It's tricky to treat many immigrants, hospitals say
By JENNIFER BOOTH REED
jreed@news-press.com
Originally posted on December 30, 2007
THE SERIES
TODAY: The effect of immigration on the health care system.
Coverage
The News-Press has spent the past year reporting on the impact of immigration on Southwest Florida.
Previously reported topics have been:
Immigration reforms.
The impact on social services.
The impact on local schools.
The impact on courts and the jail.
The boy and his parents appeared at the Family Health Centers office in Fort Myers unannounced, carrying a note from a private pediatrician:
“Please take care of this patient. He has chronic liver failure.”
Dr. Jorge Quinonez, a pediatrician and Family Health Centers' medical director, works with uninsured immigrant families. Their treatment can be difficult on both ends for them, finding doctors who will see them; for the American medical system, finding a way to manage the often uncompensated cost of their care. This was the most dramatic case Quinonez had ever seen.
Quinonez persuaded All Childrens Hospital in St. Petersburg to admit the child. When doctors there realized the extent of his illness, they sent him back. Dialysis would cost $50,000 a year, and the boy needed that, as well as immediate placement on the kidney transplant list.
Quinonez's practice doesn't offer that kind of specialized care. He told the members of the family to go home to Mexico for treatment. They did, and Quinonez has heard since the boy is doing well.
In this case, both sides achieved their aims. The boy got his medical care and the American health system avoided the cost of caring for him.
That's not typical.
Immigration poses challenges for the health care system, which often can't get compensated for cost of care. A 2003 Florida Hospital Association survey of 39 hospitals found the medical centers gave away $40.2 million in charity care for illegal immigrants. That didn't take into account the noncitizens who are here legally but who are uninsured and underemployed and are likely to land in emergency rooms.
The United States has about 36 million immigrants, a third of whom are estimated to be here illegally, according to the U.S. Census Bureau. How to pay for their medical care is part of a broader debate on immigration policy and on what to do about the country's out-of-control health care costs.
In many ways, the immigrants' stories are no different than those of uninsured citizens, who have medical doors shut on them and debt collectors chasing for impossible-to-pay medical bills when they get care. But the challenges of being a noncitizen and uninsured and the challenges of caring for them are even greater than they are for uninsured Americans.
Consider:
Medicaid will pay for emergency treatment for noncitizens, but the payments stop when the condition is no longer considered an emergency even if the patient requires prolonged hospital care. Hospitals are not permitted to bill patients for the difference. At Lee Memorial Health System, it costs about $1,700 a day to stay in the hospital. Hospital officials say they end up writing off the extended stay.
Noncitizens are not eligible for regular Medicaid or subsidized health insurance plans for children.
Uninsured people of all stripes end up in emergency rooms for care, but immigrants do so at higher rates, according to the Florida Hospital Association. The emergency room is the costliest way to deliver medical care, and it's also the place forbidden by federal law from turning anyone away. At Lee Memorial, the average ER visit cost is $325.
Hospital social workers must turn into sleuths trying to track the identities of immigrant patients who come into the trauma center unconscious a challenge if they're illegal, lacking identification and their friends and family are fearful of speaking with anyone in a perceived position of authority.
These same social workers sometimes struggle to find follow-up care for patients, who may need home health, rehabilitation or family members to care for them after discharge from the hospital. Frequently, they come across workers who share housing with other workers, but not spouses or relatives who could offer such care.
Immigrants are flooding delivery rooms to give birth to children, who are automatically U.S. citizens. In 2005 and 2006 alone, Lee County saw a total of about 2,100 babies born to illegal-immigrant mothers, state birth records show.
These children, in turn, often qualify for Medicaid or other subsidized health plans. The Center for Immigration Studies report found in Florida 18 percent of immigrant-headed households had at least one family member who qualified for Medicaid as opposed to 11 percent of native households.
The issue, suggested Steven Camarota, author of the Center for Immigration Studies report, is American immigration policy opens the door to undereducated, low-wage workers who will need American support ranging from Medicaid to food assistance. Forty-seven percent of immigrants are uninsured or on Medicaid compared with 26 percent for native born.
“The problem here for Florida and the country mainly stems from the education level,” Camarota said.
His solution: Either change the policy and admit better-educated, self-sufficient people or accept the fact these newcomers need social supports.
But until that happens, both sides continue to struggle.
“The majority of these families cannot afford to go to the dentist and even the doctor,” said Rae Nicely, the executive director of Lehigh Community Services.
She sends them to the few places she knows will see them Family Health Centers, the Salvation Army, the Health Department.
But the services aren't enough, especially for those families who don't have transportation.
“It's a real issue,” she said.
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