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The Impact of Illegal Immigration on Health care in California

The surge if illegal immigrants that began in the 1990s and continues to the present time has had an adverse effect on the delivery of health care services. Illegal immigrants are more likely to live in poverty and are less likely to have health insurance. Consequently, the medical expenses of this group must be absorbed the hospitals that provide medical services. The non-payment for services creates a financial hardship for hospitals and has been associated with reductions in services and the closure of some health care facilities.

The proposed study seeks to learn the effect that illegal immigration has had on the delivery of health care services in California. California VS The Hispanic Explosion: The Impact of Illegal Immigration on Health care in California The 1990s saw the beginning of a surge of illegal immigrants who arrived in the United States. The United States and California have dealt with periods of elevated immigration activity before, but never to this extent. By March of 2004, there were 10.

3 million unauthorized immigrants living in the United States, 57% of whom were from Mexico and another 24% of whom were from some other Latin American country (Passel, 2005, pp. 4-5). Historically, illegal immigrants have tended to settle in states that are along the United States’ southern border with Mexico. This trend has changed somewhat in recent years, as the illegal immigrant population has begun to disperse and some non-border states have become destinations for undocumented workers.

California, however, continues to be a major destination for illegal immigrants. In 2004, one out of every four of the illegal immigrants in the United States (24%, or 2. 4 million people) was living in California (Passel, 2005, p. 11). Problem Statement In addition to the need for jobs that draws undocumented workers to California, illegal immigrants also require the same basic services that are essential to all people, including health care services for themselves and their families.

Like health care systems all across the United States, the California health care system is already facing the multiple challenges of providing care for uninsured citizens, rising medical expenses, shortages of service providers and other qualified medical personnel, and other problems in the state’s hospitals and overall health care system. Simply by virtue of the numbers of illegal immigrants who utilize medical services in California, the activity of illegal immigrants places additional burdens on a system that is already stressed and that has limited resources.

The purpose of this proposed research project is to quantify what this burden costs taxpayers and health care providers and to determine how the additional burden that is created by illegal immigrants affects the overall delivery of health care services to Californians. Objective The objective of the proposed study is to determine how much of a burden do illegal immigrants place on the California health care system. The proposed paper recognizes that the term “burden” may be interpreted in different ways. The different meanings of the term “burden” provide the basis for the paper’s two research questions.

“Financial burden” will be defined as the expenses that hospitals and ultimately the taxpayers must pay for providing health care services for illegal immigrants for which the hospital will not be reimbursed. “Burden on resources” will be defined as the number of doctors, hospital beds, and other resources that are expended in the care and treatment of patients who are undocumented or illegal. The first research question addresses the financial burden that illegal immigrants place on the health care system in California.

Specifically, how much does it cost hospitals, health care providers, and ultimately the taxpayers to provide health care services for illegal immigrants? The second question addresses the burden on resources that is created by the illegal immigrant population. Is California’s health care services pipeline being clogged up by the overflow of illegal immigrants that are pushed through the system, and, if so, then what affect has this had on the delivery of health care services to California citizens and legal residents? Hypotheses

Each research question will have its own related hypothesis. Hypothesis 1 states that the cost of providing health care services to the illegal immigrant population will be significant and will be higher than the cost of providing health care services to the same number of legal California residents. In other words, this hypothesis supposes that it will cost a hospital and the State of California more to provide health care services for X number of illegal immigrants than it would to provide the same services to X number of citizens or legal residents.

This hypothesis is based on the assumption that illegal immigrants will be less likely to have health care insurance than citizens and legal residents, despite the fact that there are many Californians who do not have health insurance. Hypothesis 2 states that the introduction of additional of illegal immigrants into the health care system will result in fewer hospital beds and other resources being available for citizens and legal residents. This hypothesis is based on the assumption that health care is a finite resource.

The increased use of a limited resource by one group will result in less of that resource being available for other groups. Health care slots that are filled by illegal immigrants represent slots that are not available to be filled by citizens and legal residents. Importance of this research Although much has been written and said about immigration reform, very little has been done about it. Advocates for illegal immigrants claim that undocumented workers are essential to the economy (Passel, 2005).

Employers, for example, hire illegal immigrants because these undocumented workers are willing to accept lower wages with no medical benefits or other benefits. It is possible, however, that this source of cheap labor comes at a very high price to Californians and, by extension, to Americans who live in other states. It is possible that the cost of providing health care and other essential services to the illegal immigrant population may exceed any contributions that this group may make to the economy of California.

