Exploration of Healthcare and Immigrants - Case Study Example

Immigrants and Healthcare 2007 Outline: A) Introduction: topicality of the issue B) General Discussion: i. Myths and facts about immigrants in the U.S. health care system ii. Language barriers to health care C) Conclusion Foreword: This paper is dedicated to the issue of immigrants in the U.S health care system. The topic is of special importance today, when reforms are started in the immigration and health care systems. Immigrants make a weighty contribution to the economic, social and cultural life of the United States. Yet their eligibility to the U.S. health care system and various public benefits is largely restricted, by federal laws, low level of awareness, and language barriers. Failure of the health care system, caused by a number of reasons, was arrogated to the immigrants. However, facts and figures show that, compared to the native-born, expenditures for immigrants’ health services are much less, and their contribution to Medicaid is much larger. Moreover, Immigration Reform could improve the situation with the shortage of the medical personnel. Thesis: It is necessary to reform the health care system itself and to discredit the conventional false myths about immigrants’ impact on its failure. Immigrants are an integral part of the American life, society and economy. Currently, our country is experiencing another increase of immigration. In 2005, the foreign born population made nearly 36 million, where 35% were naturalized citizens, 33% were documented immigrants and 31% were undocumented immigrants. Children consisted 16% of the undocumented immigrants, and nearly two-thirds of them are U.S. citizens by birth. Expectations are that by 2050 about 80 of 120 million of the U.S. population will be the direct or indirect effect of immigration (King 2007, p.4). Though, contributing largely to the prospering of the country, these people experience many hardships in obtaining vital services. Access to health care system became one of the greatest problems they face. Looking back, we may suggest that the trouble started, for the reason that health care system of the US revealed its weak sides. Propaganda played its role. It was easier to misinform the public than to reform the whole health care system. Documented and undocumented immigrants were blamed for the trouble. Misinformation gave birth to numerous myths. These myths led to the restrictions in legislation concerning immigrants’ access to the health care service. In 1996 the Personal Responsibility and Work Opportunity Reconciliation Act was past, establishing that recent legal immigrants to the country were to wait five years for the eligibility for Medicaid and other public benefits programs. The same eligibility restrictions were included into the State Children’s Health Insurance Program, put in force in 1997. Further, another law was enacted as part of the Deficit Reduction Act of 2005, requiring that US citizens must provide their documents when applying for Medicaid benefits (King 2007, p.3-4). Debates around health care and immigrants issues continued for years. The promise to reexamine the problems was part of President Bush’s election campaign. Several years ago he started preparation of the Immigration Reform, which made the issues hot topics again. Presidents Bush’s proposition was to allow all the illegal, or undocumented, immigrants to work legally, providing them with temporary visas, after people pay fines and prepare all the necessary documents. The reform is really very controversial. However, it is more important for us that it collided with the need for reforms in the U.S. health care system. Opponents of the reform claim that it will increase the burden lying on shoulders of the honest taxpayers and decrease the access to the health care system for the native-born citizens even more. This panic, however, turned out to be artificial. Studies and surveys, done since 1998, showed that immigrants had little to do with the failure of the health care system. The reasons for skyrocketing health care costs are numerous and immigrants are only a scapegoat. Who is to be blamed for the increased costs are insurance companies and pharmaceutical manufacturers, physicians, hospitals and consumers themselves. For instance, consumer-targeted advertising of drugs made by the pharmaceutical manufacturers has become a real problem. Physicians often can’t prescribe generics instead of expensive brand name drugs, while patients want to have those drugs they have heard of from the advertisements (Wipf, 2003). There is another problem, colliding with the issue of Immigration Reform, which makes the reform beneficial for the country. It is lack of trained medical personnel, nurses and physicians, in some specialties. This shortage is found in both rural and urban areas. The generation of baby-boom is getting older, enlarging the rows of those in low-income, elderly and physically disabled categories. A huge number of people are registered as having chronic diseases. According to the American Immigration Law Foundation, US health care system lacks approximately 16,000 doctors, 8,500 dentists and 4,000 mental health professionals; national hospitals need more than 126,000 additional nurses, and 90% of long-term care organizations seriously lack nursing staff. This shortage could be covered due to foreign professionals (AILF, 2006). Notwithstanding obvious benefits of the proposition, the public is still more preoccupied by the fears as to the ominous consequences of the reform. There are five major myths concerning immigrants in the health care system, says Meredith King (2007) in a special report prepared for the Center for American Progress. These myths are: Documented and undocumented immigrants become a heavy burden on the U.S. public health insurance programs, causing the rise of costs Immigrants consume huge quantities of health care resources, which are limited Immigrants come to the United States to get access to health care services Restriction of immigrants’ access to the health care system is beneficial Undocumented immigrants are ‘free-riders’ in the US health care system (p.3). However, facts show that things are quite different. Undocumented