Thread: CA: Uninsured find a way

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Uninsured find a way

Health care access exists for illegal immigrants

By Cheryl Clark
STAFF WRITER

January 30, 2007





Governor brings health care pitch to S.D.



It might be called America's, and San Diego County's, not-so-little secret.
Ask most people where illegal immigrants get health care and they'll say a hospital emergency room or obstetrics unit.

In truth, many of the nation's roughly 12 million illegal immigrants obtain free or low-cost medical services – emergency as well as outpatient – through a much broader patchwork of clinics, hospitals and doctors. Expenses not covered by Uncle Sam, states or counties are quietly passed on to health insurance premiums that employers and the insured pay.




K.C. ALFRED / Union-Tribune
Gov. Arnold Schwarzenegger explained his plan to extend health insurance to all Californians at a meeting with business leaders in San Diego.
In this context, California Gov. Arnold Schwarzenegger's recently announced health-care plan would ostensibly use existing and new funds to legitimize insurance coverage for undocumented adults and children. About 2.5 million to 3 million illegal immigrants live in the state, although there's no authoritative estimate.
The governor's plan is part of a sweeping effort to make sure every Californian has health insurance by forcing businesses that don't cover their workers to pay a tax and assessing a fee on doctors and hospitals to subsidize health expenses for the uninsured, including people living here illegally.

The Schwarzenegger administration argues that his proposal would save taxpayers money by emphasizing preventive care, which is much cheaper than treatment in the ER.

“We are all now paying for (care to the undocumented), so let's be straightforward instead of just pretending it doesn't exist,” said John Ramey, senior health policy consultant to the governor, who was in downtown San Diego yesterday to discuss his overall health initiative with business leaders.

For weeks, health experts have struggled to assess the potential impact of Schwarzenegger's plan for illegal immigrants because it lacks details. They want to know how he would restructure the array of funding sources to provide earlier, higher-quality and more coordinated care for illegal immigrants. Representatives for many hospitals, clinics, nonprofit programs and physicians' groups said they haven't decided whether to support the proposal.

The governor didn't mention illegal immigrants during a news conference after yesterday's business meeting, but analysts widely believe he wants to extend significantly more tax-supported care to illegal immigrants of all ages.

Health officials statewide applaud Schwarzenegger's courage in pitching the concept, while some legislators and policy groups criticize him for envisioning a system that would further reward people who migrate here illegally.

Extending medical care to illegal immigrants is the moral thing to do, said Dr. Ellen Beck, director of a free clinic at the University of California San Diego.

“These are people who are here working in jobs and often raising children and grandchildren who are citizens,” she said. “It's our responsibility to find a way that every person who lives here has access to care.”

But government officials should try harder to block illegal migration, not encourage it with more incentives, said Ira Mehlman of the Federation for American Immigration Reform.

“This is an imposition on the taxpayers,” Mehlman said. “We don't need to be confronted every day with millions of people here illegally requiring health care and education. The problem has gotten out of hand and it has to stop.”

Such vehement opposition prompts some health care leaders to predict that Schwarzenegger's proposal won't survive the legislative process.

“It will not go anywhere because of the strong resistance you'll see from conservatives against insuring undocumenteds,” said Steve Escoboza, president of the Hospital Association of San Diego and Imperial Counties. “But there may be more willingness to do it for children, whom we know have no choice about their legal status.”

Many health experts say the governor's plan, if made into law, would coordinate what is now a disorganized and inefficient matrix of government-subsidized programs.

“It's all held together by string and bailing wire,” said Tracy Ream, director of Escondido's Neighborhood Healthcare community clinic.

Ream wishes that more uninsured patients, including illegal immigrants, would seek medical treatment before their ailments become severe.

“They delay care and then they end up in the hospital, and it's a lot more costly that way,” she said. “This is a country that doesn't have a health care system that works for the whole population, even for its own citizens.”

The Schwarzenegger setup would openly pay for preventive care and other treatments for illegal immigrants to stem transmission of tuberculosis, influenza and sexually transmitted diseases. It also would fund maternity programs for undocumented women.

In California, hospitals spend about $700 million annually on emergency room services for illegal immigrants, said Jan Emerson, spokeswoman for the California Hospital Association in Sacramento. The figure is roughly 10 percent of all money that hospitals spend on free care.

In San Diego County, about 10 percent of patients treated in hospital emergency rooms are illegal immigrants, according to a recent survey by the county's Health and Human Services Agency and the nonprofit coalition Community Health Improvement Partners.

