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No lie -- new health-care law leaves undocumented immigrants without health coverage

This article first appeared in the St. Louis Beacon, March 30, 2010 - The political divide over health reform was symbolized at one point last fall by an unlikely heckler, U.S. Rep. Joe Wilson, R-S.C. He shouted, "You lie!" at President Barack Obama after Obama had said during a health-care address that undocumented immigrants would be excluded from health benefits in the legislation.

In fact, the president turned out to be right. The bill, which he signed March 23, does not extend coverage to these immigrants. Though the issue later died down, the question of how to meet the health needs of undocumented residents is far from settled. And it's a very big question. The Congressional Budget Office estimates that roughly 10 million of these immigrants live in the United States. That number is up from 8.3 million -- including at least 40,000 in Missouri, and about 450,000 in Illinois -- cited in a Pew Hispanic Center report in 2008.

Immigration groups say many of these residents are likely to continue getting at least some care in hospital emergency rooms, which are forbidden to turn away people having certain illnesses.

But a more problematic issue, these groups say, is what to do about undocumented immigrants like Eduardo Loredo, a teen whose health problems cannot be treated or cured with a bandage or an antibiotic. He needs a heart transplant. His mother, Karina Loredo, brought him from Mexico three years ago and settled in with a sister and other relatives, all U.S. citizens, near Kansas City.

Last summer, Karina Loredo sought what she expected to be routine treatment for her son after he developed symptoms that doctors initially associated with the flu. More tests at Children's Mercy Hospital in Kansas City showed that the boy suffered from a chronic disease, called dilated cardiomyopathy, meaning his heart muscle is enlarged and has difficulty pumping blood. Eduardo's mother eventually heard something even more ominous from health officials at Children's Mercy: The cardiologist, Dr. Cather Ong Simon, told the family that a heart transplant costing "at least $500,000" would offer the boy, now 15, the "best chance for a normal life."

Karina Loredo and many immigration groups are now trying to figure out their next move. Medicaid, the health insurance program for the needy, is out of the question because recipients must also be U.S. citizens to qualify.

This case is one of the gray areas that people on both sides of the immigration issue are likely to debate in coming years as undocumented immigrants seek care for serious medical conditions that can't be cured in the ER. To some critics, the solution is simple -- give the victims one-way tickets back to their home countries.

But that response wouldn't necessarily address the medical conditions, says Monique Maes, who has acted as an interpreter for Karina Loredo. Maes says the Loredos, like others in similar situations, have been encouraged to leave the United States voluntarily. She says the family had given thought to returning to Mexico but had been told that less than half a dozen hospitals in all of Mexico are capable of performing heart transplants. Ironically, Eduardo would be covered by public health insurance in Mexico, but Maes says the family also has been told there was no guarantee the child would get a transplant even if he were lucky enough to get on the list.

One other option the family is considering is moving to New York state, where children up to age 18 are covered by Medicaid and, presumably, would be eligible for this kind of expensive surgery.

"This new health-insurance bill offers no relief, no opening, for undocumented immigrants to access health care other than through emergency rooms," says Katie Robbins, national organizer for Healthcare-NOW!, a group that favored a single-payer system. "This is not a rational approach to health. It's the most irrational way to organize care for a group of people."

Jennifer Rafanan, head of Missouri Immigrant and Refugee Advocates, notes that emergency room care for undocumented immigrants only applies to serious communicable diseases and immunizations -- in other words "services that have been deemed necessary to maintain public health and safety." She adds that there's a common misconception that these immigrants can use emergency rooms for all health problem. To the contrary, she says, "they can be turned away from emergency rooms if they are seeking treatment for non-emergency issues."

Rafanan believes the restrictions for care for immigrants are shortsighted because when a population "is systematically excluded from health care, it impacts all of us and makes our community less healthy overall."

She's particularly disappointed that undocumented workers will be forbidden to join health insurance exchanges and "enjoy benefits, such as subsidies, consumer protections, cost controls, and standard plans" that will be available to other workers in exchanges. Even more disappointing, she says, is that illegal immigrants won't be allowed to join exchanges even if they are willing to cover the cost with their own money.

The Congressional Budget Office says undocumented immigrants won't be the only group without health insurance after the new law takes effect. Another group consists of people eligible for Medicaid but who choose not to enroll in it. Under the federal law, Medicaid coverage will be expanded to reach some eligible individuals and families earning up to 133 percent of the poverty level. For an individual, that's $14,404 a year; for a family of four, it's $29,326 a year. Notwithstanding the reach and promise of the new health-care legislation, it appears that hundreds of thousands of people nationwide will continue to rely on hospital emergency room as their primary source of medical care.

Funding for health reporting is provided in part by The Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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