Undocumented Shouldn't Mean Uninsured

The New Republic: Leaving Illegal Immigrants Out Of Health Care Only Costs Taxpayers Money

(The New Republic)  This column was written by Ben Crair.

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Last October, Dr. Jack Ludmir, the head of obstetrics and gynecology at Pennsylvania Hospital, oversaw the emergency-room treatment of a young woman who was seven months pregnant, hypertensive, and convulsing. Although her condition was, according to Ludmir, "rarely seen in the United States," his team diagnosed it quickly: She was suffering from eclampsia, a severe pregnancy-related disorder that can lead to premature birth, seizure, stroke, even death.

In this country, the condition is usually caught in its early stage known as pre-eclampsia, which can often be managed with prenatal care; but, with the mother already in the ER, doctors had no choice but to deliver the baby prematurely.

Over the next three months, the newborn was threaded with respiratory tubes while doctors flushed the mother's brain of excess blood three times. "You can't imagine the costs," says Ludmir. For as little as a few hundred dollars worth of prenatal care, he says, this tragedy - and at least $250,000 of medical care - could have been avoided. Unfortunately, this was not an option. The mother was an undocumented immigrant and therefore was ineligible for publicly funded prenatal care in Pennsylvania.

The one health care issue that Republicans and Democrats agree on these days is that illegal immigrants like Ludmir's patients should not have access to publicly funded health care. Republicans see this as a facet of the immigration issue - House Minority Leader John Boehner recently issued a press release charging that providing health care to illegal immigrants "increase[s] the tax burden on American families," while conservative commentators like Michelle Malkin are more naked in their hysteria, warning that the United States is in the midst of becoming "the land of the limit-less health care handout for 'undocumented immigrants.'"

The Democrats, meanwhile, are too cowed by the anti-immigration lobby - and the prospect of losing support for their individual health care plans - to defend the undocumented. Hillary Clinton and John Edwards have already decided to exclude illegal immigrants from their universal-coverage proposals, while Barack Obama has held his tongue on the issue. As a result, doctors such as Ludmir are likely to continue to see undocumented immigrants when their medical situation is most dire - and costly to society.

This isn't the first time that the combination of Republican hostility and Democratic timidity on the immigration issue has adversely shaped policy. In 1996, as part of welfare reform, Republicans insisted on banning legal immigrants from receiving Medicaid and S-CHIP (which assists families that make too much to qualify for Medicaid) for the first five years of their residencies. President Clinton grudgingly agreed to the provision in order to shepherd the welfare-reform bill through Congress.

The Republican argument that cheap public health care was attracting impoverished illegal immigrants into the country has since been called into question: In 2000, a study from Health Affairs found that less than 1 percent of undocumented immigrants "cited obtaining social services as the most important reason for immigrating." But, although its foundation has rotted, the policy still stands, setting the tone of the current debate: If we don't provide publicly funded health care even to some legal immigrants, why extend it to illegal ones?

There are currently 12 million undocumented immigrants in the United States - the majority of whom are uninsured. Among all immigrants, both documented and undocumented, less than 40 percent receive employer-sponsored coverage. The only federal health care program that covers undocumented and newly arrived legal immigrants is known as "emergency Medicaid." Under this program, the government will pay for emergency hospital care for the pregnant, elderly, and disabled, and for children or the parent of a child. (Although what, exactly, qualifies as an "emergency" is ambiguous: The federal government recently informed New York state that it would no longer fund chemotherapy.) Those who do not qualify for emergency Medicaid must pay for their treatment out of pocket, or the hospital must write it off as uncompensated care for which it should eventually be reimbursed, at least in part, by the federal government.

While it is true that the ER expenses of immigrant children are greater than the per capita average, probably because they are sicker when they finally seek care, immigrants tend to spend less money on health care than their U.S.-born counterparts. (One study in the American Journal of Public Health found that, in 1998, the average health care expenditures of a Hispanic immigrant, documented or undocumented, totaled $972. For a white, U.S.-born citizen, they were over $3,000.) Part of the reason for this discrepancy is because immigrants are, on average, younger and healthier than citizens. This would seem to be an argument for keeping the current system rather than expanding coverage, which tends to raise expenses as patients become insulated from the costs of their care. But, although immigrants may arrive in this country healthier, they regress toward the mean, developing many of the chronic conditions, such as heart disease and diabetes, endemic to U.S.-born citizens. They are also aging as a population. As a result, the number of disabled and elderly illegal immigrants is on the rise, and a recent study of North Carolina's emergency Medicaid system found that "[t]he largest spending increases [among the undocumented] ... are occurring among the elderly and disabled groups."

