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10-27-2009, 08:38 PM #1
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TX Doc.: We're Facing a Catastrophic Situation on the Border
Texas Dr. Antonio Falcon: We're Facing A Catastrophic Situation On The Border
By Jessica Marcy, KHN Staff Writer
Oct 23, 2009
Dr. Antonio Falcon, a physician in the border town of Rio Grande City, Texas, considers himself to be the "luckiest family doctor in the world." In his nearly 30 years of practice, he has worked in the emergency room as well as the operating room and has delivered at least 6,000 babies. Currently, he says he is a geriatrician, aging along with his patients.
Falcon, a member of the Texas Medical Association and the United States-Mexico Border Health Commission, is concerned about several health threats facing border communities, including tuberculosis, diabetes, obesity and the H1N1 virus that causes swine flu. He says the current efforts to overhaul the nation's health system will benefit both the Hispanic community, which has the highest rate of uninsured of any ethnic group; and Texas, which consistently fares among the worst for state health care measures. Still, he worries that lawmakers in Washington are failing to address several important border health issues, including illegal immigrants' health care.
KHN's Jessica Marcy recently spoke with Falcon, who warned that failure to recognize the high, unreimbursed costs of caring for this population could undermine hospitals and providers along the border and open the door to public health risks for the entire nation. Edited excerpts of the interview follow.
Q: Since you began practicing medicine in 1980, how has the health delivery system's approach to illegal immigrants' health care changed? What impact has the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) -- which requires hospitals to provide emergency services regardless of a patient’s ability to pay -- had on health care in border communities?
Related Content
How Health Reform Bills Would - And Wouldn't - Affect Illegal Immigrants
(please see below)
Where Dr. Antonio Falcon Works:
Rio Grande City is located in Starr County, one of the poorest counties in Texas and the nation. Statistics from the 2000 Census Bureau found that in Rio Grande City:
97.4 percent of the population is Hispanic or Latino
34.4 percent is foreign born
48.8 percent of individuals are below the poverty line
SOURCE: U.S. Census Bureau
A: Back in the 1980s, the patient from Mexico was usually the best paying patient because in order to get care here, they would have to pay for their deliveries up front. It was a system that worked very, very well. When EMTALA [was enacted], it basically caused a very large influx of patients from Mexico … because labor and delivery became an emergency and patients had to be seen whether they paid or not. What happened in a lot of communities along the border, where the Mexican patient was the best paying patient, [they] became a huge liability because they were no longer paying for their care. So all of a sudden, these hospitals and providers were faced with this huge volume of uncompensated care. After several years of struggle, Emergency Medicaid [which helps pay for such emergency treatment of immigrants] came in ... [and] alleviated some of the burden.
Interestingly enough, it seems that nobody can answer the question of what's going to happen to border providers and hospitals if illegals aren't covered under a new health care bill. If they're not covered and EMTALA continues to exist and providers and hospitals are going to have to provide the care without compensation, it's going to cause a catastrophic situation along the border, which already has a very fragile health care system.
Q: What do you think about provisions in some health overhaul measures that would prohibit illegal immigrants from purchasing insurance on proposed exchanges?
A: The biggest risk is the financial failure of [border] health care institutions. If illegal immigrants are not going to be covered under a national health plan, then there must be a mechanism for reimbursement for the care of those patients. If that doesn't happen, then all of a sudden border hospitals and providers have to take a 35 percent cut in their gross income and they're not going to make it.
As it is, the border area already has a much higher percentage of Medicaid patients than other areas in the country. Providers and hospitals are strapped with the bare minimum of financial resources because of the reimbursement mechanism that exists. I would venture to bet that one-fourth to one-third of the hospitals along the border would close and you would see an exodus of providers in a system that already has very, very poor ratio of patients to providers. Right now, as far as I know, there isn't a discussion on how to make up for the losses that would be incurred by border institutions.
Q: Do you think there are any other specific health risks from excluding illegal immigrants from the health care system and reform?
A: I think [the risk is] the spread of any infectious disease, especially tuberculosis. TB is actually on the rise along the border. I think that 70 to 80 percent of these cases we're seeing now are related to immigrants. It's a very high percentage. That, together with the fact that we're seeing more multidrug-resistant tuberculosis, causes an enormous amount of concern. If those patients are not going to get any treatment then public-health-wise we have a huge problem.
Q: What advice would you give to lawmakers in Washington about illegal immigrants' care and health reform?
A: Illegal immigrants live among us all over the country. We should have learned from H1N1 that the potential door for emerging illnesses could exist through the Mexican-American border. To allow something to come in that is not attended to because somebody in Washington didn't play close attention to border health issues would be lamented for a long time. We need to look at the border as a portal of entry for any of a number of diseases, including bioterrorism.
It seems like policy makers want to isolate [the issue of] illegal immigrants' care as something that's kind of standing out there on its own and it's not. It's mixed in with the rest of the soup. Like it or not.
http://www.kaiserhealthnews.org/Checkin ... ealth.aspx
Related:
Paying the Price for Illegal Immigrant Care
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10-27-2009, 08:41 PM #2
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How Health Reform Bills Would - And Wouldn't - Affect Illegal Immigrants
By Jennifer Evans, KHN Staff Writer
Oct 23, 2009
As lawmakers continue to shape a health care overhaul bill to increase the number of Americans with insurance while driving down costs, one group is being deliberately barred from receiving any government benefits associated with the effort: undocumented immigrants. This brief explainer looks at some of the questions surrounding immigrants and health care in the United States.
