http://www.twincities.com/mld/twincitie ... 320617.htm

Posted on Wed, Apr. 12, 2006

Health care crisis batters both state, illegal immigrants
Taxpayer costs soar as access for patients becomes tougher
BY JEREMY OLSON
Pioneer Press

Diabetes is tough to manage for most well-to-do Minnesotans, but it's a greater burden for people like Maria, an illegal immigrant with little income and no health insurance.

Test strips to monitor her blood sugar cost $80 a box. Drugs are expensive, too, and so are the fruits and vegetables that people at La Clinica in Minneapolis tell her are a must.

When money runs tight, the medication runs out. The diabetes takes over and she becomes exhausted, which means she can't make it to work as a cleaner. That means less income for her family, and for her health care. It's a cycle that has lasted 10 years.

"It's the only way I can make it," said the 40-year-old, who only gave her first name because she came from Mexico illegally.

Stories like Maria's have increased dramatically in Minnesota in the past decade — reshaping the Hispanic community and changing the state's economy, culture and diversity. Few industries have felt the impact as much as health care, which aids an illegal population that often can't acquire health insurance or seek medical care until an emergency.

State health programs funded $37 million in medical care for illegal immigrants in 2005, compared with only $18.6 million in 2000, according to the Minnesota Department of Human Services. That doubling of state and federal tax dollars occurred despite legislative changes in 2003 that made Minnesota's public health benefits unavailable to illegal immigrants. Some exceptions are made for pregnancy and emergency care.

Those costs just scratch the surface. They only account for people who truthfully disclosed their status. A legislative audit, expected to be released today, will consider among other things how often illegal immigrants obtain public health benefits without disclosing their status.

The state costs also don't include $120 million a year in uncompensated care provided by Minnesota's hospitals. Illegal immigrants are responsible for an unknown portion of those costs, which are ultimately paid through federal tax dollars and rising health insurance premiums.

Federal lawmakers are proposing crackdowns on illegal immigrants, predominantly crossing the southern border from Mexico or Central America. But that won't solve the health care problem.

"The bottom line is they are here," said Jillian Middlebrooks of the Hennepin County Office of Multicultural Services, "and if they are not healthy or cared for, they contribute to unhealthy communities."

State lawmakers offered two proposals this session that would seek to cut the costs to Minnesota taxpayers and eliminate the dilemma of publicly supporting illegal immigrants. One bill by Rep. Fran Bradley, R-Rochester, would make county officials legally responsible for informing immigration authorities about undocumented immigrants applying for public health benefits. Another bill by Rep. Tom Emmer, R-Delano, would eliminate state funding of prenatal care for undocumented women who are pregnant.

Both lawmakers have stressed they don't oppose immigration, but find it hypocritical to publicly support immigrants who entered the country illegally.

Critics point out that these measures might offer short-term savings for the state, but will cost society more over time. Women lacking prenatal care are more likely to have children who die at birth or suffer costly birth defects, said the Rev. Jose Santiago of the Holy Rosary Parish in Minneapolis, which runs a charitable nursing clinic twice a week. Cutting off prenatal care would only make that worse, he said.

"What we need to address is the issue of health care for the poor, period," he said. "It's an issue for all the poor, whether they are documented or not and whether they are U.S. citizens or not."

Maria said she can't afford to bring her three children from Mexico, so instead they live with their grandparents. Both she and her husband have diabetes, and the cost of care is significant. Any leftover money goes to Mexico to support her family.

"There isn't much money to send there," she said, "but I send what I can send."

Health insurance is beyond their reach, so the couple goes to La Clinica, which is among about a dozen clinics providing health care for illegal immigrants in the Twin Cities.

Research suggests immigrants, regardless of their status, come to the United States in better health than Americans with similar ethnic or racial backgrounds. This "healthy migrant" effect fades over time, said Katherine Fennelly of the University of Minnesota's School of Public Health. Poverty and lack of access to health care turns this "health advantage to disadvantage," she said.

Chronic diseases such as diabetes and asthma are common. New arrivals often gain 10 to 20 pounds in their first year here, and develop poor diet and exercise habits, said Dr. Carlos Figari of La Clinica, which is part of St. Paul-based West Side Community Health Services.

Between 2001 and 2004, Minnesota's Hispanic community changed from mostly U.S. born to mostly non-U.S. born, and from mostly middle-income workers to mostly low-income workers, according to the Minnesota Department of Health. Not surprisingly, the number of uninsured Hispanics increased from 18 percent to 34 percent in that same timeframe.

The shift is putting pressure on the metro area's charitable clinics. La Clinica in Minneapolis is struggling to survive, mostly because of the surge of uninsured immigrants seeking health care, said Mavis Brehm, West Side's executive director.

The clinics in the Twin Cities are already overcrowded, and couldn't handle the need if West Side closed its Minneapolis clinic, she said. "It's a struggle, because we're all getting inundated."

Maria has heard talk that her clinic is struggling financially under the growing burden of uninsured patients and may need to close. She is scared. She feels comfortable and safe there.

"They give me medication and a lot of education in order to control my diabetes," she said. "I really need the clinic."

Jeremy Olson can be reached at jolson@pioneerpress.com or 651-228-5583.