Thread: Illegal Aliens are Healthier Than Native Born Americans?

I found this article infuriating!!!!!!! And I told them so!


Volume 357:525-529 August 9, 2007 Number 6

Immigrants and Health Care — At the Intersection of Two Broken Systems

Susan Okie, M.D.




At a primary care clinic in Montgomery County, Maryland, where I volunteer, the patients are uninsured immigrants from Latin America or West Africa. Many are day laborers, house cleaners, or construction workers; most do not speak English. Several months ago, I saw a middle-aged Hispanic baker with profound weakness, fatigue, limb swelling, and severe muscle pain, who had to be hospitalized for myxedema. Fortunately, a local charity agreed to pay most of her hospital costs, and she's now receiving thyroid hormone–replacement therapy — but with regular care, her hypothyroidism could have been diagnosed earlier and hospitalization averted. Another day, I tried to persuade a reticent West African man who had been tortured in prison that psychological counseling might help his chronic pain. However, mental health services for uninsured immigrants are sparse, and the man was reluctant to venture to a distant part of Washington, D.C., to a program for torture survivors. A third patient, a man in his 40s, came in with a nearly empty bottle of eyedrops, which he had brought from Ghana to take for glaucoma. The disease had already blinded him in one eye, and the vision in his other eye had been fluctuating. He needed a complete eye exam and visual-field testing, but arranging timely referrals to specialists is often difficult for caregivers treating the uninsured. I wrote him a prescription, and we managed to set up an appointment at a hospital-based ophthalmology clinic that accepts a limited number of uninsured patients.

***For recent immigrants — especially the estimated 12 million who are here illegally — seeking health care often involves daunting encounters with a fragmented, bewildering, and hostile system. ___The reason most immigrants come here is to work and earn money; ___on average, they are younger and healthier than native-born Americans, and they tend to avoid going to the doctor.***
Many work for employers who don't offer health insurance, and they can't afford insurance premiums or medical care. They face language and cultural barriers, and many illegal immigrants fear that visiting a hospital or clinic may draw the attention of immigration officials. Although anti-immigrant sentiment is fueled by the belief that immigrants can obtain federal benefits, 1996 welfare-reform legislation greatly restricted immigrants' access to programs such as Medicaid, shifting most health care responsibility to state and local governments. The law requires that immigrants wait 5 years after obtaining lawful permanent residency (a "green card") to apply for federal benefits. In response, some states and localities — for instance, Illinois, New York, the District of Columbia, and certain California counties — have used their own funds to expand health insurance coverage even for undocumented immigrant children and pregnant women with low incomes. Other states, however, such as Arizona, Colorado, Georgia, and Virginia, have passed laws making it even more difficult for noncitizens to gain access to health services.

Whether or not they have health insurance, immigrants overall have much lower per capita health care expenditures than native-born Americans,1 and recent analyses indicate that they contribute more to the economy in taxes than they receive in public benefits. In a study from the RAND Corporation, researchers estimated that undocumented adult immigrants, who make up about 3.2% of the population, account for only about 1.5% of U.S. medical costs.2 Many immigrants do not seek medical treatment unless they are injured or acutely ill; at our clinic, patients with type 2 diabetes often have florid symptoms and even incipient renal damage by the time their disease is diagnosed.

One study found that annual per capita expenses for health care were 86% lower for uninsured immigrant children than for uninsured U.S.-born children — but emergency department expenditures were more than three times as high.1 Although U.S. hospitals must provide emergency care without first asking about income, insurance, or citizenship, early diagnosis and treatment in a primary care setting are both medically preferable and a better use of resources. "If people keep postponing medical care because they're so concerned about being sent back over the border," noted Elizabeth Benson Forer, executive director of the Venice Family Clinic, a venerable free clinic in Los Angeles that serves many immigrants, "then you can end up with some pretty horrendous health situations."

Immigrants live, work, and attend school in communities throughout the country; laws and bureaucratic barriers that reduce their use of key preventive health services, such as immunizations and screenings for infectious disease, make for bad public health policy, and denying immigrants primary care ultimately increases health care costs for everyone. For example, labor and delivery costs for undocumented immigrant women are covered under the federal and state emergency Medicaid program, but most states do not cover prenatal care, and there is no coverage for family planning. Some of my patients say they would like to use oral contraceptives or an intrauterine device or undergo a tubal ligation, but they can't afford it. And immigrants, like native-born Americans, are vulnerable to chronic diseases; as my colleague, nurse practitioner Lois Wessel, notes, "Even the 25-year-old day laborers are eventually going to become 45-year-olds, probably still undocumented, with hypertension and diabetes. . . . Life in America is going to make them become not so healthy."

