Thursday, November 3, 2005
Immigrants Most Likely To Seek Help With Childbirth or for Emergency Treatment
By Jackie Jadrnak
Copyright © 2005 Albuquerque Journal; Journal Staff Writer
Fifth in a Series: In New Mexico, the cost of providing health care to undocumented immigrants is one more straw on an already-beleaguered camel's back. The health care system here is strained by a high poverty rate and the second-highest rate of uninsured people in the country.
How much is the problem caused or compounded by people who are here illegally?
No one knows for certain because health care providers don't ask and they don't want to ask about immigration status when a person shows up at a hospital.
"Our mission is to provide care," said Alex Valdez, chief executive officer of St. Vincent Regional Medical Center in Santa Fe. "It's not our mission to determine whether you're here legally or not."
Most people do agree on some things about illegal immigrants:
Their biggest medical impact is on hospital emergency rooms, where many immigrants come because they have no other source of care.
Hospitals often see immigrants who want to have their babies delivered on United States soil so their children will be U.S. citizens.
Latino immigrants tend to be young and are here to work not the group most likely to need medical care. But immigrants may suffer disproportionately from some diseases, such as tuberculosis, which are more common in their native countries than they are in the U.S.
Overall, the cost of care provided by New Mexico hospitals is about $2 billion a year, according to Jeff Dye, president of the New Mexico Hospital and Health Systems Association. Of that, $209 million about 10 percent is uncompensated care, he said.
"We really don't know how much indigent care is represented by the undocumented," Dye added.
A good share of it is trauma care, he said, along with treatment for flare-ups of chronic health problems. "The fact is most (uninsured) folks don't have ... a doctor they see on a regular basis," he said.
"Things they present with tend to be more out of control or more severe."
That may be particularly true for people who are here illegally, according to Eva Moya, executive director of the U.S. section of the U.S.-Mexico Border Health Commission.
They don't speak the language, don't know what basic services are available, don't know how to navigate this country's complex health care system, she said.
"If you don't have the resources, you are fearful, isolated, sick ... you wait until you can be seen in the E.R.," Moya said.
The U.S.-Mexico Border Counties Coalition sponsored a study of hospitals serving 24 counties along the border. It found they provided $832 million in uncompensated care. That study, based on 2000 statistics, pegged $190 million about 25 percent of that amount as going to emergency care of illegal immigrants.
New Mexico's portion of that $190 million was estimated at $6 million.
Congress recently made $250 million available to hospitals for emergency care to unauthorized residents. New Mexico was allocated $5.1 million.
Randy Marshall, executive director of the New Mexico Medical Society, said he doesn't think that money comes close to what the state spends on such care. "We got shortchanged," he said.
But Dye said New Mexico's share "is going to cover a good chunk of it."
There has been controversy over how hospitals will be reimbursed because they have to file claims based on undocumented residents getting medical care. That means staffers have to ask patients about citizenship status something some people fear will discourage immigrants from seeking badly needed medical care.
"There are concerns about hospitals being perceived as border control agents," Dye said. "We don't want that to happen."
Hospitals are allowed to submit claims using a patient identification number instead of an actual name, he said.
Diana Catanach, director of patient financial services at St. Vincent in Santa Fe, said patients will be asked about their status by financial aid staffers, after people have gotten their medical care.
Steve McKernan, chief executive officer for the University of New Mexico Hospital, was in Washington, D.C., the last week in October for a meeting of the National Association of Public Hospitals. He said he was getting ideas from other hospitals' executives about how they handle it.
UNM Hospital hasn't started identifying illegal immigrants yet. McKernan said the hospital does want a share of the federal funds, "but at the same time, we want to be respectful of our patients and their confidentiality."
He added that, since the hospital has never tracked patients by citizenship status, he has no idea how much their care has cost. Overall, UNM Hospital provided $87.3 million in uncompensated care medical services that were not paid for by patients or their insurance in the fiscal year that ended June 30, 2004.