The obvious way to contain these costs is to insure the undocumented, so that they have access to preventive care before they degenerate into the tax siphons conservatives already claim them to be. And there is an additional reason to take this step: public health. Just a few unvaccinated individuals can threaten a whole community, a threat that is particularly acute among the undocumented, since they often work in the food service and agricultural industries. Unfortunately, Democrats continue to conflate the health care issue with the immigration one. Clinton and Edwards claim the health care problem will solve itself after they pass comprehensive immigration reform with a path to citizenship. But this is unlikely to happen anytime soon, and, by the point it does, the benefits of incorporating the undocumented population today, while it's still largely young and healthy, will have expired.

In the regrettable absence of comprehensive federal legislation, there are some smaller, more feasible measures that should be considered. One is to extend publicly funded health care to all legal immigrants. The second is that more states should extend prenatal care to the undocumented. On this front, the federal government has already done its part: In 2002, President Bush expanded s-chip eligibility to fetuses, giving states the option to cover the prenatal care of mothers ineligible for Medicaid, including undocumented immigrants. Disappointingly, most states, including a majority of the so-called "new-growth states" - those states whose immigrant populations grew most quickly in the 1990s - have not accepted the federal government's offer and provided the necessary matching state funds.

This is unfortunate, because there are compelling reasons to do so. A study by researchers in Colorado, a new-growth state, found that only 52 percent of the state's undocumented women received prenatal care during the first trimester, as opposed to 83 percent of all other women. Consequently, 40 percent of undocumented mothers experienced a complication of delivery, as opposed to less than 30 percent of all other mothers. And, beyond the moral imperative, there's an economic one. Researchers in California, the epicenter of undocumented immigration, have estimated that one dollar in prenatal care can save over three dollars in postnatal care. (California, as it happens, is one of the 15 states that provides prenatal care to its undocumented residents.) Prenatal care isn't just a drop in the bucket of spending on the undocumented either: Over 80 percent of emergency Medicaid spending on the undocumented in North Carolina, whose immigrant population nearly quadrupled in the 1990s, was for childbirth and complications of delivery.

Jack Ludmir's patient would certainly have benefited from this limited expansion of preventive health care. Her eclampsia left her partially paralyzed, in poor condition to care for a sickly child - one who, it's worth noting, is a U.S. citizen whose continued care taxpayers must now fund.

[standlee5]

Kansas, didn''t you ever learn; freedom isn''t free. We''ve worked hard to maintain the rights granted to us under the US constitution. Personally, I''m sick to death of paying for other people''s stuff. If they''re going to come to this country they need to understand that NOTHING IS FREE. We need to teach it and they need to learn it.

[kansas1946]

We WORK for our freedom. We WORK for our food. We WORK to have a decent place to live and a car. We WORK to have decent healthcare. We educate ourselves to obtain these things. The government cannot and should not give these things away. I just want to know, why are we changing our Democratic Republic into a Socialist Welfare State?
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We work for our freedom?? I thought that was guaranteed by the constitution. Well, at least it was until Bush and co. got into power. And yes, most Americans would agree that we work to have food, health care, etc., but you have to have a level playing field to do that, and big buisness, the drug companies, the lawers, and the medical providers, have created an impossible scenario for millions and millions of working Americans. If you think communision is a silly dream, so is this perfect form of capitalism that you envision.

[kansas1946]

Well, if the right hadn''t turned a blind eye to illegals because their big-farm operation and business buddies needed the cheap labor that had no govenrment protections, and the left hadn''t whined and moaned about the poor down-trodden Mexicans, helping and securing aid for them, which just encouraged more illegals, we wouldn''t be in this mess, and a mess it is. You can not have 20 million people running around under the radar and hold together your country. The border needs to be controlled immediately, any illegals that are arrested for other crimes need to be deported immediately, and then maybe we can start getting a handle on this. As long as we coddle these people, more will come. It has to stop, and it is not lack of empathy. If I were them, I would be here too, but we can not take 70pct of Mexico, who are poor. And you liberals that are moaning about these folks, need to remember this demographic and who they are likely to vote for once they are comfortable, secure, and registered to vote.

