HEALTH CARE/Joan Retsinas

Xenophobes’ Dilemma

Illegal, unhealthy, and expensive: the xenophobes among us see illegal (a kinder term is undocumented) immigrants using emergency rooms, staying in hospitals, crowding into public clinics. Their persistent factoid holds that illegal immigrants are disproportionately gobbling up health care.

Statistics belie the factoid. Illegal immigrants use emergency rooms less than native citizens. The reason is obvious: people here illegally are too afraid of deportation to drop into emergency rooms cavalierly. In 2009-2010, in California, 11% of illegal immigrants visited an emergency room, versus 20% of native-born Californians.

In fact, illegal immigrants also go to primary care doctors less: 90% of US-born children had at least one doctor visit that year, compared to 78% of children here illegally. The same disparity held for mammograms and colorectal cancer screenings. Compared to native-born citizens, illegal immigrants are gobbling up disproportionately less, not more, health care.

There are no definitive assessments of the health of illegal immigrants. (Many immigrants overstay temporary visas; others enter without documentation.) Yet presumably immigrants, with or without documentation, are healthy enough to work arduous jobs, able to make the dangerous trek from their native land to a country where they understand neither the language nor the customs.

Over time, though, people, with and without documentation, native and foreign-born, give birth, grow ill, need care. And that care costs money.

The xenophobes’ dilemma: what to do? Although native-born citizens may profess to want to whisk everybody without a green card back to their birthplaces, for most protesters, that is empty rhetoric. The newcomers, legal and illegal, fill vital niches in this economy. Instantly deporting everybody without proper documentation would plummet the nation’s Gross Domestic Product – a fact most people acknowledge.

Yet to bring down the health care tab of illegal immigrants, xenophobes face a Catch 22: The only way to lower the cost is through government. Yet the citizens who distrust foreigners also distrust government. And those citizens have battled, successfully, to bar illegal immigrants from governmental subsidies or programs. So the conundrum is daunting: Paring the health care costs of people here illegally means bringing them under the umbrella of government.

Consider hospital costs. Illegal immigrants who visit emergency rooms are most likely uninsured. After all, government programs, including the Affordable Care Act, bar them from participating. And since uninsured patients cannot easily afford the hospital bill (a six-hour visit might cost as much as a waitress earns in six months), the bills go unpaid, sinking hospitals (and ultimately taxpayers) in red ink.

One solution is to open Medicaid to illegal immigrants. The door is already slightly ajar. Currently, under the Emergency Medical Treatment and Active Labor Act of 1986, Medicaid will reimburse hospitals when illegal pregnant women give birth via emergency rooms. (Medicaid will not pay for the subsequent care of those children.) Emergency Medicaid comprises less than 1% of the total Medicaid budget. Opening that door further would relieve hospitals’ budgets. So would allowing immigrants, regardless of documentation, to enroll in one of the Affordable Care Act’s insurers.

Sometimes patients who enter via emergency rooms end up as inpatients. When an insured patient has a stroke, or a brain injury, or needs tube-feeding, hospitals generally discharge them to rehabilitation facilities or nursing homes. Those facilities, though, will rarely accept uninsured patients. So illegal immigrants, admitted as inpatients, linger in the hospital, as “permanent patients.”

Again, the solution is to bring them under the umbrella of insurance – if not Medicare or Medicaid, then under one of the insurers in the Affordable Care Act.

Finally, we have effectively barred illegal immigrants from regular access to primary care. On the one hand, the government urges Americans to have a “medical home” that provides screening tests, immunizations, and well-child visits, that monitors patients with chronic diseases, to forestall complications. The goal: good health. On the other hand, the government denies immigrants those preventive services – in effect, promoting their ill health.

“Punishment” is a xenophobic rallying cry. They seek to punish the “illegals” by denying them the insurance that would give them access to the nation’s health care professionals. But this punishment boomerangs: it exacerbates hospitals’ debt; it yields a sicker workforce; and it surely erodes the souls of the punishers. Do they want the gardener who prunes their bushes to lose a leg to uncontrolled diabetes? Do they want the children of their coffee-house waitress to have measles? What is their threshold for cruelty?

Sometimes pragmatism trumps ideology.

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

From The Progressive Populist, June 15, 2014