants who can’t get insurance
    than to treat them exclusively in emergency rooms.

    WHEATON, Md.—When federal lawmakers wrote the act overhauling the nation’s health-care system six years ago, they ruled out any possibility of extending health insurance to illegal immigrants.
    Local officials where many of those immigrants live are treating them anyway.

    A Wall Street Journal survey of the 25 U.S. counties with the largest unauthorized immigrant populations found that 20 of them have programs that pay for the low-income uninsured to have doctor visits, shots, prescription drugs, lab tests and surgeries at local providers. The services usually are inexpensive or free to participants, who must prove they live in the county but are told their immigration status doesn’t matter.

    Whether such programs are appropriate is a matter of debate. Many voters believe it is unfair to use tax dollars to help immigrants when American citizens struggle, and that doing so encourages illegal immigration. At the same time, American hospitals are required by law to screen and stabilize any patient, regardless of his or her ability to pay, which means taxpayers already are committed to paying for care in its most expensive setting.

    County politicians figure it is cheaper, safer and easier to give basic health services to immigrants who can’t get insurance than to treat them only in the county’s emergency rooms.
    “If federal programs exclude people who live here and get sick here, then someone has to care for them,” says George Leventhal, a Democratic council member who a decade ago started a local initiative to provide care to uninsured immigrants here in Montgomery County, Md., a suburb of Washington. “We all pay anyway.”

    Local critics contend the county should support immigration enforcement rather than undermine it. Brad Botwin, a local opponent of illegal immigration, objects to the cost of the county health program. “They can’t fix the roads. The metro system is absolutely falling apart. But they have the money to put up these health benefits,” he says.

    Republican and Democratic federal lawmakers alike agree with the Affordable Care Act’s prohibition against providing government-subsidized insurance to anyone who cannot prove a legal immigration status. The presidential candidates also are in agreement. The Republican candidates also advocate overturning the entire system created by the health law, along with stepping up immigration enforcement.
    Unauthorized immigrants account for at least one-quarter of the approximately 30 million uninsured people in the U.S., the Congressional Budget Office estimates.

    Marielena Hincapie, executive director of the National Immigration Law Center, an immigrant rights group, says programs to treat them are an example of people acting locally, despite Washington’s stance. “We may not have gotten federal legislative immigration reform, but I can tell you we are getting immigration reform from the ground up,” she told health-law supporters at a recent conference.

    For communities that provide care to illegal immigrants, the financial commitment is significant. Interviews with officials in the 25 counties indicated that local initiatives provide nonemergency care for at least 750,000 unauthorized immigrants across those counties, costing them more than $1 billion a year—almost all from local funds.

    Some of the programs have operated for decades, providing services for immigrants alongside other low-income county residents. Others are brand new and explicitly exist for immigrants. All essentially serve as substitute health plans for illegal immigrants who are prohibited from getting Medicaid or subsidized private insurance under the health law, and whose jobs generally pay too little for them to buy coverage.

    Montgomery County paid about $12 million for health care for almost 25,000 immigrants last fiscal year across a dozen clinics. One of them was Proyecto Salud, or Project Health, housed in a government building in Wheaton close to a metro station, fast-food franchises and an apartment complex.

    The health centers put together treatment plans for diabetes, orthopedic injuries and anxiety disorders, among other things. Their budgets rely on donated help from area specialists, hospitals and drug companies, along with modest patient contributions. Past government evaluations of the centers credited them with a 41% reduction of behavioral-health emergency-room visits and a 67% reduction in trips related to chronic conditions—a big incentive for local hospitals to contribute, officials say.

    “We are saving money to the system by doing this,” says César Palacios, head of Proyecto Salud. “If we don’t pay now when it is easy money, we are going to pay later on.”

    The county’s program, “Montgomery Cares,” has served mostly immigrants without legal status since the biggest provisions of the health law kicked in two years ago. There were 110,000 uninsured people in the county at that time. At least 50,000 were set to remain uninsured because of the health law’s restrictions on unauthorized immigrants getting Medicaid or subsidized private coverage.

    In New York City, the public-hospital system estimates it provided nonemergency care last year to 208,000 unauthorized immigrants across Brooklyn, Queens and the Bronx, the boroughs with the largest populations of such immigrants. The cost was about $400 million, picked up by the system—essentially, local taxpayers and everyone who has insurance and uses the hospital system.

