WSJ: Illegal Immigrants Get Public Health Care, Despite Federal Policy; MAKE UP 25% OF UNINSURED

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Illegal Immigrants Get Public Health Care, Despite Federal Policy


Illegal Immigrants Get Public Health Care, Despite Federal Policy
Although Affordable Care Act provides them no insurance, 20 big counties treat them anyway

Dr. César Palacios is executive director of Proyecto Salud, one of the clinics in Montgomery County, Md., that provides health care to immigrants. PHOTO: STEPHEN VOSS FOR THE WALL STREET JOURNAL
By
LOUISE RADNOFSKY
March 24, 2016 4:08 p.m. ET
717 COMMENTS

WHEATON, Md.—When federal lawmakers wrote the act overhauling the nation’s health-care system six years ago, they ruled out any possibility of extending health insurance to illegal immigrants.

Local officials where many of those immigrants live are treating them anyway.

A Wall Street Journal survey of the 25 U.S. counties with the largest unauthorized immigrant populations found that 20 of them have programs that pay for the low-income uninsured to have doctor visits, shots, prescription drugs, lab tests and surgeries at local providers. The services usually are inexpensive or free to participants, who must prove they live in the county but are told their immigration status doesn’t matter.

Whether such programs are appropriate is a matter of debate. Many voters believe it is unfair to use tax dollars to help immigrants when American citizens struggle, and that doing so encourages illegal immigration. At the same time, American hospitals have long been required by law to screen and stabilize any patient, regardless of his or her ability to pay, which means taxpayers already are committed to paying for care in its most expensive setting.

County politicians figure it is cheaper, safer and easier to give basic health services to immigrants who can’t get insurance than to treat them only in the county’s emergency rooms.

“If federal programs exclude people who live here and get sick here, then someone has to care for them,” says George Leventhal, a Democratic council member who a decade ago started a local initiative to provide care to uninsured immigrants here in Montgomery County, Md., a suburb of Washington. “We all pay anyway.”

Local critics contend the county should support immigration enforcement rather than undermine it. Brad Botwin, a local opponent of illegal immigration, objects to the cost of the county health program. “They can’t fix the roads. The metro system is absolutely falling apart. But they have the money to put up these health benefits,” he says.

Republican and Democratic federal lawmakers alike agree with the Affordable Care Act’s prohibition against providing government-subsidized insurance to anyone who cannot prove a legal immigration status. The presidential candidates also are in agreement. The Republican candidates also advocate overturning the entire system created by the health law, along with stepping up immigration enforcement.

Unauthorized immigrants account for at least one-quarter of the approximately 30 million uninsured people in the U.S., the Congressional Budget Office estimates.

Marielena Hincapie, executive director of the National Immigration Law Center, an immigrant rights group, says programs to treat them are an example of people acting locally, despite Washington’s stance. “We may not have gotten federal legislative immigration reform, but I can tell you we are getting immigration reform from the ground up,” she told health-law supporters at a recent conference.

For communities that provide care to illegal immigrants, the financial commitment is significant. Interviews with officials in the 25 counties indicated that local initiatives provide nonemergency care for at least 750,000 unauthorized immigrants across those counties, costing them more than $1 billion a year—almost all from local funds.


Immigrant Health Care

Health care for unauthorized immigrants in the 25 U.S. counties with the largest populations of them

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Search:
Unauthorized immigrant population Health program that serves unauthorized immigrants?

Location/ Unauthorized Immigrant population / health program that serves unauthorized immigrants/ Number of immigrants treated annually (estimate)

Los Angeles County, Calif. 1,062,000 YES 135,000
Harris County, Texas 373,000 YES 65,000
Cook County, Ill.* 323,000 YES 20,000
Orange County, Calif. 274,000 NO N/A
Dallas County, Texas* 242,000 YES 115,000
Queens County, N.Y. 238,000 YES 71,000
San Diego County, Calif. 205,000 NO N/A
Maricopa County, Ariz. 190,000 NO N/A
Kings County, N.Y. 181,000 YES 80,000
Riverside County, Calif. 158,000 YES 7,600
Miami-Dade-Monroe Counties, Fla. 156,000 YES 8,500
Boston Area NECTA, Mass.† 148,000 YES 103,000
Santa Clara County, Calif. 142,000 YES 54,000
San Bernardino County, Calif.* 138,000 YES 1,300
Bronx County, N.Y. 114,000 YES 57,200
Clark County, Nev.† 113,000 YES 1,000
Alameda County, Calif. 109,000 YES 32,500
Tarrant County, Texas 103,000 NO N/A
Hidalgo County, Texas 94,000 YES 5,000
Fresno County, Calif. 86,000 YES 5,000
Broward County, Fla. 83,000 YES 900
Fairfax County, Va. 83,000 NO N/A
Montgomery County, Md. 83,000 YES 25,000
Gwinnett County, Ga.* 80,000 YES 21,600
Travis County, Texas 79,000 YES 36,100
Showing 1 to 25 of 25 entries

