Los Angeles Jose Cedillo, an illegal immigrant from Mexico, says he has
nowhere to turn.
A day laborer since 1986, Mr. Cedillo has received notice from a Los Angeles
County hospital that he must start paying out of pocket for the treatment he
will need. "I have no choice because I have no insurance and can't work while
I'm taking these treatments," he says, sitting in the tiny apartment he shares
with his wife, a janitor.
The recession and a big state deficit is leading some California counties
to cut back on nonemergency health services to illegal immigrants. In others,
cutbacks in services for the uninsured are hitting illegal immigrants especially
hard.
The problem is socking California because it is home to the lion's share of US
immigrants, both legal and illegal. The latter are often eligible for healthcare
provided to the poor. But health departments across the country are facing
budget pressures that are leading to slashed services and that could reignite
the debate over providing medical care to illegal immigrants.
"There simply isn't enough revenue to support the network of services which
heretofore has been expected," says Robert Pestronk, executive director of
National Association of County and City Health Officials (NACCHO).
In many states, budget cuts mean reduced funding for the uninsured, many of whom
are immigrants and low-income families. In Arizona, a $13 million cut from the
state budget eliminated funds partly used to reimburse hospitals for caring for
the uninsured.
About 64 percent of illegal immigrants nationwide 7.2 million are
uninsured, according to the Washington-based, Center for Immigration Studies
(CIS).
"The states and local governments tend to bear the brunt of illegal
immigration," says Steve Camarota, statistician and demographer for CIS. Now,
with revenues falling well short of predictions, services to undocumented
immigrants are getting the ax in an effort to preserve other programs, from
infrastructure to schools to the environment.
The cutbacks could potentially refire the debate over providing social services
such as healthcare for illegal immigrants. In 2007, several state legislatures
introduced bills that sought to limit social service benefits including
healthcare to illegal immigrants. An LA Times/Bloomberg survey in December 2007
found that one in three Americans wanted to deny social services, including
public schooling and emergency-room healthcare, to illegal immigrants.
In California, two counties are pulling back on health services for illegal
immigrants.
Sacramento County closed two health clinics that serve the poor and ended
services with various mental health contractors in early February, saving nearly
$6 million in an effort to close a $55 million general fund shortfall.
In Contra Costa County, a proposed plan would screen out illegal immigrants
except for children and pregnant women from nonemergency healthcare services
that are provided to low-income residents who cannot get insurance. The county
is looking at cutting services to an estimated 5,500 illegal immigrants they
serve annually, to tally a savings of $6 million.
"The pressure is purely economic," says Dorothy Sansoe, senior deputy county
administrator for Contra Costa County. Her county has already cut $90 million
from its general purpose budget and has to cut another $56 million by July 1.
"Here, many hospitals are cutting services and staff just to survive," says
Randy Ertll, who has served on the board of several Los Angeles County hospitals
and is now Executive Director of the El Centro de Accion Social, or Center for
Social Action, a nonprofit agency that promotes cultural understanding in
Pasadena.
The issue is not just one of documented vs. undocumented immigrants, he says,
but one of affordability in an economy where more and more people are losing
their jobs and often their insurance, too.
"Even many US citizens can't afford health insurance in the current recession,"
Mr. Ertll says.
But such cuts are shortsighted, immigrant support groups say, because neglecting
primary healthcare only means that hospitals will have to spend more on
emergency or acute-care treatment in the future. "[I]f you send someone home who
is ill, that person is only going to get worse or infect others in which case
you have a larger, more expensive situation on your hands," says Angelica Salas,
executive director of the Coalition for Human Rights of Los Angeles (CHIRLA).
The dilemma highlights the costs of illegal immigration to society, immigration
reform groups counter.
"We would like to give great healthcare to everyone but we just can't," says Ira
Mehlman, spokesman for the Federation for American Immigration Reform. "Cheap
labor is only cheap to the employer, while everyone else has to pay the social
costs such as education and healthcare and they can be enormous."
"Most societies say their first obligation is to serve citizens and those in the
country legally."
At the state and local level, illegal immigrants cost more in public services
than they pay in taxes, according to a 2007 Congressional Budget Office paper.
But the CBO also found that spending for illegal immigrants accounted for less
than 5 percent of total state and local spending for those services. In
California, spending was higher but less than 10 percent of total spending for
those services.
Back in his small apartment, Cedillo says he believes that healthcare is a
"basic human right." He says he is "confused and afraid." Fortunately, his three
adult children are independent. But his wife's janitor salary barely covers the
couple's monthly rent and food expenses.
So much is spent on healthcare in America the most per capita in the world
there should be enough to go around, says Mr. Pestronk of the National
Association of County and City Health Officials.
"This crisis points up the need to have political will and courage to use what
we know to create the conditions in which we can all be healthy," he says.
