Illegal Aliens on California\'s Healthcare

¶ … ILLEGAL ALIENS on CALIFORNIA'S HEALTHCARE SYSTEM

The Pew Hispanic Center estimated in March 2005 that the illegal alien population in California was 2.4 million in 2004. The impact on business, public schools, criminal justice system, and health care has been enormous. Statistics show that 63 California hospitals closed in the ten-year period between 1993 and 2003 because half of their services were unpaid because of services required under the Emergency Medical Treatment and Active Labor Act (EMTALA). (Cosman, 2005; paraphrased) These statistics show that many clinics and general practitioners do not have a hospital dedicated to their area of service. Because of the diseases that the illegal alien immigrants are bringing to the United States, it is imperative that private practitioners develop some type of initiative to respond to preventative care for these individuals. Failure to do so will result in epidemic disease rampages across the population in the United States.

RESEARCH OBJECTIVES

The objective of the research proposed herein is to attempt to find a method of addressing the rising needs of healthcare for illegal aliens in the State of California.

RESEARCH DESIGN

The research proposed herein is of a qualitative nature and is to be in the form of surveys/questionnaires, which will serve to inform the direction of focus group studies involving a random sampling of healthcare providers in California in order to pinpoint the primary needs of healthcare of the population of illegal aliens in the state.

LITERATURE REVIEW

The work of Longley (2004) entitled: "Illegal Immigration Costs California Over Ten Billion Annually" states the fact that California "bears a huge cost to provide basic human services for this fast growing low-income segment of its population. A new study from the Federation for American Immigration Reform (FAIR) examines the costs of education, health care and incarceration of illegal aliens and concludes that the cost to Californians is $10.5 billion per year." (Longley, 2004) it is stated that approximately $1.4 billion alone goes "toward providing health care to illegal aliens and their families..." (Longley, 2004) According to Dan Stein, President of FAIR: "California's addiction to 'cheap' illegal alien labor is bankrupting the state and posing enormous burdens on the state' shrinking middle class tax base. Most Californians, who have seen their taxes increase while public services deteriorate, already know the impact that mass illegal immigration is having on their communities, but even they may be shocked when they learn just how much of a drain illegal immigration has become." (Longley, 2004)

According to a report of the Federation for American Immigration Reform entitled: "Restoring Common Sense to America's Immigration System: Illegal Immigration and Public Health" the impact of immigration "on our public health is often overlooked. Although millions of visitors for tourism and business come every year, the foreign population of special concern is illegal residents, who come most from countries with endemic health problems and less developed health care. They are of greatest consequence because they are responsible for a disproportionate share of serious public health problems, are living among us for extended periods of time, and often are dependent on U.S. health care services." (FAIR, nd)

According to Dr. Laurence Nickey and reported by FAIR "Contagious diseases that are generally considered to have been controlled in the United States are readily evident along the border..." (FAIR, nd) One of these diseases is Tuberculosis, which "is considered by most Americans to be a disease of the Third World..." (FAIR, nd) However this disease has infiltrated the United States infecting a great number of individuals in recent years.

FAIR further reports: "Immigrants are often uninsured and underinsured. Forty-three percent of noncitizens under 65 have no health insurance. That means there are 9.4 million uninsured immigrants, a majority of whom are in the country illegally, constituting 15% of the total uninsured in the nation in the mid-1990s.6 the cost of the medical care of these uninsured immigrants is passed onto the taxpayer, and strains the financial stability of the health care community. Another problem is immigrants' use of hospital and emergency services rather than preventative medical care. For example, utilization rate of hospitals and clinics by illegal aliens (29%) is more than twice the rate of the overall U.S. population (11%)." (FAIR, nd)

The work of Meredith King (2007) entitled: "Immigrants in the U.S. Healthcare System: Five Myths that Misinform the American Public" the lack of health insurance coverage for the immigrant population "means that individuals are more likely to wait for their health problems to worsen before seeking care. And the statistics on immigrant children illustrate this point. While immigrant children visit the emergency room less often than U.S.-born children, because they are often sicker when seeking care their emergency room expenditures are more than three times higher, suggesting that access to primary and preventative care could have prevented illnesses from worsening and ultimately reducing medical costs." (King, 2007)