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*Number also includes U.S. low-income, uninsured American citizens because county doesn't track immigration status †Boston supports a state-run program; Clark County has a state-overseen nonprofit program

 

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Some of the programs have operated for decades, providing services for immigrants alongside other low-income county residents. Others are brand new and explicitly exist for immigrants. All essentially serve as substitute health plans for illegal immigrants who are prohibited from getting Medicaid or subsidized private insurance under the health law, and whose jobs generally pay too little for them to buy coverage.

Montgomery County paid about $12 million for health care for almost 25,000 immigrants last fiscal year across a dozen clinics. One of them was Proyecto Salud, or Project Health, housed in a government building in Wheaton close to a metro station, fast-food franchises and an apartment complex.

The health centers put together treatment plans for diabetes, orthopedic injuries and anxiety disorders, among other things. Their budgets rely on donated help from area specialists, hospitals and drug companies, along with modest patient contributions. Past government evaluations of the centers credited them with a 41% reduction of behavioral-health emergency-room visits and a 67% reduction in trips related to chronic conditions—a big incentive for local hospitals to contribute, officials say.

“We are saving money to the system by doing this,” says César Palacios, head of Proyecto Salud. “If we don’t pay now when it is easy money, we are going to pay later on.”

The county’s program, “Montgomery Cares,” has served mostly immigrants without legal status since the biggest provisions of the health law kicked in two years ago. There were 110,000 uninsured people in the county at that time. At least 50,000 were set to remain uninsured because of the health law’s restrictions on unauthorized immigrants getting Medicaid or subsidized private coverage.

In New York City, the public-hospital system estimates it provided nonemergency care last year to 208,000 unauthorized immigrants across Brooklyn, Queens and the Bronx, the boroughs with the largest populations of such immigrants. The cost was about $400 million, picked up by the system—essentially, local taxpayers and everyone who has insurance and uses the hospital system.

In Los Angeles, 135,000 low-income county residents without legal U.S. residency status are assigned primary-care providers in a “medical home” designed to coordinate their care. They get an ID card, use of a member-services hotline and a booklet akin to an insurance brochure that explains how to gain access to screenings, a clinic network for specialty care and prescription drugs.

In the past year, the number of California counties with programs akin to the Los Angeles one has jumped from nine to 48, in part because of the entry of a consortium of rural counties.

The debate is playing out county by county across other big states, including Texas. For decades, state officials there have wrangled over whether counties should treat uninsured illegal immigrants, without reaching a firm decision. As a result, local leaders have gone their own way.

Health-care professionals, working with translators, examine patients at Proyecto Salud in Montgomery County, Md. PHOTOS: STEPHEN VOSS FOR THE WALL STREET JOURNAL;


Houston and Dallas together cover tens of thousands of illegal immigrants in charity-care programs—65,000 in Houston, and some portion of an 115,000-person program in Dallas, where the county doesn’t track immigration status.

“Consider the implications of half the people on the [local] rail lines and buses carrying them to work being denied flu shots,” says Clay Jenkins, the chief elected official for Dallas County. “There are 2.5 million people that live here, and they’re all important and they’re all deserving of respect and medical care,” says Mr. Jenkins, a Democrat.

By contrast, in Tarrant County, which includes Fort Worth, the system that provides safety-net care is limited to residents who can prove legal immigration status.

Those restrictions have been in place for about a decade. “At that time, there was a tremendous discussion that occurred,” says G.K. Maenius, the county administrator. “Our hospital district was struggling to have the finances to take care of legal residents of Tarrant County.”

As a result, he says, the hospital district opted to treat people without legal status as if they lived in any other county. The emergency room treats everyone. For noncounty residents to obtain nonemergency treatment, they have to pay for it—at prices that likely are prohibitive for most.

In Fresno County, Calif., a debate over accepting $5.5 million the state said could only be used to provide specialty care for around 5,000 unauthorized immigrants split the board of supervisors 3-2. The county ended up taking the money.