Consequently, while individual employers may realize a savings by using the illegal immigrant workforce, these practices may have a negative effect on the overall economy. Since 1990, Californians have seen their taxes increase while the level of government services they receive has declined. The notable exception to the overall decline in government services for residents of California is the increase in the number of medical and education benefits that have been made available to illegal immigrants (Green & Martin, 2004).

Health care is only one of many systems and services that are used by illegal immigrants in California. However, by quantifying this one aspect of the impact of illegal immigrants on the lives of Californians, the proposed paper could provide another resource that could be used in the political fight against illegal immigration in this state. If Californians knew how much illegal immigrants were costing them, both in terms of a financial burden and in terms of a shortage of resources, then they might be more highly motivated to demand that actions are taken to solve this problem.

Literature Review Uncompensated medical care for illegal immigrants cost Californians $1. 4 billion in 2004 (Martin & Mehlman, 2004, p. 1). This figure, however, understates the true financial burden created by illegal immigrants. Uncompensated health care services, educational services for illegal immigrants and their families, and the cost of incarcerating illegal immigrants who are arrested for various crimes other than illegal immigration cost California taxpayers a total of $10. 5 billion in 2004 (Martin & Mahlman, 2005, p. 1).

Supporters of guest worker programs and other amnesty plans for illegal immigrants like to point out that illegal immigrants pay taxes and make other contributions to the economy. According to Martin & Mahlman (2005), financial contributions in the form of taxes from illegal immigrants totaled $1. 7 billion in 2004, more than the cost of uncompensated medical care, but far less than the $10. 5 billion for education, health care, and incarceration. After crediting the illegal immigrant population for their share of taxes, the net cost of illegal immigrants to legal Californians is $8. 8 billion. Admittedly, only $1.

4 billion of this total was for medical care. However, in a state in which millions of citizens are without health insurance and many cannot afford essential services, $8. 8 billion could have been spent on health care for citizens and for other programs that could have improved the quality of life and health of taxpayers and their families. Illegal immigrants tend to work low-skill jobs at wages that are below the industry average and, in some cases, below minimum wage. These jobs rarely include benefits such as health insurance, and the wages are too low for workers to be able to afford private health insurance.

Illegal immigrants and their children are more likely to live in poverty than citizens and legal immigrants (DeNavas-Walt, Proctor, & Smith, 2007). Consequently, although illegal immigrants make up about 11% of the population of the United States, this group represents 25% of all of the people in the United States who are uninsured (Green & Martin, 2004). The same lack of income that makes illegal immigrants unable to afford health insurance also makes them unable to pay for the high cost of medical care in the United States. The hospital must absorb the cost of treatment.

In El Centro, California, the Regional Medical Center and Pioneers Memorial Hospital lost a combined total of over $1. 5 million providing medical services for illegal immigrants in 2001 (Green & Martin, 2004). The cost of providing medical services to illegal immigrants is already taking a toll on hospitals. American hospitals are required by law to treat any patient that arrives in the emergency room, regardless of ability to pay and regardless of whether that person is in the country legally (California Medical Association, 2004). As a result of this law, some hospitals in towns along the U.

S. -Mexican border have reported spending as much as two-thirds of their operating income paying for uncompensated care for illegal immigrants (Green & Martin, 2004). As a result of these unrecovered losses, many hospitals have been forced to close their emergency rooms or to stop taking some ER cases, such as emergency births (Green & Martin, 2004). In other cases, the number of illegal immigrants that are filling the emergency room is so great that patients are waiting up to 6 hours to see a doctor (Green & Martin). Paying for anchors

Supporters of illegal immigration and the effort to create a bilingual America might argue that not all of the Spanish-speaking population of California was born in Mexico, and they would be correct. There are some residents of California who were born in the United States who do not speak English. A large percent of these children are the sons and daughters of illegal immigrants who were born on American soil but not within the American culture. Each year, California, through its Medi-Cal program, spends about $400 million paying for the delivery of babies of women who are illegal immigrants (Larrubia, 2007).

Each year, about 100,000 illegal immigrant women have their babies delivered at no cost to them through the Medi-Cal program (Larrubia, 2007). These children are referred to as “anchor babies” because they create a legal link between their parents and the United States. Under current U. S. law, any child born in the United States, regardless of the citizenship status of his or her parents, is a citizen of the United States. Anchor babies now account for about 20% of all of the babies born in California (Larrubia, 2007). Anchor babies represent another example of the hidden costs of medical care for illegal aliens.

In addition to the $400 million that California spends to have these babies delivered (Larruibia, 2007), the state must also spend money to educate the child. There are other expenses as well. If a mother qualifies for Medi-Cal, then she and her children will probably also qualify for other forms of public assistance. While these additional expenses for education and social services are not specifically medical in nature, they are the result of a medical procedure that was provided by the state and will eventually include additional medical services.