[wmb1957]

A 2005 study by RAND found that the "undocumented" were by far the the most likely then any other group to be uninsured.

That is why illegal immigration needs to stop. The law needs to be enforced and we need to stop making citizens chlidren whose parents are illegal. Even those whose parents have no intention of living in the US, such as student visas and vistor visas. Its just worse then foolish and unresponsive to the needs of this nation, it is taking advantage of the kindness the citizens of this country are about, and leads to nothing more then govenrment taking over more and more of our lives through providing us everything we need to survive.

[bennyblack1]

Peachsurpriz;
Um...this is the reason we NEED social security numbers: To insure citizenship. Where are you from? New Mexico? (New Mexico is unofficially a part of the UN through the World Bank, which provides welfare to illegal immigrants while officials pass them off as American citizens. New Mexico is only a part of the United States because it happens to be within its borders).

[standlee5]

Why can''t we send Mexico a bill for the care and feeding of their citizens.

[standlee5]

You see what is happening here? The reason people expect these services for free is because they are not educated about the American system and the American way of life. Posted by bennyblack1 at 09:28 PM : Nov 18, 2007

That''s so true. They''ve never been educated. We''ve given them everything on a silver platter as soon as they arrive. I''ve had numerous Russian emigrants tell me that DSHS is designed to pay for the birth and raising of their kids. I tell them it''s "welfare" and in America it''s always been something people felt a bit of shame accepting and always wanted to get "off the public dole". They can''t understand why anyone would not want to get something free. Education is lacking on the American way that''s for sure.

[peachsurpriz]

The way to insure illegal aliens and afford business to everyone else is to STOP USING SOCIAL SECURITY NUMBERS AS A MEANS OF GETTING THE PRODUCT .. that goes for home loans, bank accounts, medical treatment, car loans and anything else. the Govt should crack down on the unwarranted use of social security numbers. Id like to sue the us govt for allowing criminals to steal my identity and use my social security number.. they are the main cause of this societal plague on denial of commerce and services.

[peachsurpriz]

The way to insure illegal aliens and afford business to everyone else is to STOP USING SOCIAL SECURITY NUMBERS AS A MEANS OF GETTING THE PRODUCT .. that goes for home loans, bank accounts, medical treatment, car loans and anything else. the Govt should crack down on the unwarranted use of social security numbers. Id like to sue the us govt for allowing criminals to steal my identity and use my social security number.. they are the main cause of this societal plague on denial of commerce and services.

[peachsurpriz]

The insurance industry is so poorly managed and regulated so much money is lost and overpaid needlessly. Low cost and free health care isnt designated for Citizenship only. The same indigent white american born family has the same opportunities as the forgein born indigent family. they have to go thru certain application processes to get the billings funded. Dont let ignorance of the process be the excuse for not footing the bill. If illegal immigrants earn enough to buy a blue cross policy or whatever.. they can CITIZENSHIP ISNT THE ISSUE. The problem is.. too many business are Requiring social security numbers to GET ANYTHING. The US Govt already has a law to outlaw the unwarranted use of social security numbers. Lets see it enforced and making commerical businesses and hospitals create their own assignment numbers. That would ease the strain on all who need insurance and other services.

[peachsurpriz]

The insurance industry is so poorly managed and regulated so much money is lost and overpaid needlessly. Low cost and free health care isnt designated for Citizenship only. The same indigent white american born family has the same opportunities as the forgein born indigent family. they have to go thru certain application processes to get the billings funded. Dont let ignorance of the process be the excuse for not footing the bill. If illegal immigrants earn enough to buy a blue cross policy or whatever.. they can CITIZENSHIP ISNT THE ISSUE. The problem is.. too many business are Requiring social security numbers to GET ANYTHING. The US Govt already has a law to outlaw the unwarranted use of social security numbers. Lets see it enforced and making commerical businesses and hospitals create their own assignment numbers. That would ease the strain on all who need insurance and other services.

