Illegal immigrants barely use medical care system
Posted by Charles II on August 10, 2007
You knew this already. The Center for American Progress did a report on it. I finally got around to reading it:
“[U]ndocumented immigrants and non-permanent documented immigrants, such as individuals with student or temporary work visas, are not eligible for Medicaid, except limited Medicaid coverage for emergency services….In terms of taxes paid per household, this equates to … $11 for health care (emergency Medicaid services) for the undocumented….The facts illustrate that undocumented workers contribute more to the revenue stream for U.S. social benefits than they use.”
In other words, you might have paid as much for the medical care of illegal immigrants as you did for pizza and beer this Friday. Except they probably paid much more in Social Security that they won’t receive than they used in services.
Another important take-home point: by excluding illegals from the health care system, we increase the risk of deadly epidemics.
But you knew that.
frecklescassie said
People also complain they use the schools too much.
martygrn said
I am very sorry to have to completely and totally disagree with this report as being totally false and misleading. I am an RN who works in a Pediatric ICU. I know for an absolute fact that these numbers are outright false. I know from experience that illegals whose children are admitted to an ICU, my experience, they almost are immediatly given Medicaid. They are then covered for all of their expenses for their entire hospital stay. I assume you may be from Phoenix, so I will also tell you that I worked an assignment at Maricopa Med Center and it is absolutly true there. I am not familiar with how it works at Banner, et al. This report may be true for illegals reciept of outpatient, preventative care. However, for acute, ICU level care, it is way, way off the mark.
Marty G., RN
Charles said
Marty, the report doesn’t say that no immigrant children get Medicaid. It states that the services are limited to emergency care, which would include ICU.
The report says that the total amount of spending is very small. $11/household works out to somewhat above $1B/year.
Furthermore, the report says that 2/3 of children living in undocumented families are children who are American citizens by birth.
There are believed to be 11M illegals in this country, most of them concentrated in border states like California, Arizona, and Texas. If all of them were in those three states, something like one in seven of your patients would be illegal.
I feel confident that that’s not the case. The reason would be that illegals tend to stay in the shadows and avoid contact with official services except in an emergency so dire that life itself is at stake.
I’m sure you’re accurately relaying your observations. This report deals with the larger picture.
I should also add that I think that illegal immigration is a major problem that stresses state and local systems. The solution, though, is not to build a wall between the nations or deny medical treatment to little kids, but to raise wages in Mexico. Our national policies have created the crisis in Mexico, mostly by dumping US-subsidized crops into the Mexican market and thereby displacing small farmers from their farms.
martygrn said
I am still curious how the calculation of $11/household was made. We have no absolute accurate counts on how many illegals are in this country, so how do you calculate that average? Also, I have no very accurate way of saying when and who of my patients are illegal as we are prevented, by federal law, from asking about resident status. I have also taken care of patients whose families refused to apply for medicaid, I make an assumption it is because they are illegal and don’t want to take any chances. Of course, you know what they say about assumptions. So, then you have a certain percentage of illegals whose medical care is unreimbursed. The hospital is unable to even get a part of the bill because as soon as they leave the hospital, they disappear from the world. The names and contact information turns out to be false and we have no idea where they went. They do not make their follow-up appointments, so there is no continuity in care. I am sure some patients have been hospitalized at other hospitals previously, but since we are not told, we try to treat from square one again. This drives up the hospitals expenses yet again. Finally, the hospital deservedly needs to make up this expense. Where do you think that comes from? Those of us who are insured and/or pay our bills. Herein lies the reason why our costs are so much higher.
As for trying to raise wages in Mexico, how about cancelling NAFTA and imposing import tarriff’s that remove the incentive to move production across the border. How else would you propose to remedy the slave wage conditions? I would never, ever propose to refuse treatment to kids, I just think creating yet another reason to entice illegal border crossing is not the answer.
