Thread: Hospital, Medicare numbers tell immigration tale

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Hospital, Medicare numbers tell immigration tale
Lamm says influx is setback for goal of insuring citizens

By Rachel Brand and Rosa Ramirez, Rocky Mountain News
August 28, 2006

Illegal immigrants' use of medical care is at the white-hot center of the immigration debate.

The common refrain: Hospitals are groaning under the burden of patients who are undocumented. They flood emergency rooms and the state picks up the tab.

That drives up Medicaid costs, the argument goes, which is bankrupting states, robbing other programs and pushing U.S. citizens to the bottom of the waiting list for services.

The reality is that the costs of Medicaid and hospital charity are, indeed, spiraling upward, but illegal immigrants contribute only a small share of the uninsured, underinsured and working poor who are increasingly relying on government and charity help.

It's difficult to pinpoint growth in the costs of caring for illegal immigrants, but one measure is emergency Medicaid - which has gone up 57 percent in the past six years.

This federally mandated program pays for emergency room care for anyone who would qualify for Medicaid based on income but can't prove citizenship or five years of legal residency.

Medicaid takes care of the very poor, children born into poverty and the disabled, with the state and federal government splitting expenses 50-50.

Emergency Medicaid's cost in Colorado rose from $39.4 million in 2001-2002 to a projected $61.9 million this fiscal year. Nine of the top 10 treatments are for pregnant women.

But emergency Medicaid makes up less than 2 percent of the Medicaid budget.

Medicaid's caseload, meanwhile, has risen 60 percent in the same period.

At the same time, hospitals' costs for charity care and unpaid debt have grown dramatically, and low- cost clinics that care for the uninsured are strained.

Former Colorado Gov. Richard Lamm, a vocal opponent of illegal immigration, says the influx of people makes it even harder to reach his goal - health coverage for all citizens.

"I wish everybody in the world had good health care. But I've got 770,000 Coloradans without basic health care," he said. "If I'm going to get universal health care, I can't be the health care system to the world."

Efforts so far to limit health care for illegal immigrants have taken the form of stricter documentation requirements for some public programs.

But tighter rules on proving citizenship don't extend to most places that illegal immigrants get care - emergency rooms, federally qualified health clinics, school-based health clinics and nonprofit charity programs.

A new federal law requiring Medicaid applicants to show proof of citizenship went into effect July 1, but most people think it will have little effect.

"One of the biggest myths is that immigrants are trying to get on Medicaid," said David Adamson, executive director of the Mountain Family Health Centers in Glenwood Springs. He and others say most immigrants don't know what's available and avoid registering for government programs.

In Colorado, House Bill 1023, which went into effect Aug. 1, requires stronger proof of citizenship for state services, but exempts family planning, prenatal care and children's services.

The clinics and emergency rooms where many illegal immigrants go either aren't required to check IDs or, in the case of emergency rooms, must serve anyone who shows up in need.

Is medical care a lure?

Foes of illegal immigration say free medical care lures workers to the U.S.

Most immigrant advocates and immigrants themselves say that's not true. Immigrants come here to work, they say. Medical care is an afterthought.

"I don't think I've heard of anybody who has trekked through the Arizona desert to have their baby in Glenwood Springs, or to have their throat checked," said Adamson, who heads a low-cost health clinic in the booming mountain town.

But once here, immigrants take advantage of the decades-old safety net put in place under President Lyndon Johnson to help the poor.

It's widely known among undocumented workers, for instance, that hospitals can't turn away patients from the emergency room. They also know to get free exams at health fairs and immunizations at school.

But the biggest life raft for illegal immigrants - or any uninsured person - is Colorado's 22 nonprofit clinics and 15 community health organizations.

Community health organizations helped 395,000 patients in 2005. Nine out of 10 clinic patients are low-income, earning $40,000 a year or less for a family of four, which is 200 percent of the federal poverty level.

But uninsured patients can pay as much for their care as those with insurance.

The Sunrise Health Center in Greeley, which is partly taxpayer-funded, charges pregnant women $400 for nine prenatal visits. But it lacks an ultrasound machine, so patients just pay $300 to $600 for a scan elsewhere.

"We have all pulled money out of our own pockets," said Dr. Mark Wallace, director of the Weld County Department of Public Health and participant in the clinic. "We say, 'We know you need this, and I'm not going sit here and watch you (go without.)' "

Patient contributions make up 61 percent of the clinics' $12 million annual budget.

Maria, who asked that her last name not be used because she is here illegally, is a patient at a nonprofit, private clinic for the needy in Denver. She's faced a series of surprises since she came to the U.S. from Jalisco, Mexico, three years ago.

She dreamed of working and saving enough to build a retirement house on her small plot of land in Mexico.

But two years ago, she learned she had breast cancer. She's lived with relatives who have helped with medication costs.

"I haven't worked since I got here," she said.

She's grateful to the physicians at Denver's Clinica Tepeyac, who have arranged private funds for her chemotherapy. The clinic accepts no taxpayer money.

"I had two surgeries and treatment," she said in Spanish. She also had four sessions of chemotherapy and continues to take medicine, she said.

