SB81 could limit health care for illegal immigrants

Utah statutes » Health officials wary of law that takes affect July 1
By Heather May

The Salt Lake Tribune


Salt Lake Tribune
Updated:04/19/2009 06:08:43 PM MDT


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Midvale » One woman has had constant headaches for six months. Another hasn't seen a doctor in two or three years and wants a checkup. And a third is worried about her daughter's hours-long nosebleeds.

All are at a mobile medical clinic set up at this city's community center getting free care -- and none live in Utah legally.

That doesn't matter to the people in charge of the clinic. "I'll treat them if they need help," says physician assistant Tate Jensen, between seeing patients Thursday. "They're human beings. It doesn't matter if they're legal or not."

But it does matter to Utah lawmakers. SB81, the same immigration law that allows police officers to be cross-deputized as federal immigration officers, also affects health care. Starting July 1, agencies providing certain government-funded health benefits must verify their patients are U.S. citizens or legal permanent resident aliens. Patients who lie about their status could face criminal penalties.

Health officials are unsure which services the law will affect and are awaiting guidance from the Attorney General's office. But they are already worried patients won't seek care, even when the SB81 says their legal status won't be checked, possibly putting their own and the community's health at risk.

"There's going to be a lot of hesitation out there, for sure," predicts Bruce Costa, executive director of the Central Utah Public Health Department, who wonders if undocumented parents will forgo vaccines for their children even though the law doesn't apply to immunizations.

With undocumented residents getting less care on the front end, some are expected to turn to emergency rooms -- which must continue to provide care to all --- as a last resort. The tab for the more costly care is shifted to insured Utahns in the form of higher premiums and to hospitals that write off unpaid services as bad debt or charity care.

"There's no question the people we see in our mobile clinic, if we were not here, would end up in the ER at a tremendous cost to our system," says Kurt Micka, whose nonprofit Utah Partners for Health runs the clinic, which will see 1,200 patients this year in Salt Lake County and in Wendover.

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Some services can't be denied » The new law affects a range of federal, state and local benefits from food to housing assistance. It carves out exceptions for certain health services: emergency care, vaccines and testing and treatment for communicable diseases. Advocates believe the law won't affect services for children.

But public health officials and community groups that provide health care using government funds don't know how to implement the law. They will meet with the Attorney General's office later this month to discuss the ramifications, and a spokesman for the office declined comment in advance of the meeting.

For now, health officials have more questions than answers: Does the law apply to screenings for breast and cervical cancer for low-income women? Subsidized birth control? Food service permits? Food programs for children and pregnant women?

Today, the federally-funded Women Infant and Children's program provides food vouchers and nutritional counseling to 72,000 clients, including pregnant and breastfeeding women and children up to age 5. The program's Web sites explicitly state that clients don't have to be U.S. citizens.

Utah WIC manager Chris Furner hopes the bill doesn't apply to his program, noting that it will be adding healthier food this summer. "We would want everyone [who qualifies] on the program. ... We have an obesity epidemic going on."

Costa and other health officials need explicit guidance.

"Are we going to start worrying about all the other services [health departments provide]? If somebody comes in even for a wastewater permit ... are we supposed to verify citizenship?"

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Law targets budgets » Already, the state health department has told groups like the Utah Partners for Health that accept state-funded primary care grants they must verify their patients are legal residents this summer. That could affect up to 49 agencies that took $1.6 million in grants last year to provide care ranging from mental health to diabetes care to dental work.

A handful of agencies contacted said they don't currently check patients' legal status and don't know how many patients are undocumented.

Judy Sobin, executive director of The People's Health Clinic in Park City, uses some state money to provide health care to uninsured adults working in the construction, restaurant and lodging industries in Summit and Wasatch counties. Some are likely undocumented.

She predicts the law may stop even documented patients from seeking care, fearing it could open their undocumented family members to scrutiny. Or they might feel insecure about the documents they do have, she says.

"It has a very dark effect on everybody who is not Caucasian, who is an immigrant," she says. "When most Utahns really look at [the law], you can't agree with it."

Katalina Corwin is glad she likely won't have to ask for proof of residency when providing state-funded dental services to children in Centro de la Familia de Utah's Head Start program, saying it could "jeopardize our relationship of trust with families."

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Health consequences may be grave » Patients at Micka's mobile clinic, meant to help people who face cultural and financial barriers to care, aren't sure what they would do if they were denied care. But it could mean the difference between life and death. Jensen, the physician assistant, says he frequently treats patients with uncontrolled diabetes. And providers have found breast cancer and prostate cancer, he adds.

Juana Cortes, who said she is in the process of obtaining permanent resident status, said a doctor at another state-subsidized clinic found she had cervical cancer. It's now treated, she said while waiting to be seen at the mobile clinic. But if SB81 had been the law then, she wonders where she could have gone to get the pap screen that detected the abnormal cells.

Comprehensive immigration reform

During legislative debate of SB81 in 2008, supporters said the bill was necessary to stem the flow of undocumented workers to Utah and save money on providing government-subsidized benefits. They also said it was about respecting the rule of law.

The bill's sponsor, Mike Noel, R-Kanab, could not be reached for comment on the health care portion.


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