I do not know if you have heard about the Jessica Santillon story. Jessica was a 14 yr old girl who needed a heart-lung transplant. The only problem was she lived in Mexico, so the chances of this happening were nil to zero. What did her parents do? They successfully got here to NC to be seen at Duke, one of the premiere pediatric cardiac centers in the world. What followed was a disaster. Due to a massive breakdown in policy and systems, she was transplanted a heart and lungs that were the wrong blood-type. Long story short, she, unfortunatly, did not survive. But, the point of the story is the circus that followed the botched operation for the 10 days or so she survived. Of course, being Duke, the national media descended on the hospital. The family did not speak english, so a “family friend” became their spokeperson to the media. This ‘family friend’, it came out, made a business out of smuggling people in need of advanced medical care out of Mexico in order to be treated at Duke. The hospital did not know before this point that this man existed or what was being done. Duke also has a policy, in effect even today, that simply states that noone involved in direct patient care (doctors, nurses, etc.) be informed of a patients insurance coverage. This, in theory to make sure all patients recieve the same treatment regardless of ability to pay. Today, this family remains in NC living ‘the American dream’, even though their immigration status was all over the national media for the world to see. I also know that the ’spokesperson’ is still activly involved in his smuggling business. How do I know he is still doing this? Because he formed a charity organization call ‘Jessica’s Hope’ to help fund his efforts. He is making no efforts to hise what he is doing, publically advertising for donations to help his ’cause’. Had the malpractice never happened, he would still be in the shadows. Since, he is doing it in the open without ramifications. The family received a multi-million dollar settlement from the hospital and is living in the US with no financial worries.
Can we expect more of this with the new system? Is this really what we need to be subsidizing as taxpayers? The family also filed a multi-million dollar malpractice suit which was settles out of court, which is why I do not know the exact amount of the settlement. I am not sure I agree that someone who is here illegally should be allowed to file a lawsuit and use our court resources as well. In this case, they deserved what they got, but what about a frivilous case? And finally, there is such a thing as a medical need visa. All they had to do was prove that she needed life saving treatment that she was unlikely to obtain in her home country, and they would have been here legally. While at Duke, I worked there for 2 yrs, I took care of a number of patients who were here through that route. It is rather quick and nit as complicated as you might think. The most difficult part is finding a doctor here willing to treat you, the rest is just formality.
Finally, I would like to know what percentage of people using the ER as their primary care are illegal. I think this may be a big part of the drain on this resource, but I have no data to back that claim, so it is just a theory. I’d like to see a study done to see if this bears out. Sorry, this ended up longer than I anticipated, but I don’t think there is a simple fix to the illegal problem. I do commend you for at least correctly using the term ILLEGAL immigrant as opposed to undocumented.
Marty G., RN
shrimplate said
It’s a problem that extends well beyond the bounds of the immigration issue to the problem of providing healthcare to all the uninsured regardless of their citizenship.
Hospitals and emergency departments must at least stabilize patients who present to them, regardless of ability to pay. It’s an awful financial stress. If there’s any way at all to squeeze a few dollars out of the state systems to get some reimbursement, then hospitals really don’t have much of a choice but to help patients get those funds. Many even have staff positions dedicated to that task, AHCCCS people right on the premises.
Charles said
Martygrn says, “I am still curious how the calculation of $11/household was made.”
The statistic is referenced to D. Goldman, et al., “Immigrants And The Cost Of Medical Care,” Health Affairs, November/December 2006. An abstract is here. Basically, they did a survey in LA County and extrapolated the results nationwide. It’s useful as an order of magnitude estimate.
Martygrn says. “As for trying to raise wages in Mexico, how about cancelling NAFTA and imposing import tarriff’s that remove the incentive to move production across the border”
I’m with you. The key issue is grain prices. Because the US subsidizes production and Mexico does not, this has been driving farmers off their lands and into cities, where they depress labor prices. Displaced farmers are replaced with American retirees and the tourist business, which brings dollars in, but ends up leaving the society poorer.
Martygrn asks, “Can we expect more of this with the new system? Is this really what we need to be subsidizing as taxpayers? ”
I’m not sure which new system you are referring to. The Congress is attempting to fully fund the SCHIP program. That should reduce the stress on hospitals.
Martygrn says, “Finally, I would like to know what percentage of people using the ER as their primary care are illegal.”
The Goldman report suggests that illegal immigrants use emergency services at half the rate of the rest of the population. If illegals are 4% of the population, that means that ca. 2% of emergency services are for illegals. However, they tend to show up much sicker, so the costs may be a bit more.
Martygrn says, “I do commend you for at least correctly using the term ILLEGAL immigrant as opposed to undocumented.”