Recently, a bipartisan group of U.S. senators, with White House support, introduced an immigration bill that offered the best chance in years of achieving substantial reform of a dysfunctional system. However, the bill met with opposition from both conservatives and liberals and was killed in the Senate this past June, quashing all hope of immigration reform during the current administration. State legislatures this year are considering a record number of anti-immigrant measures, and the Senate bill's demise heightens their chances of passage. "You will see the states and cities scrambling to pass their own laws and regulations, and you're going to get a completely contradictory set of policies," Senator John McCain (R-AZ) predicted in a Washington Post article on July 8. In many areas of the country, one consequence is likely to be reduced access to health care for immigrants.

Noncitizens make up about 20% of the 46 million uninsured people in the United States. Hospitals generally do not collect information on patient immigration status, and there are no reliable national figures on hospital costs for undocumented immigrants. Nevertheless, the soaring cost of uncompensated care (see graph A) has made the problem of providing care for uninsured immigrants a hot political issue, particularly in border states and those (such as the southeastern states) whose immigrant populations have grown rapidly in recent years. Some uninsured immigrants needing emergency treatment (including pregnant women, children, adults with dependent children, and elderly, blind, or disabled patients with incomes below Medicaid thresholds) qualify for emergency Medicaid coverage. In many other cases, hospitals receive no payment for their care, although in 2003 Congress appropriated $250 million per year for 4 years (starting in 2005) to partially compensate hospitals for treating undocumented immigrants.

Cost of Uncompensated Care (Panel A), Number of Unauthorized Immigrants (Panel B), and Number of Uninsured People (Panel C) in the United States.
The annual cost to U.S. hospitals of uncompensated care (charity care plus bad debt) has been rising, although the fraction of total hospital expenses represented by such care has remained relatively constant at about 5 to 6% since 1980. The number of unauthorized immigrants present in the United States has also been increasing, although the estimates are uncertain. Treatment of unauthorized immigrants contributes to uncompensated care costs, but the main reason such costs are increasing is the rise in the number of people who lack health insurance. Immigrants represent only about 20% of the uninsured. Data on uncompensated care are from the American Hospital Association; data on unauthorized immigrants are from the Pew Hispanic Center; data on the uninsured are from the U.S. Census Bureau.




A recent study found that although emergency Medicaid spending for immigrants in North Carolina grew by 28% between 2001 and 2004, it still represented less than 1% of the state's Medicaid budget.3 More than 80% of that spending was for childbirth and complications of pregnancy, and major injuries accounted for nearly one third of the rest. In California, emergency Medicaid spending for uninsured immigrants for fiscal year 2007 exceeded $941 million, according to Kim Belshé, secretary of the California Health and Human Services Agency. "Clearly, there are medical needs faced by this population," said Belshé, "and the emergency room is not the most cost-effective place for [addressing] them." In addition, undocumented immigrants may account for as much as $750 million annually of the cost of uncompensated care in California hospitals — about 10% of the annual total — since they represent about 10% of the state's emergency department patients, according to Jan Emerson, vice president of external affairs for the California Hospital Association. "Almost half of the hospitals in California are currently operating in the red," she said. "It would not be fair to place the blame solely on undocumented immigrants, but certainly, they are a contributing factor."

The chief sources of outpatient care for uninsured immigrants are public clinics and community health centers. Such clinics are often sparse in suburban and rural areas that have recently faced an influx of immigrants. Even in cities with strong community-clinic networks and a long history of serving immigrants, access to care is uneven. For example, at the Venice Family Clinic, a bilingual nurse educator runs health and exercise classes in Spanish and English for patients with diabetes, pregnant women receive free state-subsidized prenatal care, and there are regularly scheduled clinic sessions for victims of torture and human trafficking. Yet arranging specialty referrals is a constant challenge — it usually entails sending patients to outpatient clinics at county hospitals, where some have to wait as long as a year for an appointment. In the Washington, D.C., area uninsured women, including undocumented immigrants, can get free annual mammograms and Pap smears through subsidized cancer-screening programs, but follow-up treatment for abnormal findings other than cancer is usually not included, and many clients have no source of primary care, as noted by nurse practitioner Wessel, who works monthly at one such program. "Patients come in year after year" for Pap smears — "but they've never had their blood pressure checked," she said. "We don't check it, because all we're financed to do is cervical- and breast-cancer screening."

In states seeking to expand insurance coverage, the question of including undocumented immigrants is a thorny one. About 1 million of California's 4.8 million uninsured residents are undocumented adults, and about 136,000 are undocumented children.4 As part of a proposal for comprehensive health care reform, Governor Arnold Schwarzenegger is seeking to provide health insurance coverage (through Medicaid and the State Children's Health Insurance Program, or SCHIP) to all children with family incomes at or below 300% of the federal poverty level, regardless of immigration status. Although there is considerable public support for insuring undocumented immigrant children, Republican state legislators "do not believe that state general fund revenues should be invested in people who are here illegally," said health secretary Belshé — "and that extends to children."