She's heard arguments that illegal immigrants come to this country to get benefits, but she believes most come here just to earn a living.

"I came to work, but I can't because of my illness," she said.

Rock and a hard place

Public wrath about illegal immigrants puts providers in a bind. Doctors and nurses are trained to help the sick, period. Federally funded hospitals and clinics can't discriminate based on national origin. And low-cost preventive care staves off costly emergency visits down the road.

"Health care has not been about asking, 'Are you a U.S. citizen?' " said Wallace of the Weld health department. "For those of us in the safety net, the bigger question is, 'What do we do when we have so many uninsured?' "

But Lamm says policy-makers must address illegal immigration before they can help the uninsured.

"This is another way that good- hearted people mistakenly act," he said. "You can't build public policy one individual at a time. You've got to set limits.

"I'm willing to look people in the eye and say, 'You bet you should not give an 89-year-old a heart transplant.' I sure as hell am going to start by saying, 'We're going to deliver care to people who are in the country legally.' "

1 in 5 have health coverage

Contrary to popular belief, not all illegal immigrants are uninsured. Among the 225,000 to 275,000 estimated illegal immigrants in Colorado, an estimated one in five workers has a job with a company that provides health insurance. Virtually no immigrants buy coverage on their own, experts say.

Rosa, who has been living illegally in Colorado for the past four years, gets health insurance through her husband's job. She agreed to talk if she were not identified.

Not long ago she learned that the lump in her breast was not fatty tissue, as a previous doctor told her, but a cancerous tumor.

Before each chemotherapy session, her husband takes their three children to the baby sitter. Rosa is too weak to take care of them after the therapy.

"I stay alone until my husband comes home from work at 7 p.m.," she said. "I feel weak, nauseous and my body hurts."

Her husband's work insurance covers some of the cancer treatments, including chemotherapy. Her co-payments are $40. In addition, she pays $60 for three pills after chemotherapy sessions.

In July she received her fourth round of chemotherapy. She said she has four more left.

Many of Colorado's illegal immigrants are uninsured. The RAND Corp. in 2005 estimated that about 70 percent of U.S. undocumented immigrant adults have no health insurance.

When they get sick, they rely on free or low-cost care in clinics and charity care at hospitals.

That leads to a common complaint - that hospital emergency rooms are overrun with illegal immigrants, adding to long wait times for citizens.

But knowing whether the person sitting in an emergency room is here legally or illegally isn't possible for a casual observer. And research on the matter has surprising conclusions.

Communities with high levels of Hispanics and uninsured patients have lower emergency room use than towns with many elderly and insured patients, according to a July study published in the academic journal Health Affairs.

Further, immigrants use less care than citizens, about $1,139 a year for every $2,564 used by nonimmigrants, according to Harvard Medical School researchers. They say immigrants may be more likely to forgo preventive care.

Horacio, who did not want his last name used because he is working in Colorado illegally, first sought medical care for a painful ear infection when he was living in Zacatecas, Mexico, and paid the equivalent of $23 for the visit and medication.

On a Tuesday in July, Horacio's ear was bothering him again, and the soft-spoken man waited with his year-and-a-half-old son at the Salud Family Health Center in Commerce City.

Horatio took a day off from his well-paid job with a company that ships roofing materials so he could get something for his pounding headaches - a result of the ear infection.

"The pain comes in slowly, it breaks, and my head hurts," he said in Spanish. "I've been here about five or six times for my ear infection, (the) dentist and problems with funguses."

Still, he's not one to get a regular physical, even though his work insurance would cover it.

Most of the time, Horatio says, "I feel good."

Without preventive care, minor illnesses can turn serious, and uninsured immigrants - like uninsured citizens - wind up relying on charity.

Colorado hospitals doled out $511 million in charity care and unreimbursed care to the uninsured in 2003, the latest number available. That number would be as high as $561 million in 2005 if Colorado followed the national growth rate in charity care.

"Anecdotally, we do hear it is going up dramatically," said Marty Arizumi, a spokeswoman for the Colorado Health and Hospital Association.

Colorado hospitals aren't as upset about immigration as their counterparts in Texas and California, where some hospitals are collapsing from the cost of delivering illegal immigrants' babies.

Still, uninsured patients, whether here legally or not, increase the cost of care to everyone else.

"Ultimately, it results in inflation in the cost of health care," said Bill Munson, regional facility finance director for Greeley's Northern Colorado Medical Center.

Actually tracking care to illegal immigrants is difficult.

Many hospitals are just beginning to ask for Social Security cards or other ID after care is rendered. That will allow them to take advantage of a new federal program that offers extra payments to hospitals that care for a higher-than-usual number of illegal immigrants.

But medical facilities risk being cited for discrimination if they deny care because of national origin. Many also say it goes against their mission.

"Our responsibility and our heritage is providing care regardless of ability to pay," said Kay Taylor, a spokeswoman for Exempla Health Care in Denver.

Avoiding crisis

Six years ago, Northern Colorado Medical Center saw the beginning of a crisis. Its emergency room was handling double the number of patients it could serve - and 6,000 were showing up for earaches, sprains and fevers.