This is an example of the ripple effect that illegal immigration has throughout the economy and especially within the health care industry. Additional expenses: The cost of non-acculturation Research on the cost of caring for illegal immigrants tends to focus on the cost of uncompensated medical care. While uncompensated care is the largest and probably the most easily quantified part of the overall burden of health care for illegal immigrants, it is only one part of the total cost.

Part of the expense of caring for the illegal immigrant population is their resistance to acculturation and the American culture. Unlike previous groups of immigration in which the majority of immigrants were processed at the border and documented by immigration officials, the current wave of immigrants is notorious for its largely undocumented status. Since 1995, the number of illegal immigrants coming to the United States has exceeded the number of people who have immigrated to the country legally (Passel, 2005, p. 6).

Work permits and other forms of legal documentation that were once seen as tickets to a better way of life in a new country are now viewed by many immigrants as inconvenient formalities that are best avoided. The ability of an immigrant – legal or otherwise – to work in the United States, once viewed as a privilege, is now viewed by many in the Latino community and their supporters as an entitlement, along with education for Mexican children and health care for undocumented workers and their families (Sacchetti, 2008).

Paradoxically, this expectation on the part of illegal immigrants and their supporters that the United States should provide jobs, education, and health care for those who could not obtain those necessities in their native Mexico and therefore came North is coupled with a romanticized view of Mexico that overlooks the poverty and misery from which the immigrants fled and insists on resisting American acculturation (Hanson, 2003).

This resistance to acculturation, including the refusal to learn the English language, is significant because it contributes to the burden that illegal immigrants place on institutions like hospitals and American society as a whole. The non-English speaking population in California is now so great that hospitals, clinics, and doctor offices must employ bilingual workers in order to communicate with their patients (Dower, 2005).

This practice discriminates against native-born Americans who do not speak a language other than English. Patient health information must be printed in Spanish, which drives up the cost of producing pamphlets and forms. Both of these outcomes place additional burdens on the health care system that would not exist if immigrants were required to learn to speak English.

The language barrier and the costs that are associated with it are examples of some of the often-overlooked burdens that illegal immigration places on the health care system. Freeing the system of the burden of providing medical services for the 2. 4 million illegal immigrants who were in California in 2004 and requiring legal immigrants to learn English as a condition of the legal status would reduce the need for at least a portion of the bilingual workforce. Summary of literature review

The existing literature supports both Hypothesis 1, that the cost to hospitals of treating illegal immigrants is higher than the cost of treating citizens and legal immigrants, and Hypothesis 2, that the treatment of illegal immigrants is depleting health care resources and leading to fewer health care resources for citizens and legal immigrants. Hypothesis 1 is supported by several findings in the existing body of research on illegal immigration. Chief among these findings is the link between immigration status, poverty, and insurance status. Illegal immigrants are overrepresented among uninsured people who live in the United States.

Several factors appear to be contribute to this correlation between illegal status and lack of insurance, the most noticeable of which is the working conditions of illegal immigrant workers, which are characterized by low wages and no employee benefits of any kind. The unwillingness of employers to provide health care benefits for their illegal immigrant employees, coupled with the low income of these workers, makes it difficult if not impossible for illegal immigrants to obtain health insurance that is not part of Medicaid or some other government program.

Despite the fact that California provides Medicaid benefits to illegal immigrants, the literature suggests that there are a number of illegal immigrants and their families who do not take advantage of these services, probably for fear of being identified as illegal and being arrested or deported. Medicaid is funded by tax dollars, so Medicaid recipients who are illegal immigrants are still placing a burden on the overall health care system. However, Medicaid reimburses hospitals for treatment, thus reducing the expense to the hospital that provided care for the illegal immigrant.

Hypothesis 2 is supported by research literature which indicates that the overflow of uninsured, non-paying illegal immigrants in emergency rooms and other care facilities has resulted in the closure of some facilities and has severely reduced the ability of other facilities to meet the emergency medical needs and other health care needs of all of the people who live in their service areas. Proposed Research Procedure To test Hypothesis 1, the proposed research project will use an experimental survey design to gather information from patients and/or their family members who will be found in emergency rooms in the Los Angeles area.

In the experimental design, the independent variable will be the ratio of patients who are illegal immigrants to patients that are not illegal immigrants. The dependent variable for Hypothesis 1 will be the cost to the hospital for treating patients after individual payments for services and/or third-party reimbursements other than Medicaid and Medi-Cal. If Hypothesis 1 is correct, then hospitals with higher numbers of patients who are illegal immigrants will have higher numbers of uninsured patients and will be less likely to receive payment for treating its patients.