[bennyblack1]

Therein lies the problem with Communism and Socialism. These two systems of government set themselves up as gods to the people. The people ask for it, the government provides it. The people are hungry, the government provides it. The people need health care, the government provides it. The people need a place to live, the government provides communal living. The people need a job, the government provides a job, but it won''t pay nearly enough to pay the rent, buy food, and pay the light bill. So, we have all these people running around like chickens with their heads cut off because what they should''ve been doing themselves, the government did for them. In America, it''s different. We WORK for our freedom. We WORK for our food. We WORK to have a decent place to live and a car. We WORK to have decent healthcare. We educate ourselves to obtain these things. The government cannot and should not give these things away. I just want to know, why are we changing our Democratic Republic into a Socialist Welfare State?

[bennyblack1]

You see what is happening here? The reason people expect these services for free is because they are not educated about the American system and the American way of life. Our government is compromising on the values America was established on, that being life, liberty, and the pursuit of happiness. The pursuit of happiness entails designing a life for yourself, fighting for your liberty, and living your own life with as less dependance as possible on the government. In other words, if we want to design a life that provides us with a house on land, a car, and all our bills paid, then WE have to plan, educate ourselves, and then execute the plan. Too many people come over here and expect the government to already have a plan in place for them. To choose their career, to execute a plan for them. Then, they expect free medical care, a home and the land. They do not realize that these are things they work to obtain. They are not free gifts from the government.

[standlee5]

We''ve all practically gone broke paying for healthcare the past decade and illegals have gotten the best care in the world, free of charge. Not to mention the LEGAL new immigrants who actually think it''s the responsibility of the state to pay for their obstetric care (thinking Russian immigrants). Has the American taxpayer ever been more disrespected?

[bennyblack1]

So, instead of El Presidente of Mexico wants to place blame, then he should place blame with Spain. Spain gave up the territories that were once a part of Mexico. Neither Spain nor the United States wanted anything to do with Mexicans, so Spain gave what was left of Mexico to them, and the United States evicted them to Mexico for reasons that I have previously mentioned.

[bennyblack1]

So, irregardless of my error, the United States still purchased these territories from either Spain or France. Mexico, at the time, was under the juridiction of Spain. The Mexicans just sort of, inherited it. So, in either case, Mexico has NO INTEREST whatsoever in any of the territories I mentioned. They were all purchased by the United States, therefore, the United States has the right to regulate the comings and goings of all who pass through its borders. If a migrant worker wants to become an American citizen, what EXACTLY is the problem with signing in to INS? If there is no reason for them to say, "No," then there is no cause for fear. Get bold, and sign in.

[bennyblack1]

rudy;
I stand corrected.

The Louisiana Purchase didn''t include Texas, however, the United States purchased Southern California, Nevada, Arizona, and New Mexico from Mexico as well. Then they bought Alaska and the four Northwestern states from Russia, and bought Florida from Spain.

However, here is the Louisiana Purchase:
The Louisiana Purchase was the acquisition by the United States of approximately 530 million acres (820,000 sq mi or 2,100,000 km2) of French territory in 1803, at the cost of about 4" per acre (7" per ha); totaling $15 million or 80 million French francs. Including interest, America finally paid $23,213,568 for the Louisiana territory.[1] The land purchased contained all of present-day Arkansas, Missouri, Iowa, Oklahoma, Kansas, Nebraska, Minnesota south of Mississippi River, much of North Dakota, nearly all of South Dakota, northeastern New Mexico, northern Texas, the portions of Montana, Wyoming, and Colorado east of the Continental Divide, and Louisiana on both sides of the Mississippi River, including the city of New Orleans. (The Oklahoma Panhandle, and southwestern portions of Kansas and Louisiana were still claimed by Spain at the time of the Purchase.)

[bennyblack1]

Rudy654;
It is YOU that needs to go back to school. And look up "Louisiana Purchase," while you''re at it.

[Redoubt]

Ben Crair Wrote: "The obvious way to contain these costs is to insure the undocumented, so that they have access to preventive care before they degenerate into the tax siphons conservatives already claim them to be."

To the contrary, the most obvious way to contain these costs is to secure our borders and enforce our immigration laws. If those laws were upheld by our government and then respected by potential immigrants, there would be NO issue of healthcare for illegals!

[trillion1]

Like all the arguments from the pro illegal crowd the statement we can''t deport the tens of millions of illegals does pass the laugh test. We don''t have to deport them! Enforce the laws that have been on the books since the 1950s. Take away their jobs, take away their free health care, take away their free education and they will pack up and leave on their own.