Health Forward Foundation

How Will Health Reform Impact Care for the Undocumented?

Undocumented immigrants in the Kansas City area who experience serious health problems already face a daunting task in obtaining care and federal health-care reform could make things harder for them.

That is the opinion of Erica Andrade, who holds the title “health navigator” at El Centro, a social-service center for Latinos in Kansas City, Kan. In 2010, Andrade managed to work out billing and payment issues with just one local hospital – Providence Medical Center — and get 17 uninsured clients the surgeries they needed, ranging from a biopsy to a hernia repair.

Andrade did not manage to get one other patient into surgery before her infected gall bladder burst, requiring that woman’s fifth visit to an emergency room, followed by a 10-day hospitalization.

Kansas City-area safety-net clinics are overwhelmed these days, Andrade said, with three- to four-month waiting lists for new clients. If and when undocumented patients clear that initial barrier, they face other obstacles to getting the care they need.

Undocumented persons are, by definition, uninsured, Andrade said. And as such, it is “virtually impossible” for them to get surgery or other expensive care locally.

“Surgeons want 100 percent payment up front from uninsured people,” Andrade said. “Hospitals want 25 percent of the estimated bill before they will schedule a surgery. So it’s virtually impossible for these folks.”

Dr. Sharon Lee, who runs Family Health Care, a safety-net clinic in Kansas City, Kan., spoke last year at an ethics forum about the frustration that arises when trying to treat undocumented patients who need specialist care, expensive medicines, etc.

“As a physician, I do not want to be in the position of making clinical judgments based upon a patient’s immigration status,” she said at the time.

And that was without any legal crackdown on undocumented immigrants, such as the “Kansas Illegal Immigration Relief Act” that was proposed during the 2008 legislative session.

“Two or three years ago there was an effort by state legislators to criminalize providing services to those without proper documentation,” Lee noted. “The bills included provisions that would have prevented agencies that knowingly or unknowingly provided services to undocumented persons from accessing any state funds. It didn’t pass, thank goodness.”

The Affordable Care Act did pass Congress, though, in 2010, and it specifically prohibits undocumented immigrants from buying health insurance through the plan’s exchanges or from getting tax credits to buy insurance.

“Undocumented immigrants will receive absolutely no assistance from the government,” says the White House’s health-care reform “Myths and Facts” web page.

So what does that mean for Kansas City area hospitals and safety-net clinics, which already absorb the costs of treating many undocumented patients each year?

According to Liz Cessor, vice president for mission and community services at Saint Luke’s Health System, treating illegal immigrants “is part of our mission to treat anyone who enters our doors.”

Not only must St. Luke’s (like other hospitals) stabilize anyone who enters their Emergency Room in grave condition, it has an affiliation with the Cabot Westside Health Center, which, Cessor said, “serves a largely immigrant and Hispanic population.”

“Using a medical-home strategy, patients are able to receive care to keep them healthy and prevent unnecessary hospitalizations,” Cessor said. “Many immigrants come to the U.S. with diseases such as TB, HIV and STDs. Access to a health facility without barriers ensures these health issues are addressed and do not become a community problem. At Cabot, we also care for patients with chronic diseases like diabetes and hypertension, which helps to reduce unnecessary and costly emergency care.”

Those who get ER treatment but can’t pay for it fall under St. Luke’s’ charity-care policy, Cessor said, while the Cabot health center operates on a sliding-scale fee system.

Cathy Harding, executive director of the Kansas Association for the Medically Underserved, predicted health-care reform would not have “a significant impact” on her safety-net clinic members at least with respect to treating undocumented workers.

“Their missions will remain the same: to provide health care services for those in need, regardless of insurance status or ability to pay,” Harding said.

But Andrade of El Centro said she wondered what will happen to her undocumented, uninsured clients if and when the Affordable Care Act is fully implemented.

“Once the ACA takes place, it will increase the number of Medicaid users, and that will mean fewer spots for the uninsured,” she said.

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