King states that it is generally held belief by most that immigrants use the emergency room services greatly however "...the metropolitan areas of Miami-Dade, Phoenix, and Orange County, California - all urban areas with large immigrant populations - have much lower rates of emergency room use than do areas with smaller immigrant populations..." (2007) King further points out that uncompensated health care "received by documented and undocumented immigrants in hospitals is reimbursed by the federal government. State and local governments or charitable entities that are disproportionately affected by uninsurance, such as those delivery health care services in areas with a high density lower-wage and service-sector jobs, often have a smaller tax base with which to address the health care needs of uninsured residents." (King, 2007) Those who are covered with health insurance experience a shift in cost as well. King states that in 2005 "health insurance premiums for a family of four were $922 or higher and individual health insurance premiums were $341 or higher due to the cost of health care for the uninsured." (2007) it is important to note the statement of King that "Cost-shifting is a consequence of the entire uninsured population, not just the uninsured immigrant population." (2007)

The work of Derose, Escarce and Lurie (2007) entitled: "Immigrants and Health Care: Sources of Vulnerability" states that: "Immigrants have been identified as a vulnerable population, but there is heterogeneity in the degree to which they are vulnerable to inadequate health care. Here we examine the factors that affect immigrants' vulnerability, including socioeconomic background; immigration status; limited English proficiency; federal, state, and local policies on access to publicly funded health care; residential location; and stigma and marginalization. We find that, overall, immigrants have lower rates of health insurance, use less health care, and receive lower quality of care than U.S.-born populations; however, there are differences among subgroups."

The work of Berk, Schur, Chavez and Frankel (2000) entitled: "Health Care Use Among Undocumented Latino Immigrants" states that by using data available from a survey conducted in 1996/1997 of "undocumented Latino immigrants in four sites" the reasons for these individuals coming to the United States and state findings that the reason for their coming is primarily for jobs. "Their ambulatory health care use is low compared with that of all Latinos and all persons nationally, and their rates of hospitalization are comparable except for hospitalization for childbirth. Almost half of married undocumented Latinos have a child who is a U.S. citizen."

Thompson in the November 17. 2007 report entitled: "Individual Health Care Mandates and the Problem of Affordability" states the fact that California is in the middle of a debate concerning a model bill "combining a tight affordability rule with an individual mandate. Seeking common ground with Governor Schwarzenegger, who vetoed an earlier health care reform measure in part because it did not require all residents to obtain health care coverage." (Thompson, 2007) the proposal, which will help achieve affordability "includes robust expansions of public programs and sliding scale premium subsidies for lower income residents, amount to the largest public program expansions in the country since the beginning of Medicare and Medicaid in the 1960s. The expansions include covering all children, regardless of immigration status, up to 300% of poverty, covering all parents who are legal residents up to 300% of poverty; and covering single, childless adults up to 250% of poverty." (Thompson, 2007) Further created is a new purchasing pool for the state of California "for residents to obtain health coverage, similar to the Massachusetts Connector with subsidies for Californians with incomes up to 450% of poverty in the form of advanceable tax-based credit to ensure total insurance costs do not exceed 6.5% of family income." (Thompson, 2007) Thompson states: "This revised proposal by legislative leadership, despite the problems of individual mandates, presents a promising model for ensuring affordability by tying total costs to a percentage of income and protecting families from undue health care expenses. The Assembly Health Committee passed the proposal by a party-line 10-5 vote on November 15th. Floor votes are expected after Thanksgiving." (2007)

