Thread: Immigrant health already funded in California

http://www.contracostatimes.com/mld/cct ... 000136.htm

Posted on Sun, Jul. 09, 2006

Immigrant health already funded
Fact overlooked in state's debate about whether to add money to the budget to insure undocumented children
By Clea Benson
SACRAMENTO BEE

SACRAMENTO - The recent budget debate over whether the state should provide health insurance for children who are undocumented immigrants largely overlooked one key fact: The state already spends almost $1 billion a year for some health care services for the undocumented through Medi-Cal.

Amid a renewed national focus on illegal immigration, health services for undocumented immigrants in California returned as a political flash point this year for the first time since debate over Proposition 187 roiled the state in the 1990s.

Republican lawmakers successfully argued against expanding health care for the undocumented in this year's budget, persuading Democrats and GOP Gov. Arnold Schwarzenegger to drop $23 million for new insurance coverage for undocumented children.

But almost no one was talking about the programs that Prop. 187 was designed to cut before it was blocked in court in the late 1990s: prenatal care, nursing home care and other services funded by Medi-Cal for undocumented immigrants.

Over the past decade, those services have grown by 50 percent into a $1 billion annual program serving hundreds of thousands of people each year. Spending growth has been slower than in the Medi-Cal program overall, which went up more than 100 percent in the past decade, to about $35 billion annually.

Both the number of people receiving services and the cost of those services have risen: The number of undocumented women giving birth covered by Medi-Cal rose almost 25 percent from 85,000 in 1995 to 105,000 in 2004. Meanwhile, the overall costs of those births rose by about 135 percent during that time.

State officials say the increases are largely due to inflation in health care costs and a change in the rules allowing more people to qualify for Medi-Cal.

Republican lawmakers say the fight over Prop. 187 has limited their ability to try to cut existing programs. So they are focusing on trying to stop any efforts to expand services to the undocumented.

"We've realized our hands are pretty much tied by the fact that the Proposition 187 appeal was dropped in court," said state Sen. Dennis Hollingsworth, R-Murrieta, one of the lawmakers leading this year's budget fight.

Meanwhile, advocates for immigrants and public health activists say there are not enough health care programs for undocumented immigrants. They say it is time to make sure that everyone, especially children, has access to quality preventive health care and will not rely on expensive emergency-room care that is often a last resort.

Many were dismayed when the Democrats and the governor removed the health care money for children to avoid delaying the budget.

"The Republican Party is starting to become a bit boring, and I don't think they represent the sentiment of today's Americans," said Dr. Maximiliano Cuevas, CEO of Clinica de Salud del Valle Salinas, a network of clinics that serve farm workers in the Salinas Valley.

"Politics aside, you have to plan for a healthy population," Cuevas said. "If there are components of the population who come in with illnesses that are undetected or unknown, the entire population runs that risk."

The Medi-Cal rolls show that on average, the system has about 780,000 undocumented people enrolled each month for emergency care or other limited benefits. The Insure the Uninsured Project, a Santa Monica-based nonprofit group, reports that the number actually served each month may be closer to 200,000 because some people stay in the state's computer system long after they receive care.

Despite the growth in the program, the services available for undocumented immigrants are still limited and do not include the comprehensive primary-care benefits that citizens and some legal residents receive under Medi-Cal.

What the undocumented do get, provided they qualify, is emergency care, which the federal government requires and subsidizes with Medicaid funds. The federal government also helps pay for prenatal care, partly on the theory that it is less expensive to pay for pregnancy care than it is to care for babies born prematurely.

California covers several additional services for the undocumented on its own, including breast and cervical cancer treatment and nursing-home care. A 1981 state Supreme Court ruling also requires the state to cover the cost of abortions for all Medi-Cal recipients, including the undocumented. The abortion costs have held steady at about $3 million a year over the past decade.

To be eligible for any Medi-Cal benefits, the undocumented must meet the same criteria as citizens: The program is usually open only to people who are very low-income, and who are minors, parents, pregnant or in need of long-term care.

The state also spends about $100 million a year for other programs for children who are either very sick or who do not qualify for federal health care, largely because they are undocumented. And there are federal and state subsidies for clinics such as Cuevas' that provide services to the uninsured regardless of their citizenship status.

To Hollingsworth, the health programs are tantamount to an inducement to cross the border illegally.

"It's a mistake for state government to provide incentives and encouragement for illegal immigration," he said.

Sonal Ambegaokar,a health policy attorney at the National Immigration Law Center in Los Angeles, calls it a "myth" that people come to the United States illegally to obtain health care. Advocates right now have a hard time persuading people to take advantage of the limited services available to them, she said.

"Right now, if you gave them preventative care, it's not like you would see this incredible influx," she said. "They all have their own reasons they don't use the health care system: cultural reasons and an unfamiliarity with the philosophy of Western medicine."

Meanwhile, health care providers are bracing for a change that they fear will force some Medi-Cal recipients who are here legally to use the stripped-down services available to the undocumented: a new federal rule requiring people to prove their citizenship with a birth certificate or passport to be eligible for full benefits.

State officials say they will not implement the plan until August and are working out ways to lessen the impact.

But people like George de la Mora, executive director of the Mexican American Alcohol Project, which runs a community clinic in Sacramento, believe it will be impossible for some citizens to come up with the proper documents.

"Most if not all medical people came into the business to help people," he said. "So it's a dilemma for them. What do we do? I'm hoping something can be resolved so it doesn't become an issue of citizenry but it becomes an issue of human beings' needs, and the political aspect is put aside for at least a little while."

Meanwhile, advocates for immigrants and public health activists say there are not enough health care programs for undocumented immigrants. They say it is time to make sure that everyone, especially children, has access to quality preventive health care and will not rely on expensive emergency-room care that is often a last resort.

What these illegal immigrant advocates tend to forget is who is paying for for the health care programs! That would be us, the American tax paying citizen!

Very few medical workers are willing to work for free or pay clients out of their own pockets.
Instead the OBL have no problem putting the burden on us.