I use both terms. The border between the US and Mexico is artificial, being imposed by war. People have family on both sides of the border. In the case of American and Mexican Indians, it’s not clear to me that it actually is against the law for them to traverse the border, since the Native Americans are recognized in American law, at least, as members of sovereign nations (not that our government follows the law). So, it’s possible that someone could be undocumented and legal. Yes, we should try to enforce borders, but we should have considerable humility in doing so, since through war and NAFTA and our national drug problem, we created the mess.
I hadn’t followed the Santillon case. Ironically, Mexico had a good system of basic medical care under ISSTE (See, for example here). Indeed, many Americans go to Mexico for affordable care. The Calderon government is in the process of destroying the system through privatization. So, the Duke case is an anomaly, where only very high tech care will serve. Still, it would be cheaper and more sensible to equip Mexico to do such work and have those cases dealt with there.
shrimplate said
Michelle Malkin on Jesica Santillon:
In a world of scarce resources, compassion must have limits. We cannot afford to be a medical welcome mat to the world.
Malkin, once again proving that she is a despicable monster, seems to be saying that Santillon should not have received care in the United States.
martygrn said
“Malkin, once again proving that she is a despicable monster, seems to be saying that Santillon should not have received care in the United States.”
Why is this being a monster? She also states the costs involved in caring for illegal immigrants. Are these costs just supposed to be ignored? Also, I found it interesting that after the first transplant, she was then transplanted organs of the correct blood type within a week. How exactly did this happen? How were the very scarce donor organs found this quickly? I am sure it was the work of the non-profit organ procurement network, since the further investigation found it was primarily through their fault the mistake happened in the first place. Of course, they do not have the money that Duke University does, so they were not the ones sued. Do you think someone who comes here illegally EXPRESSLY for the purposes of taking advantage of our healthcare should recieve treatment regardless of the cost? As I stated in my original post, there is a way to do this legally. It is called a medical visa. Why not go this route? It would probably been cheaper than the $5000 they paid the smuggler to get here. This I have no problem with. What about all of the other statistics stated in the article? I suppose these are not accurate as well, since they do not agree with your point of view?
MEC said
Call me silly, but I believe that saving lives is more important than saving money.
We have had other commenters inform us that medicine is a BUSINESS and that the priorities of business determine who gets medical care and who doesn’t.
That is exactly what’s wrong with the health care system in our country. It’s run for profit, so the goal is making a profit, not keeping people healthy and treating them when they’re sick or injured.
My bottom line is that letting people die because they can’t pay for health care is evil.
martygrn said
I never stated it should be about who can pay. I would be just as strongly against some multi-millionaire who can pay their entire bill in cash coming here illegally to get care. For me, it is not about ability to pay, but rather your resident status. Why should someone here illegally receive organs ahead of a poor American citizen? This is EXACTLY what happened in this case with the second transplant. My point is that people here LEGALLY should have priority over those here ILLEGALLY, no matter who has the ability to pay.
Charles said
Marty, don’t medical ethics require that when a patient is in imminent danger of death, as when they have had transplant rejection, that they receive priority over people who are stable? And don’t children generally get priority over older people?
I don’t know the Santillon case well enough to be able to answer the ethical quagmire that it sounds like it represents. So I am wondering what medical decisions would have been made if there had been no illegal arrival, no issue of who pays, and no fear of a lawsuit.
BTW, many foreign countries treat American tourists for most procedures for free (or a nominal charge).
