In 2004, Arizona's Proposition 200 wanted state and local governments to verify the identity and immigration status of all applicants for certain public benefits, and to require government employees to report violations (Wood pp). Attitudes about the problem have hardened in recent years in some states, both out of concern about the economic impact, particularly in a time of slow job growth, and out of concern about the security threat posed since 9/11 (Wood pp). The concern over illegal immigration has intensified as the federal government has shifted more of the cost and control of welfare benefits to the states, further burdening state budgets (Wood pp). Some anti-immigrant groups say illegal immigrants siphon more than $1 billion a year in social services from the Arizona treasury, roughly $700 per family in the state (Wood pp). Ira Mehlman of the Federation for Immigration Reform, says, "Arizona has a serious problem on its hands in paying $1.3 billion a year in services to illegals..."All the state is trying to do is provide a check to see if people are eligible to receive the benefits they are applying for" (Wood pp).
A study by University of California at Los Angeles and Rand Corporation found that most Latino children in Los Angeles, California, qualified for the Medicaid program, however few receive full coverage (Shinkman pp). The survey of 812 Latino households found that 84% of the households' children qualified for Medicaid, yet 19% did not use the program and 21% received only sporadic care (Shinkman pp). The lack of citizenship of the children's parents was listed as a major obstacle to care, for although 96% of the children surveyed were born in the United States, 80% of their parents were not (Shinkman pp).
Pediatricians and hospitals with special pediatric expertise are facing the dilemma of rationing care to uninsured, undocumented children, especially for expensive life-saving care such as transplants, chemotherapy, and dialysis (Berman pp). In fact, almost every community in the United States faces the challenge of providing care to this population, because the federal government has left much of the funding of health care for uninsured undocumented persons to individual states, local governments, hospitals, and clinics (Berman pp). Says Stephen Berman in the November 2004 issue of "Pediatrics," "There is an urgent priority for discussion and research initiatives to take place at the city, county, state, and federal levels to address the delivery and financing of medial care to foreign national undocumented children residing in the United States' (Berman pp). If not, major adverse consequences for our health care delivery system will persist and perhaps worsen if we continue failing to address this issue rationally and equitably (Berman pp). In 1997, the American Academy of Pediatrics recommended that all pediatricians take an active role in assuring the provision of health care to the children of immigrants living in the United States, and that they should oppose any law banning the provision of services to illegal immigrants (Health pp). Moreover, they cautioned for physicians to be aware of the health problems of immigrants, which include "hepatitis B, tuberculosis, syphilis and parasitic infections...poor nutrition, delayed development, and poor dental and mental health" (Health pp).
According to the Healthcare Association of Hawaii, the state's hospitals are owed tens of millions of dollars for care they have provided to residents of Guam, Micronesia and many other island nations, care that cannot be denied yet is unlikely to be reimbursed (Benko pp). Due to their unique immigration status as "habitual residents,' these islanders can seek medical services in Hawaii or get referrals to Hawaii specialists from their local physicians (Benko pp). Because habitual residents are considered visitors rather than legal immigrants by U.S. Immigration, they are not recognized under federal Medicaid statues, which means the state Medicaid dollars that Hawaii is spending to cover these migrants is not being matched by federal funds (Benko pp).
In May 2005, Congressman Mark Foley released the following statement concerning the guidelines for the allocation of $1 billion for hospitals that are burdened with unpaid medical expenses for illegal immigrants, "Our country's failed immigration policy should not leave our healthcare providers with the bill' (Foley pp). The largest allocations this fiscal year are going to: California, $70.8 million; Texas, $46 million; Arizona, $45 million; New York, $12.3 million; Illinois, $10.3 million; Florida, $8.7 million; and New Mexico, $5.1 million (Foley pp). However, as Barbara Ostrov points out, hospitals will have to ask patients, "Are you a U.S. citizen" (Ostrov pp). Thus, most local hospitals say they will turn down the money because the threat of being questioned about citizenship could keep illegal immigrants from seeking care, which in turn could compromise pubic health at large (Ostrov pp). However, in the wake of criticism from hospitals and immigrants' rights advocates, the Bush administration has backed off a requirement that hospitals document the immigration status of patients in order to receive additional funds (Fong pp). Moreover, unregulated medicines, rundown apartments, and food purchased from vendors may endanger immigrants' health and lives, by criminalizing healthcare options, thus leaving poor immigrants to remain on the margins of society (Kil pp). Going to the doctor can be daunting for many new immigrants, however, some such as Manuel Platero, are becoming part of a growing effort in community health to train a group of immigrants about a variety of health issue and then send them back into their communities to share that knowledge (Axtman pp).
In March 2004, approximately 400 healthcare providers, calling themselves, Coalition for Fair Payments to Health Care Providers, participated in a conference call with the CMS to discuss the provisions of the new Medicare law that provides $1 billion over four years for hospitals and physicians who have been providing uncompensated care for illegal immigrants (Reilly pp).
It is easy to understand the burden and frustration that many states are forced to deal with concerning healthcare for illegal immigrants. It is very much a 'catch 22' situation.
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