Thread: Health care a 'complicated' issue

Health care a 'complicated' issue
ILLEGAL IMMIGRATION: CLOSING THE GATES

By Jill Coley (Contact)
The Post and Courier
Sunday, June 29, 2008
Alan Hawes
The Post and Courier

Angelica Ventura Gonzalez, an uninsured illegal immigrant, has a stack of bills from her son's birth and said she doesn't know if Medicaid will pay them.

Alan Hawes
The Post and Courier

About this series:
In an occasional series, The Post and Courier has been exploring the potential consequences of illegal immigration on people in business, law enforcement, health and education.

Ana-Cecilia de Marquez, 43, rubs her belly when she talks. The illegal immigrant has bothersome and sometimes painful symptoms that require her to stay close to her Goose Creek mobile home.

"It's ... like I'm going to deliver a baby," de Marquez said. "It feels like a wound inside."

De Marquez, who moved from El Salvador to the United States three years ago, is uninsured. She said she has been bounced around the health care system for two years, unable to get her symptoms under control.

"So what?" say some opponents of illegal immigration, who don't think undocumented people should be able to receive health care at public expense.

Russ Henderson, a U.S. citizen and retired military man, lives in neighboring Ladson and is outspoken on the issue. "Every time an illegal uses services the American people pay for, they are stealing," he said. "Go back and let your government take care of you."

Henderson is not alone. Illegal immigration was second only to the economy in the top four issues that matter most among South Carolina Republicans surveyed in primary exit polls.

State legislators responded and passed the Illegal Immigration Reform Act, which became law in June.

The law, among other measures, bans any state-funded, non-emergency medical care for adult undocumented immigrants. Exceptions are made for immunizations, prenatal care and communicable diseases.

Senate President Pro Tem Glenn McConnell, who championed the reform, said, "There's no reason taxpayers should foot the bill for illegals. It's flat wrong. We're having trouble keeping up with those already here. Adding the burden of those not contributing to the system is unfair."

Jack Feussner, chairman of Medical University of South Carolina's Department of Medicine, said he can understand why legislators want to make resources for legal residents a priority. "But it's much more complicated than that," he said.

MUSC, which receives 6.4 percent of its operational budget from the state, is reviewing the legislation to identify issues and figure out how to comply. MUSC, like nearly all hospitals, accepts Medicaid funds, which are a combination of state and federal money. For every dollar the state sets aside for Medicaid, the federal government provides $3.

That means the hospital is caught between the new state law and federal law, which also mandates that people must be treated without discrimination. Any test for legal residency must be applied to everyone.

Here's one way the laws could conflict: An illegal immigrant shows up at a hospital clinic, which is bound by federal law regarding emergencies and discrimination. The immigrant doesn't speak English. Before an interpreter is brought in to help interview the immigrant about his condition, which might constitute an emergency, should that patient's legal status be screened?

Another problem with implementing the law is separating federal and state. More than 130 clinics, both hospital- and physician-based, are affiliated with MUSC. Separating the funding streams to insure that no state funds go to illegal immigrants is complicated and might be impossible for an organization of MUSC's size.

For that reason, Tammy Besherse, staff attorney with S.C. Appleseed Legal Justice Center, a low-income advocacy group, is skeptical that the law will have any effect. "I don't know of any place that only gets state money," Besherse said.

What will the law change?

To avoid a direct conflict with the federal law requiring emergency care, regardless of immigration status, legislators targeted a limited health care scenario with their bill. It prohibits illegal immigrant adults from seeking care in a state-funded facility for non-life-threatening and noncommunicable ailments.

De Marquez fits the bill.

Her womb is filled with lime-size fibroid tumors. Common in premenopausal women, the noncancerous tumors often are symptomless, but they can sometimes be painful and bleed. De Marquez also suffers from diverticulitis, a digestive condition that also can cause abdominal pain.

