Providing Primary and Preventative Care to Undocumented Immigrants: Issues of Access, Quality and Cost

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1 Providing Primary and Preventative Care to Undocumented Immigrants: Issues of Access, Quality and Cost Alina M. Perez, J.D, L.C.S.W Assistant Professor of Public Health Nova Southeastern University

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3 Introduction There are 11.5 to 12 million undocumented immigrants in the United States The majority of the undocumented immigrants live in six states: California, Texas, Florida, New York, Illinois and New Jersey. Rapid increase of undocumented immigration in the Southeast and mountain regions of the country: North Carolina, Georgia, Tennessee Arizona and Utah.

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5 Undocumented immigrants do not come to the U.S in search of welfare or health care services but for work opportunities. Immigrants are more likely to hold jobs without health benefits. Undocumented immigrants add 8 million to the 45 million people without health insurance Emergency room expenditures are three times higher for immigrants.

6 The Issues: Federal and state initiatives have created barriers to prenatal, preventative and primary care for undocumented immigrants. Lack of access to primary and preventative care results in higher use of unnecessary emergency room services, higher health care costs and poor quality of care. Lack of access to preventative care is a threat to the public s health.

7 Brief overview of the policies impacting the issues Federal Level Personal Responsibility and Work Opportunity Reconciliation Act of 1996 imposed restrictions on immigrant eligibility for means-tested federal benefits. Care mostly provided by federally qualified health centers which are not easily accessible in all regions. EMTALA provides care regardless of immigration status.

8 Policies (continued) State level Disparate use among the states of local funds for special nonemergency services. Inadequate availability of safety net organizations in some states. Many states have passed or attempted to pass legislation restricting access to local and public benefits. E.g. California Proposition 187, Arizona Proposition 200. Other state legislation requires employees of local agencies to verify immigration status and report violations to authorities.

9 Why should we provide primary and preventative care to undocumented immigrants? Undocumented immigrants suffer disproportionately form certain chronic and infectious diseases: Diabetes Tuberculosis Obesity Drug and alcohol abuse

10 Because they lack of access to care, undocumented immigrants are more likely to engage in dangerous health practices: Use of unlicensed dental and medical services Self-prescribing and administering illegal pharmaceuticals

11 Why preventative and primary care? No access to preventative and primary care = diagnosis at more advanced stages + more use of emergency room services There is evidence that preventative care can save high cost of health care and improve access and quality of life.

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13 Private business and industries in the U.S Undocumented immigrants account for about 4.3% of the civilian labor force or about 6.3 million. Absence and disability losses constitute 29% of the total health and productivity related expenditures.

14 The public health system Infectious diseases go undetected and untreated; Threat to unborn babies and their mothers; Re-emergence of diseases; Financial and emotional costs of life-threatening illnesses are staggering.

15 Private insurance, Medicaid and federally funded programs Prevention of disease before it becomes expensive it is a cost saving strategy that also avoids human suffering.

16 State, local and federal governments In 2001 federal state and local governments covered about 80% of $35 billion spent in providing care for the uninsured. 17% of that care was provided to undocumented immigrants in border emergency rooms. Undocumented immigrants do not come for better health care, however; They contribute $6 to $7 billion in Social Security that they will be unable to claim.

17 Recommendations Increase capacity of community health centers and federally qualified centers with federal grants; Eliminate questions regarding immigration status as a requirement for services; Use funds from the Medicare reform bill to provide primary and preventative care in the community; Develop health promotion programs with emphasis on culturally sensitive health education campaigns for immigrants.

18 Conclusions Denying preventative and primary care to undocumented immigrants have negative consequences on the public health system, the costs of health care, and the quality of life of people living in the U.S. While controlling the influx of immigrants is a priority, it is not sound policy to achieve it by denying health care services. Providing preventative and primary care to the undocumented immigrants already living in the US should prove to be a wise policy with significant impact on the costs of health care while improving access to quality health services.

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