The hospital, the health department and the local clinics united to raise $6 million to open an expanded primary health clinic for low-income workers.

The clinic is helping, but the flood of uninsured patients isn't shrinking. And clinics can't handle complex cases, surgery or specialized treatment.

Says Wallace of Weld County, "Everyone says we are just going to keep providing the services until we are broke."

Congressional hearing

• What: U.S. Sen. Wayne Allard, R-Colo., will hold a Senate field hearing on the potential economic impacts of national immigration legislation on state and local governments.

• When: 2:30 p.m. Wednesday

• Where: Aurora City Council Chambers, 1515 E. Alameda Parkway, Aurora

IMMIGRATION SERIES

• Tuesday: The debate over children of illegal immigrants, known as "anchor babies"

• Wednesday: The options for immigration reform in Congress

Glossary of terms

• EMTALA: The Emergency Medical Treatment and Active Labor Act. This federal law was enacted in 1986 to prevent private hospitals from dumping poor patients on county hospitals, and to ensure that any patient who shows up in a hospital emergency room is treated fairly, without discrimination. It says hospitals must screen and treat any patient who asks for care at an emergency department. If the hospital can't provide the treatment, it must transfer the patient to one that can.

• Emergency Medicaid: This law, enacted in 1996, requires state Medicaid departments to pay hospitals for the care of patients who would otherwise qualify for Medicaid, but are noncitizens. The payment covers only emergency treatment and does not apply to people whose income is too high to qualify for Medicaid, such as most working adults.

• Federally qualified health center: A nonprofit clinic designed to serve low-income or rural patients. These clinics receive federal funds through the Bureau of Primary Health Care and must report back to that agency. There are about 722 such health centers that deliver health care at 4,059 sites in the U.S. They include community health centers, migrant health centers, programs to deliver health care to the homeless, clinics in public housing and tribal health centers for American Indians.

Impact on health care

• The closest measure of the growth in immigrants' health care costs is emergency Medicaid. The program's cost rose from $39.4 million in 2001-2002 to a projected $61.9 million this fiscal year, a 57 percent increase over six years. Nine of the top 10 treatments are for pregnant women.

• Recent measures to prevent illegal immigrants from accessing health care take the form of stricter documentation requirements. But immigrants get most of their care at places beyond the reach of that law: hospitals and low-cost clinics.

• The cost of hospital charity care has grown astronomically over the past five years. At the University of Colorado Health Sciences Center, for instance, charity care and bad debt jumped 137 percent from 2001 to 2005, to $151.7 million last year.

• An estimated 20 percent of illegal immigrants have employer-based health insurance, according to the RAND Corp. The study also found that 65 percent are uninsured and 15 percent are partially insured.

• Communities with high numbers of Hispanics and uninsured patients have lower emergency room use than towns with many elderly and insured patients, according to a July study published in the academic journal Health Affairs.

• Further, immigrants use less care than citizens, about $1,139 a year for every $2,564 used by nonimmigrants, according to Harvard Medical School researchers. They say immigrants may be more likely to forgo preventive care.



brandr@RockyMountainNews.com or 303-954-5269

But gee whiz, Tony Snow said illegals don't use medicad What is wrong with this country? We have naturalized citizens without coverage going without medical services and we have illegals sucking us dry.

"One of the biggest myths is that immigrants are trying to get on Medicaid," said David Adamson, executive director of the Mountain Family Health Centers in Glenwood Springs. He and others say most immigrants don't know what's available and avoid registering for government programs.

Why do they need to worry about getting on medicaid? all immigrants know the hospitals can't refuse them service. So when they go in with no or false identification, the hospital won't be able to track them down for payment. So us taxpayers get to 'eat it.'

But emergency Medicaid makes up less than 2 percent of the Medicaid budget.

Get that anchor baby and get Medicaid!

All that doesn't apply to over run border states of cities like Los Angeles. Just walk into a county subsidized hospital in South Texas and you can see for your self who is benefiting from your tax dollars.

Dixie

Funny how the first line of this article reads:

Illegal immigrants' use of medical care is at the white-hot center of the immigration debate.

Yet the authors seem compelled to blur the line between legal and illegal throughout this peice, for example:

"One of the biggest myths is that immigrants are trying to get on Medicaid," said David Adamson, executive director of the Mountain Family Health Centers in Glenwood Springs. He and others say most immigrants don't know what's available and avoid registering for government programs.

So, we are supposed to believe that the millions of people who break our laws to enter this country, then use forged/stolen documents to secure jobs, suddenly draw the line at taking advantage of taxpayer funded benefits that dont require proof of citizenship to obtain? Those that think the American people are buying this BS deserve to have the word MORON permanently tatooed on their foreheads!

Another thing one can't help but notice is the staggering proliferation of illegal immigrant friendly (exclusive?) free "clinica's" and hispanic health fairs. Who is funding the millions, if not billions, it costs to operate them?

Nine of the top 10 treatments are for pregnant women.

Anchor babies being had solely for the purpose that the name implies. HR698 has to pass to stop this insanity!