The recent hoopla over the Arizona immigration law has brought the issue of illegal immigration front and center. In the area of health care, the issue of illegal immigration is a major one, right up there along with other health system issues. Recently, federal judge Bolton put several portions of the Arizona law on hold. Our goal here is not to debate that or the law, but to focus on the health system consequences of uncontrolled illegal immigration. Arizona Governor Jan Brewer (R) has said the problems and costs associated with illegal immigration remain dire, and she pressed the point in asking the appeals court for a review of Judge Bolton’s ruling. Despite the fact that President Obama has emphatically denied that the new health reform bill will cover illegals, the fact is that the problem is already upon us.
One of the pressing issues effecting all border states is that of anchor babies. In many cases, people come here to have babies, they come here to drop a child. It’s a process called “drop and leave.” To have a child in America, they cross the border, go to the emergency room, deliver the baby, which is automatically an American citizen. Many feel that this shouldn’t be the case, saying that this attracts people here for all the wrong reasons.
The impact of immigration on our public health is often overlooked. Although millions of visitors for tourism and business come every year, the foreign population of special concern is illegal residents, who come most often from countries with endemic health problems and less developed health care. They are of greatest consequence because they are responsible for a disproportionate share of serious public health problems, are living among us for extended periods of time, and often are dependent on US health care services, which are citizen taxpayer funded.
Public Health Risks
Illegal immigrants, unlike those legally admitted for permanent residence, undergo no medical screening to assure that they are not bearing contagious diseases. The rapidly swelling population of illegal aliens in the US has also set off a resurgence of contagious diseases that had been totally or nearly eradicated by our public health system.
According to Dr. Laurence Nickey, director of the El Paso heath district “Contagious diseases that are generally considered to have been controlled in the United States are readily evident along the border. The incidence of tuberculosis in El Paso County is twice that of the U.S. rate.” Dr. Nickey also states that leprosy, which is considered by most Americans to be a disease of the Third World, is readily evident along the U.S.-Mexico border and that dysentery is several times the U.S. rate. People have come to the border for economic opportunities, but the necessary sewage treatment facilities, public water systems, environmental enforcement, and medical care are not available on the Mexican side of the border, causing a severe risk to health and well being of people on both sides of the border.
The pork tapeworm, which thrives in Latin America and Mexico, is showing up along the U.S. border, threatening to ravage victims with symptoms ranging from seizures to death. The same [Mexican] underclass has migrated north to find jobs on the border, bringing the parasite and the sickness—cysticercosis—its eggs can cause cysts that form around the larvae usually lodge in the brain and destroy tissue, causing hallucinations, speech and vision problems, severe headaches, strokes, epileptic seizures, and in rare cases death.
The problem, however, is not confined to the border region. Illegal immigrants have rapidly spread across the country into many new economic sectors such as food processing, construction, and hospitality services. Typhoid struck Silver Spring, Maryland, in 1992 when an immigrant from the Third World (who had been working in food service in the United States for almost two years) transmitted bacteria through food at the McDonald’s where she worked. River blindness, malaria, and guinea worm, have all been brought to Northern Virginia by immigration.
Contrary to common belief, tuberculosis (TB) has not been wiped out in the United States, mostly due to illegals. In 1995, there was an outbreak of TB in an Alexandria, VA, high school, when 36 high-school students caught the disease from a foreign student. The four greatest immigrant magnet states have over half the TB cases in the U.S. In 1992, 27% of the TB cases in the United States were among the foreign-born; in California, it was 61% of the cases; in Hawaii, 83%; and in Washington state, 46%. The Queens, New York, health department attributed 81% of new TB cases in 2001 to immigrants.