Hypothesis 2 will be tested by a review of health care facilities within the same region from which the sample for Hypothesis 1 was drawn. The focus of this review will be to determine whether the increase in the illegal population that has occurred since 1995 has coincided with an increase in the use of local hospitals. This review will also seek to learn how many hospitals have been closed during this period and whether those closures coincided with an increase in the number of uninsured patients who were illegal immigrants.

Finally, the survey will seek to determine whether the overall quality of health care services as measured by emergency room wait times increased during this period. Sample The research sample will consist of 100 patients and/or family members who visit the selected emergency rooms on the night of the survey. In the event that the responses from 100 patients or family members cannot be gathered in a single night, another survey will be conducted in the same emergency rooms on the following night.

While a visit to the emergency room is often traumatic for the patient and the family, it is also provides an opportunity to talk with patients and family members while they are waiting to see a doctor. After determining the potential respondent’s linguistic preferences, the surveyor will introduce himself or herself and tell the potential respondent that they are conducting research on the level of health care services that are available for guest workers. The term “illegal immigrant” will not be used in the survey. Instead, the term “guest worker” will be used.

Surveyors will ask questions in the preferred language of the respondent, English or Spanish. The survey instrument will only ask for general demographic information, such as the gender and age of the patient and the nature of the emergency or condition that brought him or her to the emergency room. Respondents will not be asked their name, address, or any other personal information. To help encourage responses and to establish trust and credibility with respondents, each respondent will receive an information packet with information about health services that are available in the community.

Even with this procedure, there is still a possibility that illegal immigrants will not acknowledge their illegal status. The results of the survey questions about immigration status will be compared to other information about illegal immigrant population to help to check for accuracy. Other ethical concerns for this research include privacy concerns and respecting the wishes of individuals to be left alone during what can be an emotionally trying event. Critical case patients, i. e.

, patients with gunshot wounds, domestic violence cases, and other cases that are life threatening or that appear to be highly emotional for the people who are involved, will not be approached to complete a survey. The elimination of critical care cases from the sample should have an interesting effect on the results of the survey. This limited sample will give some indication of the number of patients who use the ER for non-emergency cases because they cannot afford a regular office visit to the doctor.

The practice of using the ER in cases in which most people would use a regular family physician is one example of how the health care system becomes clogged when resources are used in a manner in which they were not intended. Research instrument To help to ensure a higher response rate, the survey instrument will be brief. Surveys will be completed by the interviewers. In addition to gathering non-specific demographic information about the sample population, the surveys will also ask the following questions (questions will be asked in the preferred language of the respondent):

1. Does your employer provide health insurance? 2. If your employer does not provide insurance, then are you receiving health benefits through Medicaid or some other program? 3. How often do you or members of your family visit the emergency room? 4. Do you or your family use doctors other than those who are in the emergency room? 5. When you come to the emergency room, how long do you usually have to wait to see a doctor? 6. Was there another emergency room that you went to before you started coming to this one?

If so, then where was it and why did you choose to come here today instead of going there? This survey instrument should have high validity but the reliability of the responses may be suspect. Reliability refers to the integrity of the research sample and the likelihood that respondents will be truthful in their responses. One of the potential weaknesses of this survey design is the understandable reluctance of illegal immigrants to identify themselves as being in the country illegally. This reluctance could affect the reliability of the survey questions and of the proposed research project.

To reduce this anxiety and to overcome language barriers, bilingual Spanish-speaking interviewers will be hired to ask the survey questions. Validity refers to whether the survey questions are aligned with the research questions in the objective of the research study. In this study, the research questions pertain to whether hospitals that treat illegal immigrants are being compensated for their services and how the treatment of illegal immigrants affects the treatment of citizens and legal immigrants.

Not having employer-provided health insurance and not being enrolled in Medicaid (see Survey Question 1) are strong predictors of the inability of patients to pay for services rendered. Frequent visits to the emergency room (see Survey Question 3) is an indicator of inappropriate use of emergency room services, i. e. , using the emergency room as a primary care provider. Frequent use of the emergency room is also an indicator of an uneven distribution of medical resources between illegal immigrants and citizens and legal immigrants. This overuse would be consistent with Hypothesis 2.

This indicator would be further supported by the response to Survey Question 4, which asks the illegal immigrant whether he or she uses doctors other than those in the emergency room. Survey Question 5 refers to the quality of care that is received by all patients. Assuming that there is no bias for or against illegal immigrants in the waiting room, this question should provide an indication of the quality of care that all patients receive. Finally, Survey Question 6 seeks to learn whether the respondent is aware of any emergency room closures or other changes in service.

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