Andreas Borgeas was one of the supervisors to vote “no.” He says his opposition is chiefly fiscal. “We have distorted the discussion and created an ongoing entitlement that’s going to be difficult to sustain,” he says. “If California wants to have this coverage, it should be by Sacramento.”

California, like many states, doesn’t have an ironclad prohibition on providing health care to people here without authorization. States have flexibility over Medicaid eligibility, and 16 of them allow the program to cover populations of illegal immigrants, such as children and pregnant women.

California and New York have some of the broadest inclusion criteria. Oklahoma has a pregnant-women’s program aimed at ensuring prenatal care for babies who will become U.S. citizens, named “Soon to be Sooners.”

States would struggle to find the money to insure all immigrants, even if they wanted to.

California will have around 1.5 million adult immigrant residents without insurance in 2019. To offer Medicaid to those who meet the program’s low-income criteria, the state likely would have to find at least $400 million more a year, according to an estimate by the University of California, Berkeley’s Center for Labor Research and Education that is based on the assumption that not everyone would enroll. If everyone did, the price would likely grow to at least $720 million.

Democratic presidential candidates Bernie Sanders and Hillary Clinton have said they want to see universal health coverage in the U.S., but that they favor the status quo on the health law’s immigration restrictions. They have said they would be willing for illegal immigrants to use HealthCare.gov as a tool to shop for coverage, but wouldn’t want the federal government to help pay for premiums or allow them to enroll in Medicaid.

The Republican front-runner has made tighter immigration restrictions a core part of his health plan.

“If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve health-care cost pressures on state and local governments,” Donald Trump said in his health-policy platform.

Obama administration officials, including Health and Human Services Secretary Sylvia Mathews Burwell, acknowledge that immigration status is a key factor in the size of the U.S. uninsured population, and that reducing that number to zero would require changes in immigration policy.

But even those changes likely wouldn’t resolve the health-coverage issue.

The Obama administration has said that children granted immigration-enforcement reprieves under a 2012 executive action still will be subject to the health law’s restrictions. After an executive action that would extend that reprieve to around four million adults, the Obama administration said it would continue to subject them to the restrictions, too.

That action is now before the Supreme Court, with arguments in mid-April.

Write to Louise Radnofsky at louise.radnofsky@wsj.com

 

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vote Trump

 

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[Groanman]

George Bush don't care abut straight Black people

 

[TRUEST]

if u guys believe these immigrants aren't "paying their fair share", yall some uneducated morons.

not all illegals get paid under the table. many use legitimate social security numbers that dont belong to them. and yes, the tax man collects his share of whatever earnings they make under the assumed number. the problem is, since these numbers dont belong to the illegals, they can't file taxes and get back a refund. so where does all that refund go??? it stays with the government.

so as of a few years ago, there's several hundred billions of dollars of unclaimed funds that the IRS can't give out because they dont know who it belongs to. i mean, they know, but the person has to come forward and claim it. and if u cant prove that number belongs to you, you'll either get arrested or deported or both. and these illegals dont want any part of that.

to think these people are just draining the US economy is just pure foolishness.

there's billions of unclaimed funds sitting with the government, and yes, they're collecting interest on it.
so before u go hating on people for no real reason, calm yourself down and think.

 

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if u guys believe these immigrants aren't "paying their fair share", yall some uneducated morons.
.

They aren't. All studies show this.

not all illegals get paid under the table. many use legitimate social security numbers that dont belong to them. and yes, the tax man collects his share of whatever earnings they make under the assumed number. the problem is, since these numbers dont belong to the illegals, they can't file taxes and get back a refund. so where does all that refund go??? it stays with the government.

Bruh. Thats Fraud. Straight up and down. Thats jobs and money that could be going to other low-wage, unskilled demographics i.e. BLACK PEOPLE.

so as of a few years ago, there's several hundred billions of dollars of unclaimed funds that the IRS can't give out because they dont know who it belongs to. i mean, they know, but the person has to come forward and claim it. and if u cant prove that number belongs to you, you'll either get arrested or deported or both. and these illegals dont want any part of that.

Thats money that belongs to by-and-large, black people.

to think these people are just draining the US economy is just pure foolishness.

Bruh, healthcare is expensive as fukk. Someone has to pay for it. You can't treat millions of people who don't even "exist" and expect those costs to just disappear.

there's billions of unclaimed funds sitting with the government, and yes, they're collecting interest on it.
so before u go hating on people for no real reason, calm yourself down and think

Its money that belongs to people who don't commit fraud.

 

[TRUEST]

They aren't. All studies show this.