and non-permanent documented immigrants are eligible only for a limited coverage for emergency services and for services protecting public health (e.g. immunization). Yet many undocumented immigrants do not turn even for this limited care while feel fear and confusion about the eligibility rules or have language barrier. Permanent documented immigrants, though being eligible for public coverage after five-year period of waiting, are still subject to numerous stipulations and restrictions. Like undocumented immigrants, they do not always seek public care, for the same reasons. Nearly 44% of documented immigrants were uninsured in 2005, which is more than three times the rate among the native-born Americans. The five-year limit also covered children and pregnant women (King 2007, p.5). It has been calculated that the majority of people, who lack insurance are U.S. citizens, while illegal immigrants make only a tiny fraction of the uninsured population. There are 46 million people, who lack health insurance in the USA and only 26% of them are immigrants. A number of factors, mostly rising health care costs and decline in job-based insurance, contribute to the condition. Millions of people are self-employed or are not offered insurance at their work place. Those, who do have job-based insurance, often find it difficult to pay for constantly escalating premiums. As a result, three out of four uninsured individuals in California are U.S. citizens from working families with low-income (CIPC 2006, p.2-3). The system itself is known for numerous cases of abuse, mismanagement, waste and inefficiency. Prevention and proper care still remain a golden dream. As a result, the state has to spend more cost on serious cases, instead of preventing them, and hospitals often have to pay back for their mistakes. As a consequence of permanent malpractice lawsuits and compensations for hundred of millions of dollars, liability insurance costs for medical professionals and facilities have grown enormously, and the greater part of medical bill goes directly to liability insurance. The number of uninsured people continues to grow, and immigrants make only one forth of them. Uninsured people, be they immigrants or low-income citizens, receive inappropriate health care service. For instance, they have to wait for months for surgery and the like (Wipf 2003). Surveys have demonstrated that only one-half of male and one-third of female documented immigrants turn for health service, notwithstanding the fact that many of them have occupational or serious chronic diseases (King 2007, p7). Per capita expenditures are at least 55% lower for immigrants than for the native-born, receiving about $1,139 per capita in health care in comparison with 2,546 for native-born residents. It also concerns immigrant children. Figures speak for themselves: medical expenditures for immigrant children are 74% lower per capita than those for native-born children (Mohanty 2006). Contrary to the common opinion, immigrants rarely use emergency room service. Lack of insurance makes immigrants refrain from seeking care until they feel very bad. This point is illustrated by the statistics. The emergency room expenditures for the immigrant children are three times higher, while they visit it less often than U.S.-born children. Thus, they get to the emergency in a worse state (King 2007, p.7) Understanding the significance of providing health care to the immigrant population, 21 states (California, Texas and New York among them) and the District of Columbia offer basic health services to documented children and pregnant women, falling within the five-year limit, at state cost. Various local and state health care programs function in order to provide services for the immigrants. These programs have proved to be effective. Yet, the programs depend on limited grants, not all the immigrants are aware of the programs, many do not trust, or are confused by the rules and language barriers, so that these activities are not enough for covering needs of a growing immigrant population (King 2007, p.5, 7). Immigrants come to states, where jobs are available, and not to those providing general health care for the residents. They are occupied in such spheres as agriculture, construction, hospitality industry and food processing, which do not offer health insurance coverage. Wages are not high, so that it is impossible to pay insurance premiums. Meanwhile, the mentioned industries are known for a high level of occupational injuries. According to a 2003-2004 national health survey, one-fifth of the day laborers had suffered a work-related injury, while less than half got medical care for the injuries (King 2007, p.8). Many believe that restricting immigrants from the health care system should have positive effects. Yet, life shows that such a policy causes only troubles. First of all, leaving immigrants without support, we risk our own health. People arriving to the United States are usually healthier than the native population. However, in several years they start having health problems and often suffer from obesity. Changes in health and food behaviors, hard labor, and absence of insurance, lack of coverage for preventive health service lead to deterioration of immigrants’ health. As a result, people turn for care, when their health is poor and health services that are needed are costly. Areas with high uninsured rates have more instances of communicable and vaccine-preventable diseases, as well as disabilities. Immunizations are aimed at preventing such diseases as flu, measles and pneumonia. But uninsured immigrants are often not covered, while healing costs more than prevention. Thus, providing preventive service, concludes King (p.9), the country will reduce health care costs in the long run. Documented and undocumented immigrants can receive uncompensated health care, which is reimbursed by the federal government. Local and state governments and charitable organizations often have lower tax base addressing the health needs of uninsured immigrants. Cost-shift for the whole uninsured population, most of whom are native-born, lies on shoulders of individuals with insurance, both U.S. citizens and immigrants (King 2007, p.9). “Policies that