Wednesday, June 15, 2005

Underreported Study of the Uninsured

This study garnered two 3-sentence paragraphs in the Business section of my local paper. It is a study by the Employee Benefit Research Institute entitled "The Impact of Immigration on Health Insurance Coverage in the United States," briefly reviewed at Medical News Today. Their "take home points" from the study based on census data from between 1994 and 2003 include:

  1. Immigrants accounted for 26% - or 11,600,000 people - of the USA's uninsured in 2003, a 70% increase from 1994.
  2. Noncitizens were more than twice as likely to be uninsured as naturalized citizens;
  3. Immigrants who arrived in the United States after 2000 were twice as likely to be uninsured as those who arrived before 1970.
  4. 60% of uninsured immigrants lived in four states -- California (27%), Texas (15%), New York (10%) and Florida (9%) (Lipman, Atlanta Journal-Constitution, 6/14).
  5. Immigrants represented 86% of the growth in the number of uninsured between 1998 and 2003.
While Medical News today correctly states that the study did not distinguish between "undocumented" and "documented" immigrants, the graph on page 3 of the study clearly illustrates that 9.4 million, or 21% of the total, uninsured individuals are characterized as "Foreign born, not a citizen." In other parlance, these are illegal aliens; I suspect that number is a significant underestimate. While these folks are uninsured, they are not denied care when they arrive at your friendly local ED. The study basically blames Congress for this rise in "uninsured immigrant" population, as in 1996 it passed the Personal Responsibility and Work Opportunity Act, which restricted benefits under public assistance programs for five years after they enter the US.

A lot of much smarter people than me can debate circles around me fast enough to make my head spin as if Angelina Jolie gave me one of those delicious, "I'm a homewrecker" sneer-smiles. But if we are going to talk about these complex issues, I would ask that some simple, understandable terminology to be used:

  • An illegal alien is an illegal alien. As in "illegal." As in "not entitled to taxpayers' money." "Undocumented" is an intentionally misleading description.
  • A legal immigrant is "legal," having gone to the trouble of actually becoming a citizen of this country, with all the good and bad that entails.
  • "Uninsured" is not synonymous with "unable to get emergency medical care." Each and every medical blogger can explain that when people show up at our door, we take care of them. Period. It is charity care, but people should not be so naive as to believe that the costs of delivering that care are not passed on to the insured population.
Stating that we have a problem with illegal immigration is not racist, xenophobic, greedy, or any of a number of other nasty things. It is simply stating a fact. How we deal with that fact, and its economic ramifications on the healthcare system (and the educational system, taxes, etc.) is what needs to be debated ....... and in order to have that debate, we need studies such as the one above to be clear in their definitions. It does none of us, or our policy leaders, any good to work with numbers that are skewed because of political considerations. For example, 70% of the uninsured in this study are described as native Americans. How many are working? How many are children under 18? Children under 10? Single parent households? Between jobs? Elderly? Have been uninsured their entire adult lives? Have lost employment due to illness? Make enough money to purchase insurance, but choose not to? Have a job that offers insurance, but do not purchase coverage for their children (something I see not infrequently)?

Health care in this country is severely affected by illegal immigration, but it is a minor part of the entire problem. We need to get out of the politically correct arena and have a real debate, with real data, in order to decide what is best for the country.