HEALTH CARE/Joan Retsinas

Illegal and Sick: Medical Repatriation

So many toilets to scrub! So much grass to mow! Walls to paint … crops to harvest … foundations to dig. Even as wired a country as ours, overrun with technological gizmos, needs strong backs to do the physical labor that must be done.

One solution is to rely on home-grown backs; in short, to use our native labor force. But most Americans, even the ones hardy enough for physical labor (obesity hasn’t toughened many of us for heavy lifting, literally), spurn these jobs. Or spurn them at the wages that employers want to pay. If employers jacked up the pay, attached benefits (the package most American workers want – health insurance, vacation pay, sick time), and instituted workplace protections (no excessive overtime, child labor, or dangerous conditions), then more of us would scrub, mow, paint, harvest, and dig.

But cheap labor undergirds not just the profits of many businesses, but their solvency. Employers want the 21st-century equivalent of serfs: people who will labor for little, with no complaints, fearful of reprisals, grateful for subsistence.

The solution: undocumented immigrants from Latin America, especially Mexico. We don’t need to pay them what we’d pay native workers. They won’t join unions. They won’t protest. They have done the math: life at home, wherever home is, versus life in the United States. So they come. Our country resembles those oil-rich emirates which also depend on immigrant labor.

To welcome them, we have left Emma Lazarus’ gate ajar. Sometimes Mexicans sneak across the border. Sometimes they come on temporary visas, then overstay. Sometimes they have children here – who, by virtue of birthplace, are citizens. Sometimes they marry legal immigrants, or citizens. Shake a family tree; you may dislodge a relative whose status-of-the-moment is iffy.

Of course, politicians, especially the right-wing ones, declaim against the “illegals,” even though the rants are more than a bit hypocritical. The ranters recognize the crucial workplace niche that immigrants, particularly undocumented ones, fill.

The dilemma happens when these modern serfs grow ill. Hospitals will treat undocumented patients for emergencies. Period. They are not eligible for private or public insurance. (Even documented immigrants are eligible for Medicaid only if the state picks up the full tab. The federal government will not contribute.) The “exchanges” created under the Affordable Care Act similarly will not cover undocumented patients; nor will Medicaid.

Immigration reform promises a road to citizenship for as many as 11 million undocumented residents. But that road-to-health-insurance will be 8 years, under the administration’s bill, 10 years if Sens. Rubio and McCain prevail. Sen. Jeff Sessions (R-Ala.) proposed “never”: even after gaining citizenship, these once-undocumented immigrants would never be eligible for subsidized health insurance. The Senate rejected that budget amendment, 43 to 56.

But the dilemma persists. Must hospitals and “safety-net” clinics pick up the tab for these workers? In Nevada, 34% of the low-income non-elderly workers who would otherwise be eligible for Medicaid fall into that immigration-hole. Some hospitals would soon be insolvent.

Do we let workers who can no longer work die needlessly? Even right-wing politicians might find that too harsh.

Or do we force them to leave?

We are forcing them out. Hospitals are starting to send very ill patients without documentation home. Ousted patients travel, sometimes comatose, on charter flights. Numbers are hard to track, but immigrant-groups estimate at least 800 patients have been “medically repatriated.”

We purposefully left the immigration door ajar, knowing that immigrants’ “illegal” status would guarantee us a cheap workforce for back-breaking jobs. Yet over time these workers may well grow ill – the 20 year-olds who dodged border guards may grow less robust, especially since they work in dangerous occupations. But health care is expensive. Safety net hospitals are hard-pressed to pick up the tab. As for employers, they don’t want to pay. Their workforce would then cost much more. Politicians, pandering to xenophobic hysteria, bar these workers from government-subsidized insurance plans.

So we shove them back out Emma Lazarus’ door.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, June 1, 2013