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HOME > ABOUT > PRESS > YOLO SHOULD CARE FOR UNDOCUMENTED
Article published - May 3, 2009
Credit: THE DAVIS ENTERPRISE
YOLO SHOULD CARE FOR UNDOCUMENTED
by Lisa M. Baumeister, M.D., M.P.H.
On Tuesday, the Yolo County Board of Supervisors will conduct a public hearing regarding its proposal to severely cut funding for the Yolo County Healthcare for Indigents Program. The YCHIP program serves as a medical safety net for poor, uninsured county residents. The board is proposing to cut the already-strained YCHIP program budget by 36 percent.
The board hopes to achieve this reduction by a variety of coverage changes, but the bulk of the proposed reduction would be achieved by eliminating eligibility for undocumented residents. Unlike some California counties, Yolo County has historically elected to provide safety net health services to undocumented immigrants.
As a Woodland-based family physician serving many YCHIP patients, I believe it has been wise public health policy to provide safety net health care to poor, undocumented immigrants, and Yolo County should continue to do so, despite current economic challenges.
As reported recently by the Pew Research Center, an estimated 95 percent of undocumented immigrants are employed and contribute to local economies. Typically, they work in low-skilled positions in agriculture, construction, food service or maintenance. Yolo County's agricultural economy, in particular, depends on the inexpensive labor of undocumented farm workers.
Although most undocumented immigrants are relatively young and healthy, in the case of illness or injury, all workers need access to basic health care to maintain productivity and to prevent disability. In addition, nearly half of undocumented immigrants (47 percent) are married, and many have children who are U.S. citizens.
Children growing up with parents who are medically or mentally impaired are at higher risk for abuse, and stressful home environments. Children from such unstable homes would be more likely to drop out of school, use drugs, develop mental illness and engage in crime.
An example from my clinical practice may illustrate the potentially adverse consequences of this policy shift. One of my patients is a 34-year-old poor, undocumented woman, a mother of two children, who works as a house cleaner and whose husband works in construction. She has been diagnosed with a benign brain tumor.
Owing to the relatively inexpensive specialty care financed by the YCHIP program, her condition is well-controlled by medication, and her prognosis is excellent. As long as she has access to this medication, she is able to continue working. If her eligibility for YCHIP ceases, she will lose access to specialty care and will be unlikely to afford her medication, putting her at serious risk for permanent loss of vision.
From a strictly fiscal standpoint, one might argue that Yolo County cannot afford to pay for this patient's chronic medical care, regardless of her contribution to the local economy. But denying her coverage won't necessarily save money. Studies show that when access to primary care is reduced there is a predictable increase in emergency care and hospitalizations for a range of conditions.
In my patient's case, without medication, enlargement of her brain tumor eventually could lead to the need for emergency neurosurgery. As with care for all uninsured, we would all bear the costs of this expensive care, because the costs of emergency care for uninsured patients eventually are passed on to insured patients in the form of high premiums.
I am also concerned about the broader public health implications of using immigration status to allocate medical care. Immigrants have legitimate, deep-seeded fears of immigration authorities. Many immigrants may avoid clinics if they know they will be asked for their legal status because of fears that this could endanger themselves or an undocumented family member.
When Proposition 187 was passed by California voters in 1994, it had a prolonged chilling effect on health care use within immigrant communities. Yolo County's decision to check immigration status may similarly deter health care use among both documented and undocumented immigrants.
Delays in or avoidance of care could lead to the spread of infectious diseases like tuberculosis or swine flu. Indeed, a California survey of tuberculosis patients showed that fear of deportation was associated with delays in treatment of tuberculosis, which has a high prevalence rate in immigrant communities.
Although our clinic will continue to accept all patients regardless of their insurance or immigration status, most undocumented immigrants have low-paying jobs and would have difficulty paying for regular care at our clinic, for medications, or for needed specialty care.
If we want a healthy community and a vibrant economy, we must provide safety net health care to all sectors of our society who need it, including the undocumented. Yolo County should be proud of the wisdom of previous county supervisors who consistently elected to provide safety net health care to poor residents, regardless of immigration status.
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