Born in the U.S.
Moya said she doesn't think too many people cross the border solely to get health care. "It's not as much as people want to think," she said.
The exception, she said, is obstetrics since any baby born in the United States is considered a citizen.
The Center for Immigration Studies estimated that births to illegal residents accounted for 9.5 percent of births in this country in 2002.
Marshall said the biggest impact of undocumented immigrants on physicians undoubtedly comes to obstetrician/gynecologists in southern New Mexico. "They see a high percentage of Medicaid and a high percentage of undocumented care," he said.
Undocumented immigrants are not eligible for Medicaid.
Dr. Anthony Levatino, a Las Cruces obstetrician/gynecologist, said his practice is buckling under the strain.
"Undocumented aliens are not a problem to me and my partners," he said. "What is killing us is the absolutely abysmal reimbursement the state gives under Medicaid, when that is the majority of our patients."
Mexico has universal care for its residents, yet the U.S. has more sophisticated care for more complicated medical problems, Moya noted.
That can mean Mexicans come looking for life-saving care they may not find in their country at least not without money. Recently a man was detained in Denver who had come with both HIV and tuberculosis, according to Dr. Gary Simpson, medical director for infectious diseases with the state Health Department.
"The young man came over the border with the specific intent of wanting to survive TB," Simpson said.
But, overall, the number crossing illegally to get care for such specific conditions as HIV/AIDS "can be counted on your fingers and toes," he said.
People coming to this country also may carry diseases uncommon here, such as tuberculosis or malaria, Simpson said.
In any case, public health treats infectious diseases no matter who has them, to contain their spread. "At the end of the day, disease does not carry a visa," Moya said.
Clinic safety net
Health clinics operated by the state Department of Health give a range of treatments vaccinations, prenatal care, testing and treatment for sexually transmitted diseases. They generally attract people who can't get care anywhere else.
In 2004, the state's health clinics gave $8.9 million worth of health care to uninsured people. Those clinics do not seek proof of citizenship.
Federally funded primary care clinics also attract low-income, uninsured people. Those clinics don't ask a person's residency status either, according to David Roddy, director of the New Mexico Primary Care Association.
"There are certainly significant numbers (of undocumented workers served) in the Santa Fe area, as well as the border areas," he said. Las Cruces and Santa Fe clinics see a particular demand for prenatal care.
Doctors with Hidalgo Medical Services, one of the nonprofit agencies operating primary care clinics, delivered 13 babies to undocumented immigrants at the Gila Regional Medical Center last year, according to Charlie Alfero, Hidalgo's executive director.
Overall, 7 to 10 percent of the agency's charges are written off. "That's a lot of additional services we could provide," Alfero said.
Lack of insurance
In a November 2001 report, at the direction of the Legislature, a task force tried to analyze the impact of illegal immigrants on state services. It noted that an Institute of Medicine report called immigrants "only a small percentage" of the uninsured population.
Immigrants are far less likely to have health insurance than people born here. An Employee Benefit Research Institute study released this year said immigrants (legal or otherwise) accounted for 26 percent of uninsured people nationwide in 2003. From 1998-2003, immigrants accounted for 86 percent of the growth in uninsured, according to that study.
Looking at Latinos, it said 60 percent of immigrants were uninsured, compared to 22 percent of Latinos born here.
But a study published in Health Affairs magazine in 2000 found that undocumented Latino immigrants have fewer doctor visits and fewer hospital admissions (except for childbirth) than other Latinos in this country.
An article in a February 2005 newsletter of the American Association of Medical Colleges quotes experts saying most Latino immigrants are young and healthy, coming to this country to look for jobs, not medical care.
Moya concurred, saying "They are hard-working, highly-respected and are risking their lives" to cross into this country.
"The greatest challenge is how to make health care services affordable, accessible and available to all regardless of immigration status," she added.