restrict access to health coverage based on immigration status endanger individual and public health, increase health care costs, and inevitable harm U.S. citizens,” – write the authors of the report or the California Immigrant Policy Center (2006, p.3). “Policies that restrict immigrants access to some health care services lead to the inefficient and costly use of other services (such as emergency room care) and negatively impact public health. The future economic success of the United States depends on a healthy workforce. Therefore, policies must be devised that improve, rather than restrict, immigrants access to quality health care,” – concludes Sarita Mohanty (2006). Such policies are evidently shortsighted. Children of immigrants will be lifelong residents of the USA and part of the nation’s workforce. The future of the country depends on them. They will become doctors and teachers, serve in the military or perform hard labor. It is in the interest of the U.S. that these children became successful grownups, which is impossible under the conditions, when they do not have proper access to health care and nutrition. Immigrants make a significant contribution to the economical, social and cultural life of the country. Moreover, like citizens, immigrants are obligated to pay taxes that fund public services. Thus it is not logical to deprive them of the access to the services they pay for (National Immigration Law Center 2006). Several examples from King’s report (2007, p.10) vividly illustrate the situation. In 2005 about 7 percent of state population in Texas was undocumented immigrants. The state spent only $58 million on health care for undocumented immigrants, while state revenues collected from undocumented immigrants that year exceeded all the social services (health care and education) by $424,7 million. It has been calculated that ‘immigrants will pay on average $80,000 per capita more in taxes than they will use in government services over their lifetimes’ and estimated that undocumented immigrants ‘contribute $7 billion in Social Security tax revenues and roughly $1,5 billion in Medicare taxes annually’, yet rarely being qualified for Medicare or long-term services provided by the U.S. health care system (King 2007, p.10). As we can see, the major myths existing around immigrants in the U.S. health system are not simply false, but strongly distort the reality, actually turning it upside down. We have said much about low rate of access of the immigrants to the health care services, caused by the legislation. At the end we would like to dwell on the issue of language barriers, which is another hot problem for the diverse immigrant population. The fact is that there are very few representatives of the minorities in the medical profession, doctors and nurses do not know all the languages immigrants speak. Thus very often immigrants seeking care have to interpret themselves. As a result, physicians often put wrong diagnoses, which sometimes may even have tragic consequences. In 1998, the Office for the Civil Rights of the Department of Health and Human Services issued a memorandum stating that the delay or denial of medical care because of language barriers is discrimination and that recipients of the Medicaid with limited English proficiency must be provided with adequate language assistance. Third-party reimbursement for interpreter service is currently provided in thirteen states. However, most of the states with the greatest number of working immigrants do not follow the suit in order to economize. This way, immigrants’ access to health care becomes more problematic, their lives often get in hazard, while hospitals and physician risk losing patients, reputation and money. Thing could be easily changed. It is estimated, that it would cost only 44,04 more per physician visit to provide all U.S. patients with limited English proficiency with appropriate language services, states Glenn Flores (2006, p.231). Conclusion: Immigrants make a weighty contribution to the economic, social and cultural life of the United States. Yet their eligibility to the U.S. health care system and various public benefits is largely restricted, by federal laws, low level of awareness, and language barriers. Failure of the health care system, caused by a number of reasons, was arrogated to the immigrants. However, facts and figures show that, compared to the native-born, expenditures for immigrants’ health services are much less, and their contribution to Medicaid is much larger. Moreover, Immigration Reform could improve the situation with the shortage of the medical personnel. Thus, it is necessary to reform the health care system itself and to discredit the conventional false myths about immigrants’ impact on its failure. References: American Immigration Law Foundation (2006). Caring for America: Healthcare Workers and Immigration. Last updated: March 30, 2006. Accessed July 6, 2007 at: www.ailf.org/pubed/healthcare.shtml - 16k California Immigrant Policy Center (2006). Immigrants and the U.S. Health Care System. September. Accessed July 4, 2007 at: http://www.nilc.org/immspbs/health/Issue_Briefs/imms&ushealthcare_2007-01.pdf Flores, Glenn (2006). Language Barriers to Health Care in the United States. The New England Journal of medicine, Volume 355, No. 3 (July 20), pp.229-231. King, Meredith (2007). Immigrants in the U.S. Health care System: Five Myths that Misinform the American Public. Center for American Progress, June 7. Accessed July 5, 2007 at: http://www.americanprogress.org/issues/2007/06/pdf/immigrant_health_report.pdf National Immigration Law Center (2006). Facts About Immigrants’ Low Use of Health Services and Public Benefits. Immigrants’ Rights Update, Vol.20, Issue 5 (September 29). Mohanty, Sarita A. (2006). Unequal Access: Immigrants and U.S. Health Care. Immigration Policy in Focus, Volume 5, Issue 5 (July). Last updated: July 5, 2006. Accessed July 5, 2007 at the American Immigration Law Foundation site, URL: http://www.ailf.org/ipc/infocus/unequal_access.pdf Wipf, Jennifer and Peter (2003). Impact of Immigration on the Healthcare Costs. About.com.>Immigration Issues. Accessed July 3, 2007 at: immigration.about.com/cs/economicslabor/i/ImmHealthCCosts.htm - 25k Read More