Neither condition is immediately life-threatening for her, so if de Marquez visits a clinic that receives state funds, she could be turned away, according to the law. Clinics that rely on membership dues, donations and federal grants are not affected by the law, but they are few and have limited resources.

It's still unclear how the law will be enforced. It requires any adult seeking medical care at a clinic or hospital that receives state funds to assert in an affidavit that he is lawfully present in the U.S. It does not ask for proof of citizenship.

The affidavit will be accepted as proof of citizenship until status is verified through the Systematic Alien Verification Entitlement program operated by the Department of Homeland Security.

No agency is charged with enforcing the prohibition against state-funded care, Lynn Bailey, a Columbia-based health care consultant, pointed out. "It's a piece of feel-good legislation that's absolutely impossible to administer," she said.

Andres Arias, an Orangeburg internist who also runs a North Charleston clinic four days a week, said a misconception exists that immigrants are using up resources at ambulatory clinics, the primary target of the legislation.

Undocumented adults would rather go to private clinics and pay up front, he said, rather than leave a paper trail of bills. Patients visit him from as far away as Georgetown and Myrtle Beach. One man comes from Virginia, he said.

Even before the law passed, not having insurance was a roadblock to receiving comprehensive care. Most insured adults with de Marquez's conditions would be treated in a doctor's office. But without insurance, de Marquez is unable to afford to go to a doctor.

When her symptoms become crippling, she goes to the emergency room, which under federal law must stabilize her. But emergency physicians treat only her current symptoms, rather than perform diagnostic tests necessary to determine why her conditions are disabling.

De Marquez always gets billed for her treatment, and invoices are piling up. Unable to work because of pain, she can't pay, she said.

Hospitals have long felt the pinch of treating uninsured patients. Most facilities ask patients to pay up front for non-emergency and elective procedures.

Officials at the Medical University of South Carolina, Trident Health System, Roper St. Francis Healthcare and East Cooper Regional Medical Center confirmed that they ask for payment up front, sometimes at discounted rates if patients do not qualify for charity care.

The move is necessary to remain financially solvent, officials said. In fiscal 2006, state hospitals reported they delivered more than $500 million in uncompensated care.

How much is attributed to illegal immigrants is unknown, since health-care providers do not record patients' legal status.

Based on other data, the S.C. Hospital Association estimated that in 2006 there were 27,000 discharges of uninsured non-citizens. That's not necessarily illegal immigrants, said Rozalynn Goodwin, director of policy research for the association.

The term "uninsured non-citizens" encompasses legal permanent residents and holders of temporary visas, as well as illegal immigrants.

South Carolina hospitals charged uninsured non-citizens about $117 million, including $59 million in emergency room charges, according to the association. Patients paid for an undetermined amount of those charges, Goodwin said.

Fear

In the end, whether the law has teeth or not might be irrelevant. Fear may reduce the number of illegal immigrants seeking health care.

Arias, the Orangeburg internist, said there is fear in the Latino community about going anywhere they have to identify themselves. "The perception that things are going to change makes people really nervous," said Arias, whose North Charleston patients are almost all Latino.

One of his patients, Delfino, is an undocumented laborer who did not want to disclose his full name. He suffered a puncture wound when a cement mixer collapsed on his leg.

Delfino said his boss did not take him to a doctor but instructed him to pour gasoline on the gash. He did not seek medical help for fear of being deported, until a week later, when his ankle swelled to three times its normal size.

After extensive hospital treatment, he owed $3,600, which he pays off in $100 weekly installments.

The law actually might end up costing the health care system more money if many illegal immigrants, like Delfino, wait to seek medical care until a little problem becomes a big one.

"This is going to be complicated to say the least," MUSC's Feussner said.


Illegal immigrants and health care

Q: Do illegal immigrants burden public health insurance?

A: Medicaid is a national health insurance program for low-income adults and children and disabled citizens. Illegal immigrants are not eligible, except for emergency services, including childbirth.

From November 2006 to November 2007, 5,731 people in South Carolina were denied because they could not prove citizenship, said Jeff Stensland, spokesman for the state's Medicaid agency.