In a report in the Washington Times published August 27, 2007 entitled: "California Travesty" relates a story of Dr. Gene Rogers who served as the medical director for Sacramento County's Indigent Services program for the most of the last decade who has "waged a long fight against the central California country's practice of providing non-emergency medical care to illegal immigrants - a policy he says violates federal law and results in the poorest American citizens being denied the care they deserve." (Cromer, 2007) it is related in Cromer's report that "That fight cost Dr. Rogers his job. In a two sentence memo to Dr. Rogers, the county's Health and Human Services director, Lynn Frank, informed him that he was fired, but thanked him for his services. No reason for his termination was offered..." (Cromer, 2007) According to Cromer "The local cost of the medical treatment provided to illegal immigrants is small when contrasted to the billions of dollars the state and federal governments spend every year on the 'undocumented' but the numbers have grown dramatically. According to county health officials, the hundreds of illegal immigrants who were being treated through the indigent program in the mid-1990s have now grown to thousands of people, with the annual cost to taxpayers swelling into the millions of dollars." (Cromer, 2007)

The work entitled: "Illegal Aliens Bringing Drug-Resistant TB and other Diseases with Them" states that: "In an article in the Journal of the American Medical Assn., Dr. Reuben Granich, a lead investigator for the Centers for Disease Control and Prevention, reports the emergence in the U.S. Of a particularly virulent, multi-drug -resistant form of tuberculosis known as MDR-TB. Evidence of it has surfaced in 38 of 61 California health jurisdictions, and it could 'threaten the efficacy of TB control efforts,' Granich said. The infected were said to be four times as likely to die from the disease and twice as likely to transmit the disease to others. Reluctant to label the infected as 'illegal' or even 'undocumented' aliens, the report notes that of the 407 known cases of MDR-TB, 84% were 'foreign-born' patients, mainly from Mexico and the Philippines who'd been in the U.S. less than five years. The percentage of TB cases among the 'foreign-born' jumped from 29% in 1993 to 53% as of last year." (the Business Word, 2005) the report continues by stating that: "What is unseen is their free medical care that has degraded and closed some of America's finest emergency medical facilities, and caused hospital bankruptcies: 84 California hospitals are closing their doors. 'Anchor babies' born to illegal aliens instantly qualify as citizens for welfare benefits and have caused enormous rises in Medicaid costs and stipends under Supplemental Security Income and Disability Income.... By default, we grant health passes to illegal aliens. Yet many illegal aliens harbor fatal diseases that American medicine fought and vanquished long ago, such as drug-resistant tuberculosis, malaria, leprosy, plague, polio, dengue, and Chagas disease." (the Business Word, 2005)

The work entitled: "Illegal Aliens and American Medicine" states that: "The influx of illegal aliens has serious hidden medical consequences." (Cosman, 2005) Medical care for these individuals is stated to have "degraded and closed some of America's finest emergency medical facilities, and caused hospital bankruptcies; 84 California hospitals are closing their doors. 'Anchor babies' born to illegal aliens instantly qualify as citizens for welfare benefits and have caused enormous rises in Medicaid costs and stipends under Supplemental Security Income and Disability Income..." (Cosman, 2005) the problem has been that while "43 million lives are at risk in American because of lack of medical insurance. What is unseen is that medical insurance does not equal medical care. Uninsured people receive medical care in hospital emergency departments (EDs) under the Emergency Medical Treatment and Active Labor Act of 1985 (EMTALA) which obligates hospitals to treat the uninsured but does not pay for that care." (Cosman, 2005) Cowman relates that "High-technology EDs have degenerated into free medical offices. Between 1993 and 2003, 60 California hospitals closed because half their services became unpaid. Another 24 California hospitals verge on closure. Even ambulances from Mexico come to American EDs with indigents because the drivers know that EMTALA requires accepting patients who come."

The following figure shows the overall immigration population in the United States for the years 1900 through 2002.