    In Los Angeles, 135,000 low-income county residents without legal U.S. residency status are assigned primary-care providers in a “medical home” designed to coordinate their care. They get an ID card, use of a member-services hotline and a booklet akin to an insurance brochure that explains how to gain access to screenings, a clinic network for specialty care and prescription drugs.

    In the past year, the number of California counties with programs akin to the Los Angeles one has jumped from nine to 48, in part because of the entry of a consortium of rural counties.

    The debate is playing out county by county across other big states, including Texas. For decades, state officials there have wrangled over whether counties should treat uninsured illegal immigrants, without reaching a firm decision. As a result, local leaders have gone their own way.

    Houston and Dallas together cover tens of thousands of illegal immigrants in charity-care programs—65,000 in Houston, and some portion of an 115,000-person program in Dallas, where the county doesn’t track immigration status.

    “Consider the implications of half the people on the [local] rail lines and buses carrying them to work being denied flu shots,” says Clay Jenkins, the chief elected official for Dallas County. “There are 2.5 million people that live here, and they’re all important and they’re all deserving of respect and medical care,” says Mr. Jenkins, a Democrat.

    By contrast, in Tarrant County, which includes Fort Worth, the system that provides safety-net care is limited to residents who can prove legal immigration status.

    Those restrictions have been in place for about a decade. “At that time, there was a tremendous discussion that occurred,” says G.K. Maenius, the county administrator. “Our hospital district was struggling to have the finances to take care of legal residents of Tarrant County.”

    As a result, he says, the hospital district opted to treat people without legal status as if they lived in any other county. The emergency room treats everyone. For noncounty residents to obtain nonemergency treatment, they have to pay for it—at prices that likely are prohibitive for most.

    In Fresno County, Calif., a debate over accepting $5.5 million the state said could only be used to provide specialty care for around 5,000 unauthorized immigrants split the board of supervisors 3-2. The county ended up taking the money.

    Andreas Borgeas was one of the supervisors to vote “no.” He says his opposition is chiefly fiscal. “We have distorted the discussion and created an ongoing entitlement that’s going to be difficult to sustain,” he says. “If California wants to have this coverage, it should be by Sacramento.”

    California, like many states, doesn’t have an ironclad prohibition on providing health care to people here without authorization. States have flexibility over Medicaid eligibility, and 16 of them allow the program to cover populations of illegal immigrants, such as children and pregnant women.

    California and New York have some of the broadest inclusion criteria. Oklahoma has a pregnant-women’s program aimed at ensuring prenatal care for babies who will become U.S. citizens, named “Soon to be Sooners.”

    States would struggle to find the money to insure all immigrants, even if they wanted to.

    California will have around 1.5 million adult immigrant residents without insurance in 2019. To offer Medicaid to those who meet the program’s low-income criteria, the state likely would have to find at least $400 million more a year, according to an estimate by the University of California, Berkeley’s Center for Labor Research and Education that is based on the assumption that not everyone would enroll. If everyone did, the price would likely grow to at least $720 million.

    Democratic presidential candidates Bernie Sanders and Hillary Clinton have said they want to see universal health coverage in the U.S., but that they favor the status quo on the health law’s immigration restrictions. They have said they would be willing for illegal immigrants to use as a tool to shop for coverage, but wouldn’t want the federal government to help pay for premiums or allow them to enroll in Medicaid.

    The Republican front-runner has made tighter immigration restrictions a core part of his health plan.

    “If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve health-care cost pressures on state and local governments,” Donald Trump said in his health-policy platform.

    Obama administration officials, including Health and Human Services Secretary Sylvia Mathews Burwell, acknowledge that immigration status is a key factor in the size of the U.S. uninsured population, and that reducing that number to zero would require changes in immigration policy.

    But even those changes likely wouldn’t resolve the health-coverage issue.

    The Obama administration has said that children granted immigration-enforcement reprieves under a 2012 executive action still will be subject to the health law’s restrictions. After an executive action that would extend that reprieve to around four million adults, the Obama administration said it would continue to subject them to the restrictions, too.

    That action is now before the Supreme Court, with arguments in mid-April.

  2. #2
    Senior Member Beezer's Avatar
    Join Date
    Apr 2016
    They are here illegally, save costs by deporting them. Process them on military bases and load them up on C130s. NO taxpayer funded health care for non-citizens. They can get care in their country.

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