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Everyone will suffer if illegal immigrants aren’t covered in reform, some caregivers say

By admin | October 18, 2009

South Florida Sun-Sentinel.com

Health care reform

Everyone will suffer if illegal immigrants aren’t covered in reform, some caregivers say

Florida, home to a million undocumented immigrants, pays big to take care of those who can’t get insurance, including those here illegally. If health care reform leaves out the undocumented, we’ll still be paying, caregivers warn.

By William E. Gibson

South Florida Sun Sentinel

6:15 PM EDT, September 25, 2009

WASHINGTON

Excluding undocumented immigrants from health care reform could jeopardize everyone’s health and perpetuate a costly gap in insurance coverage, medical experts warned this week.

Much of the point of health care legislation in Congress is to cover all Americans to protect the public health and ease the high cost of treating uninsured patients in emergency rooms. Some health leaders worry that leaving the undocumented out of a newly created health care system would impair attempts to prevent the spread of infectious disease, such as tuberculosis or swine flu, and continue the growing burden on public hospitals.

The gap in coverage is especially big in Florida, home to a million undocumented residents.

The warnings come while the Senate Finance Committee is drafting a bill designed to prevent illegal immigrants from tapping into new health care marketplaces, known as exchanges, where individuals and small businesses could shop for insurance.

The committee, which will resume its work next week, is expected to produce a bill that would require consumers to show proof of citizenship or legal status when joining these exchanges. The bill also would prevent the undocumented from getting tax breaks designed to make insurance affordable. And it would force newly arrived legal immigrants to wait five years before joining exchanges or getting tax breaks.

Some health leaders in Florida fear these exclusions and restrictions would undermine the advantages of reform.

“If I’m standing next to someone who has tuberculosis and who is uninsured, it doesn’t protect me if they aren’t treated,” said Fernando Trevino, dean of the School of Public Health at Florida International University. “To the degree that someone is not getting care, they are more likely to spread infectious diseases to the rest of the population.”

He and other public-health experts also say any bill that leaves a big gap in coverage would miss an opportunity to lower costs by providing preventive care to everyone.

“People forget that we already provide inefficient and expensive care to undocumented residents,” said Dr. Olveen Carrasquillo, chief of general internal medicine at the University of Miami medical school. “They come into emergency rooms with advanced stages of an illness. Often they have medical conditions that are very expensive to treat but could have been prevented with primary care.”

Restrictions on the undocumented, if approved by Congress, would apply to new benefits provided by the reform legislation. The exclusion would not block immigrants from buying insurance on the private market outside these exchanges.

Florida Sen. Bill Nelson, a Democrat on the Finance Committee, supports exclusion of the undocumented.

“Nelson’s bottom-line position is that a health care bill should not provide benefits to folks here illegally,” said spokesman Dan McLaughlin. “In fact, he supports tough verification.”

These measures stem from a determination to prevent explosive immigration issues from derailing an overhaul of the health care system. President Barack Obama tried to assure Congress in a nationally televised speech this month that “the reforms I’m proposing would not apply to those who are here illegally.”

The remark sparked an outcry from conservatives — most immediately from Rep. Joe Wilson, R-S.C., who shouted, “You lie!” during Obama’s Sept. 9 health care address to Congress. Wilson and many other Republicans say the reforms being considered would allow illegal residents to sneak into the health care system at taxpayer expense.

The undocumented have access to health care. By law, hospitals and other providers are required to treat all patients who need emergency care.

Public clinics in South Florida and elsewhere do not ask patients about their immigration status. They also give vaccinations for such things as swine flu without demanding documents.

But some public-health leaders are concerned that the heated rhetoric and exclusions coming out of Washington will further discourage immigrants and some U.S. citizens. They say some residents who don’t speak English or meet the profile of a typical American — even those here legally — are reluctant to show up at public facilities for fear of harassment or deportation.

“By not covering them, we are choosing the worst for them and the worst for the rest of us in terms of financial cost,” Carrasquillo said. “We end up paying for it.”

William E. Gibson can be reached at wgibson@SunSentinel.com or 202-824-8256.

 

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