Bruh. Thats Fraud. Straight up and down. Thats jobs and money that could be going to other low-wage, unskilled demographics i.e. BLACK PEOPLE.

Thats money that belongs to by-and-large, black people.

Bruh, healthcare is expensive as fukk. Someone has to pay for it. You can't treat millions of people who don't even "exist" and expect those costs to just disappear.

Its money that belongs to people who don't commit fraud.

yes it is fraud. but the way the media portrays this is, immigrants are rapists, killers, they siphon benefits from the country and on and on. but, there are citizens who commit all these same things, on a much larger scale. why are u focusing on the ones commited by the immigrants as if they are much worse than what citizens commit.

anyway, i'm not going to be going on about this in this thread. but, the one thing i'll say is, no, immigrants are in fact paying their fair share. they're just not legal and they have no way to get credit for the work they've done.

and by the way, being illegal is not a choice to these people. every illegal immigrant would love to be legal instantly. but the process to become legal is extremely long, expensive and painful. again, the media makes u believe "ohh whats wrong with these people. why cant they do it the legal way? why can't they get in line?" this type of thought process clearly shows a troubling lack of knowledge.

 

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Nikkas won't care until blacks are living in the middle of nowhere with no resources win l while the cacs and mexicacs take over our neighborhoods

 

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yes it is fraud. but the way the media portrays this is, immigrants are rapists, killers, they siphon benefits from the country and on and on. but, there are citizens who commit all these same things, on a much larger scale. why are u focusing on the ones commited by the immigrants as if they are much worse than what citizens commit..

I'm not even focused on illegal immigrant crime. Crime is crime

But they shouldn't be here, on top of breaking this country's laws.

anyway, i'm not going to be going on about this in this thread. but, the one thing i'll say is, no, immigrants are in fact paying their fair share. they're just not legal and they have no way to get credit for the work they've done.

Bruh. If you collect wages on a job you earned through fraud, thats not your money. And they don't pay sales tax. And its damn near impossible to document the taxes they pay otherwise if its not from a point of sale.

and by the way, being illegal is not a choice to these people. every illegal immigrant would love to be legal instantly. but the process to become legal is extremely long, expensive and painful. again, the media makes u believe "ohh whats wrong with these people. why cant they do it the legal way? why can't they get in line?" this type of thought process clearly shows a troubling lack of knowledge

My parents came here LEGALLY and I have my own proposals to the immigration process.

But coming illegal doesn't change that.

 

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Nikkas won't care until blacks are living in the middle of nowhere with no resources win l while the cacs and mexicacs take over our neighborhoods

"Intersectionality"

 

[TRUEST]

I'm not even focused on illegal immigrant crime. Crime is crime

But they shouldn't be here, on top of breaking this country's laws.


Bruh. If you collect wages on a job you earned through fraud, thats not your money. And they don't pay sales tax. And its damn near impossible to document the taxes they pay otherwise if its not from a point of sale.



My parents came here LEGALLY and I have my own proposals to the immigration process.

But coming illegal doesn't change that.

your parents came to this country legally at a time when the country wasn't at war with the world. they came at a time of peace. now, with all the terrorist bombings, its damn near impossible to "legally" come in here. and if u do get here illegally, its damn near impossible to become legal.

ur parents may have came here legally back then, but to assume the process they went through is the same or anywhere near what it is now, is just plain silly.

lets not forget back in the 80s. reagan legalized millions of illegals. so i wouldn't be surprised if ur parents who came here "legally" got their citizenship papers or green card under the bill reagan signed into law. now, how fair is that to those who are illegal in today's world?

trust, i've read ur arguments and they really hold no weight.

 

[iFightSeagullsForBread]

nikka I'm broke, you think I give a fukk about insurance fraud?

 

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your parents came to this country legally at a time when the country wasn't at war with the world. they came at a time of peace. now, with all the terrorist bombings, its damn near impossible to "legally" come in here. and if u do get here illegally, its damn near impossible to become legal.

ur parents may have came here legally back then, but to assume the process they went through is the same or anywhere near what it is now, is just plain silly.

lets not forget back in the 80s. reagan legalized millions of illegals. so i wouldn't be surprised if ur parents who came here "legally" got their citizenship papers or green card under the bill reagan signed into law. now, how fair is that to those who are illegal in today's world?

trust, i've read ur arguments and they really hold no weight.

Nah. Don't even try that fukk shyt. My parents were RECRUITED here. I know the law, I know the history, and I know the obstacles.

You want emotional arguments to evade form the accountability of the law