Health care void fills immigration debate

It has been nearly two years since a car hit Jesus Arroyo as he crossed a Chicago street on his way home from work, an accident that crushed his left side, fractured his skull in multiple places and left him in a coma for six months.

Today, Arroyo, 38, remains partially paralyzed and in constant pain, his plight an illustration of a health care problem that Congress sees as politically toxic and that area hospitals and other medical facilities are struggling to address: Who will pick up the health care tab for millions of immigrants who could become citizens under new immigration reform legislation?

Arroyo, in the country illegally and with no medical insurance, has been recuperating in a stuffy bedroom of his Elmwood Park home without any help from a doctor or nurse. He relies on donations to purchase his medicine, family members for personal care, and an auto mechanic-turned-health care activist who visits once a week to massage his broken body.

'Move it, move it, move it on your own,' Jesus Vargas, the mechanic, urged during one recent session as he opened and closed Arroyo's deformed left hand. Arroyo's wife, Ana, murmured words of encouragement.

Groaning in pain, Arroyo cried out: 'It can't be done!'

Arroyo and roughly 11 million others living in the country illegally would benefit from federal legislation making its way through Congress that would grant them a pathway to U.S. citizenship. A bipartisan bill that places those people on a 13-year track to citizenship recently passed the Senate, and members of the House of Representatives are preparing their own piecemeal approach to immigration reforms.

But the question of access to Medicare and Medicaid - or of providing those 11 million with federal tax credits to purchase their own insurance - has been off the table because of the political uproar anticipated if those put on a path to legalization were covered under the soon-to-be implemented Affordable Care Act, immigrant advocates say. More of the health care law, also known as Obamacare, goes into effect next year.

Intense pressure from groups pushing a harder line on illegal immigration led to restrictions in the Affordable Care Act that bar people in the country illegally from receiving federal health benefits, or purchasing their own coverage through new insurance exchanges.

The Senate bill that was approved last week places a 10-year bar on health benefits for people who win legal immigration status - a political compromise reached after conservative senators sought a permanent ban.

That would continue to leave people here illegally who are sick or injured relegated to ad hoc treatment that relies on home remedies and donation drives at neighborhood stores and churches for medicine. In cases that require emergency room visits or long-term hospital stays, a heavier burden will be on the hospitals to handle the cost of care, some health care officials say.

'We do not get compensated for that care most of the time,' said Dr. Ram Raju, CEO of the Cook County Health and Hospitals System, which, as a last resort for the uninsured, provides roughly $600 million worth of free treatment per year, many patients without legal immigration status.

'Whether they are legally here or illegally here, they are here,' Raju said. 'It's much cheaper if you can give them insurance and bring them into health care. Disease does not stop just because you're an undocumented immigrant.'

Even among those who oppose providing a path to citizenship for those who are here illegally, there is dissension over how to deal with health care.

A few Republican senators have sought tougher health care restrictions for those here illegally. But, some conservative think tanks say that if the country is going to provide legal status to those 11 million people, barring them from the nation's health care system would be immoral and could lead to more problems for hospital emergency rooms dealing with people with no insurance.

'If you're really going to make them permanent residents, is that the way you want to be as a country?' said Roy Beck, director of Virginia-based NumbersUSA, which seeks to limit all forms of immigration. 'It creates a kind of dual or triple-tiered status. From the point when we outlawed indentured servitude in the 1880s, we really haven't countenanced the idea of two tiers.'

Hospital groups warn that, under the Affordable Care Act, there will be a drastic reduction in federal money available to reimburse charitable care for the uninsured, making it more difficult for doctors in predominantly immigrant areas to treat those patients for extended periods.

By 2019, almost half of the $22 billion currently provided for uncompensated care under federal Medicaid and Medicare programs will be cut, under the presumption that there would be fewer uninsured patients, said Xiaoyi Huang, assistant vice president for policy for America's Essential Hospitals, an umbrella organization for about 200 public and nonprofit hospitals and health systems nationwide.

Using the same assumption, states are also likely to cut their charitable care reimbursements, she said. That created a heavier burden for hospitals and clinics in low-income immigrant areas because they would be treating the same population of uninsured patients, Huang said.

'We don't have a good answer as to what they're going to do once the funding level gets reduced that drastically,' Huang said. 'At some point, hospitals are going to have to make the choice of: 'How do I balance the books and stay open so we can treat the vulnerable patients in our communities?''

For uninsured immigrants, it could mean more cases where hospitals are either moving to send seriously injured and sick patients home with their families or back to their native countries, a practice known as 'hospital repatriations,' said Lisa Polumbo, a supervising attorney with the Legal Assistance Foundation of Metropolitan Chicago.