The state paid $14.5 million in emergency Medicaid for 3,638 illegal immigrants during fiscal 2007. That includes emergency services for inmates, but most went for services to undocumented people, Stensland said.

Medicare, which provides health coverage for citizens 65 and older, does not cover illegal immigrants.

Q: Do illegal immigrants consume many health care resources?

A: There is no way to know, because health-care providers do not usually ask patients their status.

Those on the front lines of health care say undocumented adults rarely seek treatment for themselves, unless it's an emergency. They are far more likely to seek care for their children, many of whom are U.S. citizens and hence entitled to Medicaid if their family's income is low enough.

By far, the larger problem for the health care system is uninsured patients, said Rozalynn Goodwin, director of policy research for S.C. Hospital Association. About 800,000 South Carolinians are estimated to be uninsured. South Carolina's illegal immigrant population, which is largely uninsured, is estimated at 55,000 to 75,000.

Q: Why don't illegal immigrants pay for health care?

A: Anecdotal evidence suggests that this notion is unfounded. Jason Roberson, head of MUSC interpreter services, said people often ask, "Where do I pay?" It might take an illegal immigrant several years to pay for costly procedures.

Those who cannot pay are treated the same as all uninsured. If they do not qualify for emergency Medicaid, hospitals either tap charitable resources, write off their care as bad debt (which drives up costs for insured patients) or refuse to provide elective procedures.

Q: Do illegal immigrants qualify for Medicaid by having a baby?

A: Undocumented pregnant women are eligible only for emergency Medicaid to cover delivery and complications. Babies born in the U.S. are citizens.

Once born, the child may qualify for Medicaid, depending on his parents' income. But having their child qualify does not entitle parents.

Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.
http://www.charleston.net/news/2008/jun ... ssue46018/

It's not complicated at all, either you have insurance or you MUST PAY!

Social programs must be reserved for US citizens (anchor babies are not born to US citizens, they should not receive any benefits from this country)!

I'm sick and tired of the "gimme, gimme's" these illegal aliens have. We don't owe them diddly. Go home and make your government take care of you, I can barely afford my own insurance!

Thank you Mr and MRs AMERICAN TAXPAYER.

Its not complicated.
Its just outrageous and repugnant. I've watched hospital after hospital close down in California before I left that craphola state.

A: Medicaid is a national health insurance program for low-income adults and children and disabled citizens. Illegal immigrants are not eligible, except for emergency services, including childbirth.

Well I'll be.

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I CANT BELIEVE THIS ARTICLE STATES THAT THIS IS A COMPLICATED PROBLEM. DEPORT THEM. SIMPLE AS THAT. LET THEM GET MEDICAL CARE IN THEIR OWN COUNTRY. AMERICANS HAVE THEIR OWN MEDICAL CARE TO PAY FOR AND WE CANT AFFORD TO PAY FOR OTHERS AS WELL.

A: Anecdotal evidence suggests that this notion is unfounded. Jason Roberson, head of MUSC interpreter services, said people often ask, "Where do I pay?" It might take an illegal immigrant several years to pay for costly procedures





Oh yeah? And evidence from the stacks upon stacks of medical bills which come into my office every day, addressed to the IA tenants living here, only to be returned to the P.O. after 5 days because they have refused to take delivery, suggests that they DON'T pay their damned bills.

I'm sorry, but I'm sick and tired of hearing about the medical care issues of people who have no flipping right to even be in this country let alone demand that we take care of their every want and need.

This is not a "complicated issue". In life threatening situations stablize them and then transport them home for further care. Childbirth is NOT an emergency.....stop paying for these deliveries and you will have solved the birthright citizenship headache to a huge degree. And lastly, force these people's home countries to get off their asses and take care of their own while we care for ours.

In the meantime, 40 million Americans are uninsured and get NO sympathy from either the press or their elected officials.

Duplicate post:

http://www.alipac.us/ftopict-121343-closing.html+gates