The federal Medicaid program has always been restricted to U.S. citizens and legal residents, but recent federal and state laws designed to strengthen enforcement of eligibility rules have created new barriers, even for infants and children who are citizens, and have had a chilling effect on other programs providing health services for immigrants. The 2005 Deficit Reduction Act requires all persons applying for or renewing Medicaid coverage to provide proof of identity and U.S. citizenship. Since that law went into effect, at least eight states have reported dramatic declines in Medicaid enrollment, and some Medicaid-eligible infants and children have gone without immunizations and needed medical care because of delays in coverage.5

In Georgia, which last year passed a law requiring immigrants to show proof of legal residency in many situations, "we've started seeing a lot of kids not going to the doctor," said Flavia Mercado, a pediatrician who runs the International Medical Center at Atlanta's Grady Memorial Hospital. "A lot of my clients are leaving and going to other states, and a couple are even going back to their country. Everyone is very fearful." She said that Atlanta organizations are scaling back health services for Hispanics and have stopped sponsoring Hispanic health fairs, fearing that they will be raided by police or immigration officials. Meanwhile, faced with rising health care costs and increasing numbers of uninsured persons, the state's Medicaid program has sharply reduced benefits: it recently stopped paying for prenatal care for high-risk women and for nonemergency hemodialysis. Although immigrants make up a minority of the uninsured, Mercado said media reports regularly blame illegal immigrants for the worsening problems of the state's health care system. Anger over high medical costs and reduced access to care no doubt contributes to anti-immigrant sentiment; the remedy, however, is not immigrant bashing, but health care reform.

"As an American citizen, I understand that you want to make sure the resources are there for the right people," Mercado said. "Yet how can you deny someone health access? If we don't treat and prevent illness . . . our whole community is going to suffer."
Source Information

Dr. Okie is a contributing editor of the Journal.

[Erratum, JAMA 2007;297:1774.] [Free Full Text]
Brown ER, Pourat N, Wallace SP. Undocumented residents make up small share of California's uninsured population. Los Angeles: UCLA Center for Health Policy Research, March 2007.
Pear R. Lacking papers, citizens are cut from Medicaid. New York Times. March 12, 2007:A1.
http://content.nejm.org/cgi/content/full/357/6/525

Or course they do. Because of their income that gets them free medicaid with dental, perscriptions and dental. My family which cannot afford to pay the deductable do not get the healthcare their children need.

I work with illegal aliens in a roundabout way in a helping profession.
Their constitutions are strong. They do get sick a lot (more than the average). I think that it is due to their personal hygiene and living standards. They don't clean the way an average American cleans a home.
I feel that they get healthier the longer they stay here on our dime, of course. The ones fresh from the border particularly carry diseases like TB.

I have another theory with absolutely nothing to back it up. I believe that the herpes virus was sparked somehow by illegal immigration. Herpes came about around 1983. It was rare for the most part until the 90s. The explosion of herpes seems to conincide with the the massive illegal immigration invasion.

Bed bugs in our motels especially seem to come back in major proportions right around 2002. I know that in my area that year was a major exposion with illegals (probably around the country too).

There is a lot of PC hype on the internet dissing your concerns, but here is what doctors and scientists are saying:

http://pediatrics.aappublications.org/c ... l/106/1/e3

Screening tests should be performed on the first visit because this may be the only patient contact.

A thorough history and physical examination should be performed, considering the diseases endemic to the patient's country of origin.

Infectious disease screening is necessary for HIV, hepatitis B, syphilis, stool for ova and parasites, and tuberculosis (PPD). Hepatitis B and HIV screening should be repeated in 6 months. Screening for hepatitis A is of little value because immunoglobulin G antibodies are almost ubiquitous.

All immigrants should have complete blood count with differential and a blood smear review.

Well-child issues including hearing, vision, weight, height, language, psychosocial, and immunization status should be addressed.

http://mpelembe.mappibiz.com/archives_0 ... ening.html

Approximately 266,000 children entered the United States as immigrants in 2001,1 and in Minnesota during 1999 more than 50% of refugees entering the state were children under the age of 18 years.2 These children carry a large disease burden, and most of them lack a history of adequate preventive health care. More than 50% of internationally adopted children, regardless of age, sex, and country of origin, will have a previously undiagnosed medical condition, which is identified on initial evaluation in the United States.3 Infectious diseases are the most prevalent conditions identified; of the refugees entering Minnesota in 2000, 53% had positive Mantoux skin test for tuberculosis, 31% had pathogenic parasite infestations, 14.9% had anemia, and 7.5% were hepatitis B carriers.2

http://blogcritics.org/archives/2004/09/02/160807.php

MDR-TB has developed largely out of the misuse of antibiotics used to treat tuberculosis, which must be taken under a strict regimen and overseen by a health-care professional. If the plan is not followed and the antibiotics discontinued before the requisite time, the TB will recur and be resistant to the drugs used to treat it: it has formed an immunity to the antibiotics. This resistant form of TB is contagious and has entered the United States, the authors believe, largely through immigrants - most of them from the Former Soviet Union which is considered one of the world's epicenters of TB according to the World Health Organization (W.H.O.)

