Just Don’t Get Sick
Undocumented migrants in Connecticut are afraid that seeking health care will get them deported. And when they do get treated, it costs the state and the nation about $60 million a year.
By Meir Rinde
September 21, 2006
A 23-year-old Ecuadoran immigrant named Carlos Acero-Leba was working on a roof in Middletown in May when he fell 30 feet to the ground, breaking his leg, dislocating his shoulder and injuring his face.
The seven other Ecuadorans in his work crew ran to help him, but they didn’t call an ambulance. After half an hour, when a neighbor saw them lifting him into their work van, she called 911.
The workers were apparently afraid of being reported to immigration authorities; when police arrived, three of the men ran into the neighboring woods. Their fears were justified. When they couldn’t produce identification, police called the Hartford office of the federal Immigration and Customs Enforcement agency, whose agents took the men into custody. A helicopter took Acero-Leba to Hartford Hospital, where he was treated and, after he recovered, released.
Connecticut has an estimated 75,000 undocumented immigrants, and according to health professionals who work with them, every day they face the same dilemma the Ecuadorans faced: whether to overcome their fears and seek treatment for medical problems, or suffer while their conditions worsen. Doctors and administrators who see immigrant patients generally do not quiz them about their legal status, not wanting to scare them away, but those who are undocumented remain wary nonetheless.
“They’re very frightened that all of us are immigration agents,” said Dr. Bruce Gould, an associate dean at UConn. Gould directs a program of mobile clinics for migrant workers at Connecticut farms, and oversees clinics at homeless shelters. “It is not infrequent that there’s someone standing over to the side or in the bushes, like they’re thinking, ‘Are you going to tell on me? Are you going to tell my boss that I’m sick? Am I somehow going to get turned in?’”
The immigrants’ stories also merge into the larger story of the uninsured, an estimated 47 million people in the U.S., some 356,000 of them in Connecticut. The threat of receiving hefty bills keeps many people, among them the undocumented, away from hospitals except in the most serious situations, resulting in more expensive emergency room visits, increased costs for hospitals and the government, and the problem of untreated disease in the community at large.
Health professionals who administer to Connecticut’s immigrants say when undocumented aliens delay needed medical treatment, it’s often for serious but non-emergency conditions like hypertension, diabetes, infections, skin problems and mental health issues, or for childhood vaccinations and other preventative care. However, even a serious injury like Acero-Leba’s sometimes doesn’t get the immediate attention it requires.
“People do delay care extremely,” said Gould, who is also medical director of Burgdorf Health Center, an affiliate of St. Francis Hospital. “We had a woman come in a year ago. Her fingers had fallen off. Basically, she had had painless auto-amputation of the third and fourth fingers. The bones were sticking out. The ends had fallen off. I’d never seen anything like that.”
Gould said it was never resolved whether the woman, an undocumented immigrant, had diabetes or some other condition like Hansen’s disease, which is treatable. She knew for at least a year that she needed a doctor, but didn’t go in until she’d suffered irreversible harm.
“She was afraid that in some way she was going to be reported — as are many people,” he said. “She had delayed her care to such an extent that then she needed radical surgery. That someone would walk around like that, incredibly worried, and yet be afraid to seek care — how bad must that be? How terrible.”
In addition to ending up in emergency rooms at St. Francis and Hartford hospitals, undocumented Connecticut residents tend to use community health centers like Charter Oak Health Center and Community Health Services in Hartford, or may get checkups at free clinics like those run by Gould and his medical students.
At the HAVEN Free Clinic in New Haven, students in Yale’s medical and health programs treat immigrant patients including Mexicans and some Dominicans, according to Jacqueline Olvera, a volunteer translator at the clinic. Many of the patients are comfortable enough with the clinic that they come in for non-emergency care, like prostate cancer screenings and hypertension treatment, though Olvera also recalled one man — an undocumented immigrant whose wife was in the country legally — who’d had pain and a bump on his abdomen for about a month before he came in to be treated for a hernia.
“The pain was getting severe enough that he decided to come in, and he’d heard about the free clinic,” she said. “They had other medical bills, because he’d gotten shot in the face months before. When we saw him he was already recovering from that. They had other medical bills they were dealing with, which is probably what had kept him from getting treated.”
And then there are those who never make it to the doctor. Olvera, who is Mexican-American and an assistant sociology professor at Connecticut College, said that during her academic research in New Haven she recently encountered a Mexican immigrant in his mid-20s who worked 18 hours a day, six days a week, and who sent much of his earnings home to his wife and kids. He had cut himself on a broken dish at one of his three restaurant jobs.
“He had a big gash on his hand. It looked really bad. I was pretty grossed out,” she said. “But since he didn’t get health insurance, and he didn’t have money to go to the emergency room, he sewed his own hand up. It was his thumb — he kind of sewed it back up. I don’t know how he was going to keep it from being infected. He seemed to be taking good care of himself.
