I said in my last entry that I was not going to write about immigration policy. My friend Josh Freeman has done a good job of writing about it for me today so I will refer you to his blog if you still crave HB 56 information.  I have spent a good bit of effort trying to get my arms around the extent of the problem and do have some information to share that will challenge the statement that reducing health care costs justifies HB 56 style “immigration reform.”

There is a belief among proponents of “immigration reform” that folks are coming like moths attracted to a flame to take advantage of our exceptional health care delivery system at no cost to them. The Federation for American Immigration Reform (the “hate group” that was the driving force behand HB 56) has put together a list of diseases spread by “those people” (tuberculosis, trichinosis, and typhoid, mostly culled from case reports related to a single index case). Although they could use these diseases to make a case for the development system of care for undocumented workers, instead they suggest that the fact that these folks are “uninsured” is costing America a bunch of money. From their information: “A California study put the number of these anchor baby deliveries in the state in 1994 at 74,987, at a cost of $215 million.” Contrast this with data from a RAND report:

The report – which appears in the November edition of the journal Health Affairs – estimates that in the United States about $1.1 billion in federal, state and local government funds are spent annually on health care for undocumented immigrants aged 18 to 64. That amounts to an average of $11 in taxes for each U.S. household. In contrast, a total of $88 billion in government funds were spent on health care for all non-elderly adults in 2000.

Is $11 in taxes too high a price to pay for inexpensive catsup? The New England Journal of Medicine article “cited” by FAIR offers a much different perspective as well.

The reason most immigrants come here is to work and earn money; on average, they are younger and healthier than native-born Americans, and they tend to avoid going to the doctor. Many work for employers who don’t offer health insurance, and they can’t afford insurance premiums or medical care. They face language and cultural barriers, and many illegal immigrants fear that visiting a hospital or clinic may draw the attention of immigration officials. Although anti-immigrant sentiment is fueled by the belief that immigrants can obtain federal benefits, 1996 welfare-reform legislation greatly restricted immigrants’ access to programs such as Medicaid, shifting most health care responsibility to state and local governments. The law requires that immigrants wait 5 years after obtaining lawful permanent residency (a “green card”) to apply for federal benefits.

Regarding costs,most data suggests the costs are much less than the taxes paid.

In a study from the RAND Corporation, researchers estimated that undocumented adult immigrants, who make up about 3.2% of the population, account for only about 1.5% of U.S. medical costs

When costs do get high in these young, mostly healthy people it commonly is associated with barriers to care:

Although U.S. hospitals must provide emergency care without first asking about income, insurance, or citizenship, early diagnosis and treatment in a primary care setting are both medically preferable and a better use of resources. “If people keep postponing medical care because they’re so concerned about being sent back over the border,” noted Elizabeth Benson Forer, executive director of the Venice Family Clinic, a venerable free clinic in Los Angeles that serves many immigrants, “then you can end up with some pretty horrendous health situations.”

While there are other costs associated with an influx of undocumented workers (primarily education), to use health care costs as an excuse to encourage the spreading of intolerance is disingenuous at best. Health care costs are high in this country for some very well documented reasons, not including this one. Groups concerned about the future of this country, given our obligation to our “citizens,” should support the Affordable Care Act’s proven cost savings. If they are worried about infectious disease transmission as well as desire to reduce the cost of emergency care delivered to undocumented workers, they should support eliminating barriers to primary care access for these folks through specialized programs.