“Just in San Diego County, taxpayers are paying $56 million, (much of it) on emergency care for the undocumented,” said Ruth Liu, associate secretary of health policy for the California Health and Human Services Agency.

Liu added that Schwarzenegger's plan would expand health coverage for undocumented children because they “are going to school, and if a child has a communicable disease, (he/she) is sitting right next to a child here legally.”

Officials for several organizations that receive money from San Diego County's Health and Human Services Agency said they are prohibited from using those dollars to provide care for illegal immigrants.

As a result, they don't ask patients for their residency status.

“We don't know who's documented and who isn't,” said Ed Martinez, director of the San Ysidro Health Center, which receives money from numerous government sources. “The public health mission doesn't really partition people off because of their documentation.”

Today's government-backed network of medical services for the poor in San Diego County, including those here illegally, is as wide as it is confusing. For instance:

Thousands of low-income women, some of them undocumented, receive prenatal services through two state-funded programs administered by the county. One is for women who have income levels that qualify under Medi-Cal rules. The second is Access for Infants and Mothers, including pregnant women who make a little too much money to qualify for Medi-Cal but are still low-income and uninsured.

The county redirects tobacco funds to a large network of community clinics that accept everyone needing outpatient care.

Federally qualified health centers, including many community clinics, obtain money from the U.S. Health Resources and Services Administration to deliver outpatient primary care.

The Reach Out agency receives county and other funds to refer uninsured and underinsured residents to health providers charging greatly discounted fees for primary care, surgery, dental and/or vision care.

County, state and federal funds cover programs for illegal immigrants with tuberculosis or sexually transmitted diseases.

California has a program, funded by various government sources, that offers therapy and rehabilitation for certain disabled children regardless of their immigration status.

A state-funded program allows low-income illegal immigrants with breast or cervical cancer to get free coverage for their treatments as soon as they are diagnosed.

Child Health and Disability Prevention provides disease screening and other primary care for all children in California. The program receives federal and state money.

Through the Every Woman Counts system, various community clinics give free pap smears and mammograms.

Federal funds routed through the state enable hospitals that take care of high numbers of uninsured patients to receive “disproportionate share” money.

Federal law requires hospitals that receive money for Medicare and Medicaid (called Medi-Cal in California) patients to treat and stabilize anyone who shows up in the emergency room.

But little money was available for reimbursing the care that such hospitals provided to illegal immigrants until 2005. That year, the federal government launched the four-year, $1 billion Federal Reimbursement of Emergency Health Services for Undocumented Aliens program.

Hospitals, ambulance services and doctors who can show their patients are undocumented will recover a small portion of the ER treatment rendered. Of the $250 million available nationally per year, about $72 million goes to California providers.

Some hospitals haven't tapped the program because of the time, expense and sensitivities involved in documenting a patient's lack of legal residency. Also, hospital officials said many illegal immigrants decline to give pertinent information because they fear deportation.

At the state level, California requires all of its counties to provide last-resort care to indigent people. This service often is accomplished by county hospitals.

But San Diego County, which does not have a county hospital, administers its obligation by contracting with private health providers. Its program for medically indigent adults has strict eligibility criteria that preclude illegal immigrants.

In contrast, most major counties in the state allow illegal immigrants to join the program as long as they meet other requirements, said Richard Brown of the UCLA Center for Health Policy Research.

“San Diego County is exceptional in the state in how draconian its policy is with respect to the undocumented,” Brown said. “All of these things are very political. In Los Angeles (County), the politics of the area lead the Board of Supervisors to provide coverage. In San Diego (County), the politics are different.” The Los Angeles region is more Democratic-leaning than the San Diego area.

Of San Diego County's five supervisors, only Dianne Jacob responded to phone calls seeking reaction to Schwarzenegger's initiative for illegal immigrants.

“It's too soon to comment,” she said. “(The proposal's) impacts are still being analyzed by the county. California's health care crisis is a tangled web involving insurance companies, lawyers, hospital operators, physicians and many other parties. At the very least, the governor deserves praise for having the guts to take on this staggering issue.”

“It will not go anywhere because of the strong resistance you'll see from conservatives against insuring undocumenteds,” said Steve Escoboza, president of the Hospital Association of San Diego and Imperial Counties. “But there may be more willingness to do it for children, whom we know have no choice about their legal status

STOP, using the children to push your agenta, were not falling for it anymore.

And why don't you just get out a bullhorn and stand on the border and announce free health care for all, what a bunch of losers. Poor calif. taxpayers my heart goes out to you!!