Immigrant Population 1900-2002

Source: The Dark Side of Illegal Immigration: Facts, Figures and Statistics on Illegal Immigration (2007)

The work entitled: "The Dark Side of Illegal Immigration: Facts, Figures and Statistics on Illegal Immigration" states: "the numbers of immigrants are higher than they have ever been and the numbers of illegal immigrants is approaching the number of legal immigrants. Some of the newer data actually indicates that annual number of illegal aliens entering now exceeds illegal immigrants." (2007) Noted as well is the statement of Robert J. Samuelson in the June 13, 2006 Newsweek article entitled: "The Hard Truth of Immigration" which states: "Being brutally candid means recognizing that the huge and largely uncontrolled inflow of skillful Latino workers in the United States is increasingly sabotaging the assimilation process" and "no society has a boundless capacity to accept newcomers, especially when many are poor and unskilled." (the Dark Side of Illegal Immigration: Facts, Figures and Statistics on Illegal Immigration, 2007)

The work entitled: "More Facts about Illegal Aliens Invasion" states that costs to the United States annually for provision of emergency health care for illegal aliens in border states is the amount of $200 million dollars. Furthermore in California, who has over three million illegal aliens the costs for emergency health care in 2004 was the amount of $79 million dollars in hospital care." (Michael and Huhl, 2004) While individuals may not live in these border-states, the taxpayers still pays "commensurate medical care..." (Michael and Huhl, 2004) the work entitled: "Excessive Immigration is Sinking Golden State" states: "Immigration advocates claim that illegal immigrants are needed to boost California's economy. If this were true, why is it that California, the largest illegal-immigration-receiving state, is experiencing its worst budgetary deficits." (Ling-Ling, 2003) According to Ling-Ling: "Mass immigration is also leading to growing fragmentation and political stability in California and the nation." (Ling-Ling, 2003)

The work entitled: "Illegal Aliens Threaten U.S. Medical System" reports that "the increasing number of illegal aliens coming the United States is forcing the closure of hospitals, spreading previously vanquished diseases and threatening to destroy America's prized health-care system..." (World Net Daily, 2005) Furthermore "The influx of illegal aliens has serious hidden medical consequences..." (World Net Daily, 2005) These hidden medical consequences include the spread of the following diseases: (1) Chagas disease, also called American trypanosomiasis or "kissing bug disease," is transmitted by the reduviid bug, which prefers to bite the lips and face. The protozoan parasite that it carries, Trypanosoma cruzi, infects 18 million people annually in Latin America and causes 50,000 deaths. The disease also infiltrates America's blood supply. Chagas affects blood transfusions and transplanted organs. No cure exists. Hundreds of blood recipients may be silently infected; (2) Leprosy, also known as Hansen's disease, was so rare in America that in 40 years only 900 people were afflicted. Suddenly, in the past three years America has more than 7,000 cases of leprosy. Leprosy now is endemic to northeastern states because illegal aliens and other immigrants brought leprosy from India, Brazil, the Caribbean and Mexico; (3) Dengue fever is exceptionally rare in America, though common in Ecuador, Peru, Vietnam, Thailand, Bangladesh, Malaysia and Mexico. Recently, according to the report, there was a virulent outbreak of dengue fever in Webb County, Texas, which borders Mexico. Though dengue is usually not a fatal disease, dengue hemorrhagic fever routinely kills; (4) Polio was eradicated from America, but now reappears in illegal immigrants as do intestinal parasites, says the report; and (5) Malaria was obliterated, but now is re-emerging in Texas." (World Net Daily, 2005)

SUMMARY of the LITERATURE REVIEWED

The impact of illegal alien immigrants on the California health care system is astronomical and it does not appear that illegal immigration will be stopped or even slowed in the near future. The largest impact of the illegal immigration problem is the unseen problem of infectious disease spread across California and the United States due to the diseases, which illegal immigrants bring to the U.S. with them. Many of these diseases have never been known in the United States while others were long ago eradicated from the U.S. It is critically necessary that the physicians in the state of California develop an initiative to address preventative health care and disease detection and treatment in the population of illegal immigrants in the state of California to prevent spread of these infectious and dangerous diseases.

METHODOLOGY

The methodology of this research is one of a qualitative nature, which will bring together private practitioners in the state of California through focus group discussion studies to formulate a plan through which private practitioners may provide preventative medical care for illegal immigrant aliens. This focus is toward proactively addressing the diseases that these individuals are bringing into the United States and which are diseases that the United States eradicated many years ago but which stand the chance of infecting the population at epidemic proportions if not addressed.