”We’re running an H.M.O. for illegal immigrants and if we keep it up, we’re going to bankrupt the county” said Los Angeles County supervisor Michael D. Antonovich in a quote from the New York Times (May 21, 200). “What is unseen is their [illegal aliens’] free medical care that has degraded and closed some of America’s finest emergency medical facilities, and caused hospital bankruptcies: 84 California hospitals are closing their doors”, (Madeleine Peiner Cosman, Ph.D., Esq. “Illegal Aliens and American Medicine,” Journal of American Physicians and Surgeons, Spring 2005)
Costs of Medical Care
Immigrants are often uninsured, underinsured and 43% of non-citizens under 65 have no health insurance. That means there are 9.4 million or more uninsured immigrants, a majority of whom are in the country illegally (15% of the total uninsured in the nation in the mid-1990s). The costs of medical care for uninsured immigrants is passed onto the taxpayer, straining the financial stability of the health care community.
Another problem is immigrants’ use of hospital and emergency services rather than preventative medical care. Utilization rate of hospitals and clinics by illegal aliens (29%) is more than twice the rate of the overall US population (11%). As a result, the costs of medical care for immigrants are staggering. The estimated cost of unreimbursed medical care in 2004 in California was about $1.4 billion per year. In Texas, the estimated cost was about $.85 billion ($850 million), and in Arizona the comparable estimate was $.4 billion ($400 million) per year.
One frequent cost to US taxpayers is delivery of babies to illegal alien mothers. 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. At that time, those births constituted 36% of all Medi-Cal births, and they have grown now to more than 50% of the annual Medi-Cal budget. In 2003, 70% of the 2,300 babies born in San Joaquin General Hospital’s maternity ward were anchor babies. Medi-Cal in 2003 had 760,000 illegal alien beneficiaries, up from 2002, when there were 470,000.
The Emergency Medical Treatment and Active Labor Act (EMTALA) requires every ER to treat those who enter with an emergency, including cough, headache, hangnail, cardiac arrest, herniated lumbar disc, drug addiction, alcohol overdose, gunshot wound, automobile trauma, human immunodeficiency virus (HIV)-positive infection, mental problem, or personality disorder. The definition of emergency is flexible, vague and patient defined. It is vague enough to include almost any condition. Any patient coming to a hospital ER must be screened and treated until ready for discharge, or stabilized for transfer whether or not insured, documented, or able to pay. A woman in labor must remain to deliver her child.
The hospital must have specialists on call at all times for all departments that provide medical services and specialties within the hospitals capabilities. EMTALA is an unfunded federal mandate. Stiff fines and penalties may be imposed on any physician or hospital refusing to treat any patient that a zealous prosecutor deems an emergency patient, even though the hospital or physician screened and declared the patients illness or injury non-emergency. Government pays neither hospital nor physician for treatment. In addition to the fiscal attack on medical facilities and personnel, EMTALA is a club with which to pummel politically unpopular physicians by falsely accusing them of violating EMTALA.
American hospitals have been set up to welcome anchor babies. Illegal alien women come to the hospital in labor and drop their “little anchors”, each of whom pulls its illegal alien mother, father, and siblings into permanent residency simply by being born within our borders. Anchor babies are, and instantly qualify for public welfare aid. Between 300,000 and 350,000 anchor babies annually become citizens because of the Fourteenth Amendment to the U.S. Constitution which states that all persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and the State wherein they reside. Recently, Senator Lindsey Graham (R-SC) has suggested a new amendment to the constitution to amend the and rectify this unintended consequence of the 14th amendment.
New immigrants coming to America from Europe via Ellis Island, were stripped naked, examined and observed for signs of contagion. Legal immigrants prior to 1924 were examined for infectious diseases upon arrival and tested for TB. Those infected were shipped back to their country of origin. Even today, immigrants must demonstrate that they are free of communicable diseases and drug addiction to qualify for lawful permanent residency green cards. In contrast, illegal aliens simply cross our borders without any medical examination whatsoever, carrying with them any number of communicable diseases. Many illegals who cross our borders have tuberculosis. That disease had largely disappeared from America, thanks to excellent hygiene and powerful modern drugs such as isoniazid and rifampin. TBs swift, deadly return now is lethal for about 60% of those infected because of new Multi-Drug Resistant Tuberculosis (MDRTB). Until recently MDR-TB was endemic to Mexico. MDR-TB is resistant to at least two major drugs. Ordinary TB usually is cured in 6 months with 4 drugs that cost about $2,000. MDR-TB takes 24 months with many expensive drugs that cost around $250,000, with toxic side effects. Each illegal with MDR-TB coughs and infects 10 to 30 people, who will not show symptoms immediately. Latent disease explodes later.
