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Borderline healthcare

October 18, 2005

THAT ILLEGAL IMMIGRANTS to the United States might hesitate to go to a hospital emergency room and surrender detailed personal data is not surprising. Even so, a comprehensive national study showing that recent immigrants, whether in the United States legally or not, use emergency room care about half as often as the U.S.-born population is valuable information.

The emergency room study by UCLA and the Mexican government, and an earlier USC study on overall healthcare of immigrants, undermine the belief that undocumented migrants are overwhelming healthcare systems (at least in national terms). Immigrants' reluctance to seek care, or their difficulty in obtaining it, also indicates that they are enduring chronic illnesses, some of them contagious, that could be cured or controlled.

U.S. border crackdowns of the last several years have made it harder for undocumented workers who can't get U.S. coverage to go to Mexico to get cheaper healthcare. Immigrants who have been here for more than 10 years thus grow to be in worse health than similar people who stayed in Mexico. In the end, the fact that they don't get preventive care in their younger years, especially because they tend to work in more hazardous occupations, means they become more of a drain on public health systems as they age (to say nothing of the misery they endure).

Hospitals in border areas will continue to argue, rightly, that they provide for free or for low cost a disproportionate amount of care to immigrants. The federal government should not use the study to try to reduce the paltry compensation that is offered them.

The bottom line is the same as before the study: Any rational healthcare system for those who pick California's crops or, increasingly, build its houses requires a new federal immigration policy. President Bush and Congress have debated some interesting ideas and given lip service to immigration reform, but it is no nearer than when Bush took office.

In the meantime, one little-noticed corner of the UCLA study deserves more attention: Recent immigrants, when they do seek healthcare, make heavy use of walk-in community clinics and health centers that offer a sliding scale of payments.

Los Angeles County has a fairly robust network of such clinics, operated by nonprofit groups using federal funds intended to keep people out of more expensive county hospitals. The UCLA-Mexico study puts some urgency into supporting these clinics, which are constantly threatened by the loss of federal funding.

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