The Henry J. Kaiser Family Foundation

Health care, without question


By Robert Davis
Reprinted with permission of USA Today

LAREDO, Texas Hector Salino waits patiently as his wife sees a nurse at their local medical clinic.

But he is in no ordinary waiting room, and she is in no ordinary clinic. He stands in the sweltering heat by his dusty pickup, not far from his home, as his wife gets her health care inside a specially equipped, air-conditioned truck. The medical visit is free, and no questions are asked especially the question most dreaded by millions of Hispanics living illegally on this side of the border. In health circles here, few people care if any patient who enters the door is a legal U.S. resident.

The medical mantra here is just treat; don’t ask.

As President Bush and Mexican President Vicente Fox meet this week to negotiate key immigration issues, health officials across the nation are paying more attention to preventive-care visits like the one the Salinos recently made to the mobile clinic. Immigrants, most of them from Mexico, are settling in surprising numbers across the nation’s midsection.

While California, Florida, Illinois, New York, New Jersey and Texas have the highest number of legal and illegal immigrants, the states in between from Oregon to the Carolinas have seen the fastest growth in immigrant populations, the latest Census found.

“These places are not used to dealing with immigration,” says Jeffrey Passel of the Urban Institute, a think tank on public policy. “Their health care systems may not be set up to deal with these populations.”

Hospitals, already facing financial difficulties, face many challenges, from figuring out ways to unclog emergency rooms to translating Spanish to English.

“Texas, California and Florida have managed this for a long time,” says the American Hospital Association’s Rick Wade. Now, “some of our members who were not dealing with it are now having to deal with it.”

Law sometimes forbids treating illegals

The number of Hispanics living in the USA soared in the past 10 years, according to the 2000 Census. Today, the number of Hispanics roughly equals that of black Americans.

The immigrants who enter illegally have changed the look of many American homes. Ten percent of children now live in a house with an illegal immigrant, the Urban Institute says.

The illegal residents are coming in droves, numbering as many as half a million a year, and the last thing they want to do is make their presence known.

“As an undocumented immigrant, you are extremely hesitant to receive services and help,” says Clarissa Martinez De Castro, director of state and local public policy for the National Council of La Raza, a Hispanic advocacy group. “You just want to work, support your family and keep a low profile.”

One concern is that any health worker could feel compelled to report the illegal immigrant.

“We have to be careful, because what we are doing is technically illegal,” says Steve Saldana of Catholic Charities in San Antonio, which helps poor Hispanic families get free medical care. “If you know where an illegal alien is, you are supposed to report them.”

But some immigrants also fear that accepting help will hurt later attempts to become a legal resident. Legal residency is bestowed upon immigrants who show, among other things, they don’t need federal aid.

In 1996, a federal law put restrictions on which immigrants could get Medicaid. At the same time, some immigrants were asked in widely reported cases to repay Medicaid benefits or risk their residency status.

Use of public benefits by immigrants dropped more than 30% from 1994 to 1997.

Recently, the push has been in the opposite direction. Last month, the Bush administration announced changes in Medicaid aimed at making it easier for states to provide insurance for children, including illegal immigrants. But confusion and fear remain.

A legal fight is ongoing in Houston, where the hospital district has been told to stop using public money to treat illegal immigrants. Texas Attorney General John Cornyn says the 1996 federal law prohibits states from offering non-emergency health care to illegal immigrants. The case is being watched by hospitals across the nation.

Health officials want to treat the new residents.

“The kind of treatment they get here is vital,” says David Lauricella, spokesman for the Laredo Health Department. “If we don’t treat them here now, they’ll end up in the emergency room later.”

But they’ve found here that simply offering care isn’t enough. Coaxing immigrants out of their homes and into the health system takes a lot of effort.

Key to success: Being nice

Beside the truck-turned-clinic near the Salinos’ home along the Rio Grande, Sister Rosemary Welsh of Mercy Regional Medical Center has taken to the streets of immigrant towns along the border colonias to make a difference in the hospital.

“We’re trying to train them not to use the emergency room as a clinic,” she says. In the process, she has perfected one solution to the immigration health problem a key tip that she shares with colleagues looking for help.

Be nice. “We were the barriers,” Welsh says. “We were not nice, and we made people feel stupid. That was our biggest barrier.”

As Salino’s wife finishes in the tractor-trailer clinic, he smiles with gratitude.

“Mercy, they are good people,” he says. “That’s great for people here.”


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