How many are there and what is the law now?
There are nearly 12 million illegal immigrants in the U.S. In 2007, almost 60 percent of the adults had no health insurance, more than double the proportion of uninsured adults among legal immigrants and four times the share among U.S.-born adults, according to the Pew Hispanic Center.
Related Content
Texas Dr. Antonio Falcon: We're Facing A Catastrophic Situation On The Border
Undocumented immigrants are barred from Medicaid and the Children’s Health Insurance Program (CHIP) - the federal/state government programs for the poor. However, everyone - including illegal immigrants - have access to emergency room care through the 1986 Emergency Medical Treatment and Labor Act, which ensures public access to emergency health services regardless of an individual's ability to pay.
How do undocumented immigrants get medical care now?
Low-income immigrants -- both legal and undocumented -- are less likely than citizens to receive primary or preventive care, and they have lower rates of emergency room use than those of citizens, according to a 2007 policy brief by the Kaiser Family Foundation. (KHN is a program of the foundation.) But low-income non-citizens turn to health centers and clinics at a significantly higher rate than insured low-income citizens, with six in 10 relying on clinics and health centers as the place to go when they need medical help.
Who pays for their care?
Undocumented immigrants who seek care at health centers and clinics are typically billed on a sliding scale based on their ability to pay.
If illegal immigrants cannot pay their bills, hospitals and other providers first look to the federal government and charities for help in covering their uncompensated costs. The federal government, through the Disproportional Share Hospital program, allotted about $20 billion in 2009 to help hospitals and providers cover the costs they incurred treating uninsured patients, including citizens, legal immigrants and the undocumented.
But those government funds are generally not enough to cover the costs, and hospitals raise their fees for other patients to help provide the revenues needed to treat the uninsured.
Researchers estimate the cost of all uncompensated care was roughly $56 billion in 2008, according to a recent study published in the journal Health Affairs. However, because hospitals cannot inquire whether a patient is in the country illegally, it is difficult to tease out the cost of uncompensated care attributed to illegal immigrants.
How will reform proposals affect illegal immigrants?
All of the bills specifically exclude undocumented immigrants from qualifying for Medicaid or CHIP.
Neither the House bill nor Senate Health, Education, Labor and Pensions (HELP) Committee bill restricts illegal immigrants from being eligible to purchase coverage through a health insurance "exchange" or gateway set up in the legislation. However, the House bill explicitly states that undocumented immigrants would not be eligible to receive government subsidies to buy insurance, regardless of income. The Senate Committee Bill is much tougher and bars illegal immigrants from purchasing health insurance through the exchange.
Baucus’ proposal also includes verification requirements to ensure that illegal immigrants are blocked from receiving federal subsidies or entering the exchange -- an effort to quell Republican concerns that loopholes would allow illegal immigrants to benefit from receiving health insurance at a reduced rate.
The Senate and House proposals also call for reducing the federal DSH payments to hospitals for uncompensated care on the assumption that health care reform would provide insurance to more people.
None of the bills would change the requirement that hospitals offer emergency services to all patients, including illegal immigrants.
Sources
Affordable Health Choices Act, Senate HELP Committee bill, section 171
America's Affordable Health Choices Act House bill H.R. 3200, sections 246, 1704
America’s Healthy Future Act of 2009, Senate Finance Committee bill
Covering The Uninsured In 2008, Health Affairs
Disproportionate Share Hospital Allotments for FY 2009, U.S. Health and Human Services
Five Basic Facts on Immigrants and Their Health Care, Kaiser Family Foundation, March 2008
Health Insurance Coverage and Access to Care for Low-Income Non-Citizen Adults, Kaiser Family Foundation, June 2007
Immigrants’ Health Coverage and Health Reform: Key Questions and Answers, Kaiser Family Foundation, September 2009
Medicaid Disproportionate Share Hospital Payments, National Policy Forum, June 15, 2009
Portrait of Unauthorized Immigrants, Pew Hispanic Center, 2009
Treatment of Noncitizens in H.R. 3200, Congressional Research Service, August 2009
http://www.kaiserhealthnews.org/Stories ... ainer.aspxJoin our efforts to Secure America's Borders and End Illegal Immigration by Joining ALIPAC's E-Mail Alerts network (CLICK HERE)
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10-27-2009, 09:36 PM #3Back in the 1980s, the patient from Mexico was usually the best paying patient because in order to get care here, they would have to pay for their deliveries up front. It was a system that worked very, very well. When EMTALA [was enacted], it basically caused a very large influx of patients from Mexico … because labor and delivery became an emergency and patients had to be seen whether they paid or not.Join our efforts to Secure America's Borders and End Illegal Immigration by Joining ALIPAC's E-Mail Alerts network (CLICK HERE)
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10-28-2009, 10:51 AM #4Originally Posted by miguelinaCertified Member
The Sons of the Republic of Texas
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10-28-2009, 11:05 AM #5
And yet our borders remain open!! well don't they really seem concerned with the cost of health care!
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10-28-2009, 02:52 PM #6
Doesn't an American in need of medical attention in a Mexican hospital have to prove ability to pay before treatment?
As it should be here!Join our efforts to Secure America's Borders and End Illegal Immigration by Joining ALIPAC's E-Mail Alerts network (CLICK HERE)
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