http://www.ajph.org/cgi/content/abstract/82/8/1127

An epidemic of imported leprosy began in the United States in 1978, peaked in 1985, and ended by 1988. This increase was primarily due to cases among refugees from Indochina and was limited by a decrease in the influx of Indochinese refugees in the mid-1980s. There is no evidence that these cases resulted in transmission in the United States.

[my comment: leprosy is very difficult to catch, especially in 'first world' living conditions]

http://www6.lexisnexis.com/publisher/En ... 4&start=44

Most of the illegal immigrants apparently come from South and Central America, and Mexico. Many of these poor people sneaking across the border into "El Norte" also are sneaking across with a parasitic disease common to the rural regions of the southern hemisphere.

This is called Chagas and the parasite is Trypanosoma cruzi. You might think some of these infected individuals are coming north looking for better medical care, but most people with Chagas don't even know they have it.

Chagas, which can persist for years or decades, is largely a silent infection that can destroy the heart, or choke off the esophagus and bowels. There may be 10 to 12 million people in South and Central American with Chagas disease. They are mostly poor and mostly children. There is no cure.

So far, no pandemics are occuring. That's because of many factors: the incursions of disease are small compared to our population, and most of us are not exposed, and are able to stay healthy and clean. But if poverty increases, the middle class continues to be eroded, as more and more people have to go without health insurance, if the number of immigrants with communicable diseases increases greatly, if our food supply or public safety is in any way compromised, our vulnerability to these 'new' [to us] diseases will increase.

Immigrants with diseases are, for now, a danger mostly to themselves. But let's not forget that times change. The sexual revolution in America accellerated in the 60s and roared on for about two decades until AIDS appeared. Either a genetic mutation in an old African virus, or the transmission of an isolated African virus, made possible by modern travel technology and culture, changed the entire populated world in just a few years. I submit that the automatic, knee-jerk charge of xenophobia whenever these concerns are raised is not valid or fair. If someone is a xenophobe, these news items will certainly add fuel to that fire, but at least some level of concern about the spread of communicable disease is real and justified.

"No pandemic's", I guess you don't have to count the hundreds or thousands of cases of Leprosy, Meningitis, Tuberculoses, ect. and many others we and our children have been vaccinated against.

These people can sure come up with some propaganda, they really don't give us much credit do they! Maybe they should stop comparing us to our politicians, its the only answers I can come up with, they are making a mistake thinking we are ALL stupid.




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I don't believe there's any vaccination being routinely given in the US against a lot of that stuff. Meningitis is a new one, and being stressed for college students, but leprosy, TB? My big worry is that someone will unleash smallpox, which still exists in labs - they stopped vaccinating for that long ago, but can't you just see some accident?

As long as we are able to maintain good nutrition, clean and uncrowded living conditions, and access to modern medical care, we will come out better than the third world in the next pandemic (bird flu, maybe?)

But we still have a right to regulate immigration and screen for diseases that threaten our society. Anyone who calls that racism is being childish (I'm thinking of the 'other' board here).

http://www.cdc.gov/tb/pubs/tbfactsheets/BCG.htm
http://www.medicalnewstoday.com/articles/78163.php
http://www.stanford.edu/class/humbio103 ... onally.htm

Originally Posted by BetsyRoss

I don't believe there's any vaccination being routinely given in the US against a lot of that stuff. Meningitis is a new one, and being stressed for college students, but leprosy, TB? My big worry is that someone will unleash smallpox, which still exists in labs - they stopped vaccinating for that long ago, but can't you just see some accident?

As long as we are able to maintain good nutrition, clean and uncrowded living conditions, and access to modern medical care, we will come out better than the third world in the next pandemic (bird flu, maybe?)

But we still have a right to regulate immigration and screen for diseases that threaten our society. Anyone who calls that racism is being childish (I'm thinking of the 'other' board here).

http://www.cdc.gov/tb/pubs/tbfactsheets/BCG.htm
http://www.medicalnewstoday.com/articles/78163.php
http://www.stanford.edu/class/humbio103 ... onally.htm

[b]DITTO Betsy!!!![/b Thanks for the links!!