martygrn said
Charles,
Yes, it is true that is how things are prioritized. My issue is not so much with the second transplant as with the original one. Once the mistake was made, it became a completely different issue. The medical decisions at the beginning were just that, medical decisions. I cannot discuss specific medical details that have not already been made public as that would violate HIPPA and confidentially, except to say that the decision to transplant was made on a 100% medical basis. I just feel that the original transplant should have been done under better circumstances. If we made resident status a basis for a transplant, do you really think people would continue to come here illegally for treatment? Had there been such a restriction in place at the time, it would have taken away the motivation for her family to come here the way they did. I understand your point about foreign countries treating American tourists. However, are the American tourists not in the foreign country legally? Are they not their with a valid passport entering the country legally? My position would not have any impact on these people as they would be legal. Increasing wages in Mexico is the same as the argument I am making here. Remove the motivation and the unwelcome actions stop. Is that not one way to discipline children? Removing the reward stops the behavior. Duke is one hospital I know who, by policy, do not allow the doctors, nurses, etc. to know the pay status of patients on the basis that pay-status should in no way influence treatment decisions. I worked there for a number of years and can say, without a doubt, that they are one of the most charitable hospitals in existence. If you have an outstanding bill with them, yes they will continue to send a bill every month, but that is all. You will never get a collections call. After 3 or 4 years, the bills will even stop coming. No interest is ever charged either. And, finally, it will never show up on you credit report. I have known people with longstanding bills from the hospital, so know this to be true. How do they survive doing business like this? I don’t know the details, but I can say that they are never at a loss for money. They spend whatever it takes to upgrade equipment, buildings, etc. Does the Universities multi-Billion dollar endowment fund account for any of this? I don’t know the answer to this as they are private and this is not something they publically release. I do know the endowment was established in the 1920’s with $1 million and the principal has never been touched.
Finally, if our system is so bad, why do people from all over the world come here to get treatment?
MEC said
“Finally, if our system is so bad, why do people from all over the world come here to get treatment?”
The best medical centers in the country are very good indeed. But most people living in the United States don’t have access to “the best”; too many of them don’t have access even to “adequate”; far too many have no access at all.
This New York Times editorial provides the grim details, particularly this paragraph:
“Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.”
Charles said
I don’t have any argument with the proposition that people should come here legally, Marty. Illegal immigration is bad from many standpoints, including the public health risks posed by having a population afraid to visit a doctor. Drug-resistant TB has no better friend than neglect.
As for treatment of tourists in foreign countries, if memory serves, for the ones I am directly familiar with, no one would know if they were there legally or not, because the doctor/hospital doesn’t ask for ID.
As for your question. “if our system is so bad, why do people from all over the world come here to get treatment?”, let’s be precise. I haven’t said that the US system is bad. For people who can’t use it, however, it’s as bad as no system at all. Americans are going to Canada, Mexico, and even India for treatment. So, maybe their systems aren’t so bad?
The US prides itself on high-tech, experimental medicine of the kind that’s of interest only for people who are desperate. Those tend to be the rarer situations. When one looks at outcomes for more typical procedures, I believe they’re comparable.
wandaperez said
why everybody is putting down immigrants whether they be legal or not there are some pretty dern good because im married to one and he is from mexico and he works every day and takes care of me and our son. i dont have to work he does no drugs nor does he drink and want to raise hell like most hispanics. he drives my father to atlanta every time he has to go to the heart doctor and he loves my family like you all love yours and still he cant get anything anywhere and we have filed the papers for his visa and before you go saying thats all hes using me for we have been married for 5 yrs. and we have 2 sons one is 3 and the other one died at birth. this is a real man but nobody wants to give the immigrants a chance and i know some are terrible but not all and i know that when my husband goes to the hosiptal or the er or just the regular doctor he pays out of pocket and it is not cheap so see it is not all and i dont care what anyone says is the man for me and im proud to say i love an immigrant. this is a relationship that no political bull hocky can break up and while so many people are worried about immigrants what about all these drugs and violence out here. need to clean that up first. in every race there are good and bad and what makes americans think they are so much better than other people from another country when really they are just as bad but they have their green card.
wandaperez said
i would like to add just a few more lines i know they should not come over here illegally but how would you feel if you worked sun up to sun down for $4 or $5 day that is what my husband was making before he can over here compared to what he is making now $30 hrly. he is a wonderful hispanic and i hope congress will go through and give the ones that are not making in trouble for anyone and pays their taxes just like a natural born american i hope they give them anmesty.
Charles said
Wanda, immigration as it exists, is bad for everyone. It is used by employers to drive down wages in this country. In Mexico, it is used by the government as a safety valve so that they can engage in policies that drive people off their land and into maquila jobs with terrible working conditions and desperately low wages.
Illegal immigration creates the shadows in which organized crime, communicable diseases, and terrorism can hide. Illegal immigrants live in this country with no elected representation and–because of bad legal precedents– without protections that the Constitution guarantees to all human beings.
Immigrants are people, neither all good nor all bad. But illegal immigration is all bad, except for those rare good relationships that happen as a result.