Chagas disease, also called American trypanosomiasis or kissing bug disease is transmitted by the reduviid bug, which prefers to bite the lips and face. The protozoan parasite that it carries infects 18 million people annually in Latin America and causes 50,000 deaths.
Leprosy, the scourge of Biblical days and medieval Europe, horribly destroys flesh and faces. It was called the disease of the soul. Lepers quarantined sounded noisemakers when they ventured out to warn people to stay far away. Leprosy, Hansens disease, was so rare in America that in 40 years only 900 people were afflicted. Suddenly, in the past three years America has more than 7,000 cases of leprosy. Leprosy now is endemic to northeastern states because illegal aliens and other immigrants brought leprosy from India, Brazil, the Caribbean, and Mexico.
Dengue fever is exceptionally rare in America, though common in Ecuador, Peru, Vietnam, Thailand, Bangladesh, Malaysia, and Mexico. Recently there was a virulent outbreak of dengue fever in Webb County, Texas, which borders Mexico. Though dengue is usually not a fatal disease, dengue hemorrhagic fever routinely kills.
Polio, once eradicated from America, now reappears in illegal immigrants, as do intestinal parasites. Malaria was obliterated, but now is re-emerging in Texas. About 4,000 children under age five annually in America develop fever, red eyes, strawberry tongue, and acute inflammation of their coronary arteries and other blood vessels because of the infectious malady called Kawasaki disease. Many suffer heart attacks and sudden death. Hepatitis A, B, and C, are resurging. Asians number 4% of Americans, but account for more than half of Hepatitis B cases.
At the end of the day, our immigration policy has not only a powerful political and economic effect, but a major public health impact. It is not in the interests of America or its legal citizens to continue to be exposed to the risks of illegal immigration. Clearly, the federal government has abdicated by its inaction, its role in controlling the border, immigration and protecting the health of the public at large.
One proposal in the literature is referred to as CRAG: A Proposal to Prevent Medical Cataclysm. It consists of four points:
- Close Americas borders
- Rescind the citizenship of anchor babies
- Aiding and abetting illegal aliens is a crime and should be prosecuted as such
- Grant no new amnesties
Clearly, it will take bold leadership and political courage to address the reality of this issue. We can only hope that the electorate and Congress will have the spine to stand up to the threat and meet the challenge . . . obi jo and jomaxx
Emotions Flare After Immigration Law Is Blocked – http://www.nytimes.com/2010/07/30/us/30arizona.html?scp=3&sq=Health%20costs%20of%20illegal%20aliens&st=cse
Obama: No Health Care For Illegal Immigrants – http://www.cbsnews.com/8301-503544_162-5178652-503544.html
Rising health care costs put focus on illegal immigrants – http://www.usatoday.com/news/washington/2008-01-21-immigrant-healthcare_N.htm
Illegal Immigration Costs California Over Ten Billion Annually – http://usgovinfo.about.com/od/immigrationnaturalizatio/a/caillegals.htm
Graham eyes ‘birthright citizenship’ – http://www.politico.com/news/stories/0710/40395.html
Illegal Immigration and Public Health – http://www.fairus.org/site/PageServer?pagename=iic_immigrationissuecenters64bf
Chagas disease – https://health.google.com/health/ref/Chagas+disease
Leprosy – http://www.who.int/mediacentre/factsheets/fs101/en/
Dengue fever – http://en.wikipedia.org/wiki/Dengue_fever
Polio and Post-Polio Syndrome – http://www.nlm.nih.gov/medlineplus/polioandpostpoliosyndrome.html
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