“He didn’t seem distressed. It was like, this is just something that was part of the day. His hand looked pretty swollen. I don’t know how he was getting his work done.”
Some undocumented immigrants are insured; past studies published by organizations such as the Kaiser Family Foundation and the American Journal of Public Health suggest that perhaps 30 percent have some level of health insurance, many of them through their jobs. The rest either come up with cash for their medical bills, or don’t pay.
The question of how much their unpaid health care costs the country has long been a political football. It’s been kicked around again in the past year as Congress has argued over illegal immigration, border control and proposals to give more immigrants a path to citizenship.
Reliable data is elusive, in part because health providers generally don’t ask about or record their patients’ legal status. Very rough, back-of-the-envelope calculations, based on estimates of the size of the undocumented population and the cost of their health care, suggest that Connecticut’s undocumented immigrants account for more than $120 million in health care costs, including out-of-pocket spending by patients themselves and insurance payments for those who do have insurance.
The state’s total health care spending was about $15 billion last year, according to a recent report from the Universal Health Care Foundation of Connecticut.
The foundation’s report says uninsured residents end up paying about 39 percent of their health care costs, suggesting that the 70 percent of undocumented immigrants who do not have health insurance may cost $60 million in state and federal health spending and losses absorbed by hospitals. But without direct statistical data on the immigrants and their health care situation, it’s impossible to judge the accuracy of that estimate.
One state that has attempted to break down costs is Minnesota, a larger state with perhaps 10 percent more illegal immigrants than Connecticut. In Minnesota, state spending alone on health care assistance programs for the undocumented was $17.3 million in fiscal 2005, according to a report from the state Department of Administration.
The Center for Immigration Studies, a conservative Washington think tank, published a study saying that in 2002, publicly-funded health care for undocumented immigrants nationwide cost $2.5 billion in Medicaid dollars and $2.2 billion in charity care for the uninsured. The report also pointed out that those immigrants pay billions in Medicare and Social Security taxes that they will never get back, in addition to regular taxes. The organization claimed that the undocumented cost the government $10.4 billion more in 2002 than they paid in taxes, but that figure included costs other than health care.
Problems accessing health care are just part of a larger set of barriers that stunt the lives of undocumented immigrants. Poverty and the fear of deportation mean they are afraid to assert their legal rights and less willing to fight injustices and hardships they encounter.
Take the example of Charo, a grandmother in her late 50s, who came to the U.S. from her native South America seven years ago. (She asked that her real name not be used.) Charo’s brother is a legal immigrant, as are her parents; she also has three grown children and five grandchildren living in the U.S. But she herself is undocumented, which made all the difference when she was badly injured at her $8-per-hour job three years ago.
In an interview during a recent lunch at her church in East Hartford, Charo said she’d been working at a commercial pie bakery for two years when, one day, a part in a machine she was cleaning slammed down on her right hand. There was no blood, but the injury was very painful; a co-worker took her to Hartford Hospital, where she was told she had a fracture and should see a specialist in five days, she said. She didn’t have insurance, and the specialist wouldn’t schedule an appointment until her employer OKed treatment, she said.
Two weeks passed before he agreed, and it wasn’t until more than a month after the injury occurred that she was able to see a physical therapist. Then she started receiving bills, which she took to her employer. “He made an unhappy face,” she said, speaking through a translator. “I began to get nervous, because I was getting the same bills over and over, a second time, a third time, because he wasn’t paying them. I called the number on the bill and told them my employer’s insurance was paying, and they said, ‘No, the bill is in your name.’”
She wasn’t able to use her hand, and wasn’t working, and when she went into her old job several months later to pick up a tax form, a supervisor told her she no longer had a job at the bakery, she said. In June 2004, 10 months after the injury, she had an operation, but she still can’t curl the fingers of her right hand into a fist. Workers compensation insurance paid her about $12,500 to live on over two years, but the bills kept coming until she hired a lawyer, who still hasn’t concluded the matter, she said.
She’s recently also had problems with her hip, which she traces back to another on-the-job accident, three months before her hand was injured. She was pushing a tall cart of pies when a wheel caught in a drain and the cart fell on her, pushing her to the floor, she said. Her hip has never been examined by a doctor, she said. “That’s my earning from that job,” she said, with a laugh. She now cleans houses in Avon, and lives with untreated hip pain.
Charo blamed her plight, in part, on her legal status, which makes it difficult for her to find work and forced her to put up with her former employer’s demands. “They were pressing us to work, work, work, work, and because I didn’t want to lose my job I had to take everything,” she said. She routinely worked 10 hour days, and her bosses sometimes demanded she work even longer hours. If she had residency papers, she said, “I would have more opportunity, and a voice to complain and ask for my rights.” ●
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