Under the Radar and Inside the E.R.

A Failed Healthcare System for Undocumented Immigrants

Julie Aiello

José attempts to explain his seven-year-old son’s chronic headaches to a nurse at Peak Vista Community Health Center, and his nerves heighten. He is unable to communicate well in broken English and cannot afford to buy the medication his son needs. José is a Mexican-born immigrant and six-year resident of the United States, with two young kids. His thick hands and a sturdy build reflect long days of stocking, bussing and other physical labor in the restaurant business. José is one of 250,000 undocumented immigrants living in Colorado without healthcare.

The Gazette estimates there are 10,000 undocumented residents in El Paso County, which is relatively low compared to most counties in the country. Yet there are thirteen free or low-cost community health centers in operation—a substantial number for a city this size—that are constantly overwhelmed. Many immigrants in Colorado Springs are unaware of free clinic services and do not utilize government healthcare at all. Instead, they resort to Mexican-owned pharmacies that sell over-the-counter drugs imported from Mexico, or they simply make periodical trips to the Emergency Room.

Cindi DeBoer, an administrator at Memorial Hospital claims, “People use the ER for two reasons. They either wait until they are very sick or they come for primary care needs.” A study by The Partnership for Medicaid reported that in 2004 only twenty percent of emergency room visits in the United States were urgent. Better-funded community health centers would alleviate highly trafficked emergency rooms and decrease incidents of major medical events.

Despite the low number of truly urgent ER visits, ninety-five percent of all visits were treated and discharged. The Emergency Medical Treatment and Labor Act mandates emergency care for everyone, putting doctors in the awkward position of deciding whether a patient truly needs emergency care. “Medical malpractice laws make doctors very hesitant to release patients too quickly, for fear of a law suit,” DeBoer says. As a result, many uninsured immigrants are treated without questioning the severity of their ailment.

In October 2007 President Bush vetoed the expansion of the State Children’s Health Insurance Program (SCHIP), denying approximately 4 million children healthcare. The veto fails to compensate for the 7.4 million children affected by the expiration of the SCHIP this past September, and perpetuates the long-standing practice of denying undocumented immigrants eligibility for Medicaid or the Children’s Health Insurance Program. José and his wife await the processing of their papers in the hopes of receiving a green card, which will bring them one step closer to eligibility. However it is likely that the state will fall short of resources, unable to accept new Medicaid members. Without a green card there is no chance of being insured or gaining adequate healthcare.

Like José, David and undocumented immigrants in Colorado Springs appreciate the free access to Emergency Room service in the U.S. David’s family, also from Mexico, supports three children—the oldest with diabetes. “I didn’t know for a long time that I could go there,” he says. “But they help you, ” even if you don’t have the money to pay. David praises his wife for keeping his children healthy with the limited resources of the community clinic available to them, and he knows he can use the ER to treat one-time issues, but not chronic ailments.

According to a night-time security guard of Penrose Hospital on Weber Street, the hospital does not discriminate against anyone seeking medical services. “We treat everyone who walks through that door,” he says. “First you’re seen by a doctor, and not until after the bill is rung up are financial issues discussed. ER doctors are dedicated and there to serve the people. They want to do their job as best they can and move on to the next patient.”

Research by both pro and anti immigration organizations such as Republican backed Defend Colorado Now and the Democrat supported group the Colorado Alliance for Immigration Reform show that many of the 12 to 15 million illegal immigrants in the U.S. are using the system and incurring costs on the government’s bill. According to the New England Journal of Medicine, the cost for an ER visit is on average six times more expensive than a primary care visit, meaning those who cannot afford to pay are costing the government more than they would if they had primary care. Studies from The Bell Policy Center, a progressive non-profit research and policy center show that undocumented immigrants pay around $180 million in taxes annually to the state through income, sales and property taxes, while they use around $225 million in government-based services. Therefore Coloradans pay around $45 million per year supporting undocumented immigrants, roughly equivalent to the national average paid per state.

This fiscal drain on Colorado’s healthcare system by undocumented immigrants has propelled a circuitous battle surrounding how taxes are spent, preventing de facto changes to the healthcare system. Curbing healthcare costs for Colorado taxpayers is at the forefront of the Republican agenda for Colorado representatives. Regarding his stance on government costs of undocumented immigrants, last year Representative Dave Schultheis told Rob Larimer of the Colorado Springs Business Journal that, “Basically, our goal is to make the working environment in Colorado as unfriendly as possibly to illegal aliens.” Schultheis is the leader of a handful of GOP lawmakers of whom proposed Colorado’s Initiative 55, an amendment to the Colorado Constitution to restrict all non-emergency services to undocumented immigrants. The bill includes provisions such as: a plan to strip Colorado cities of state funding if they offer sanctuary to illegal immigrants, a bill that would revoke the business licenses of employers that hire undocumented workers, a proposal to count the number of illegal immigrants enrolled in Colorado public schools and a bill to preclude illegal immigrants from receiving workers' compensation benefits.

Hector Suarez, Colorado College civic engagement coordinator and expert on immigration action in Colorado, says that, “The debate in Colorado has taken on new form. Lawmakers are pursuing a ‘war of attrition strategy’ to alienate the immigrant groups in the state.” The 2006 elections incited discussion on immigrants in Colorado, dividing Representatives along party lines where Republicans took a stand against illegal immigrants. In January last year, a Republican coalition held a campaign kickoff news conference for an initiative that would bar the state from providing any service except K-12 education and emergency health care to illegal immigrants.

Not until there is federal compensation on state budgets and better allocation of resources towards primary care expenditures will low-income and uninsured familieshealthcare concerns be ameliorated. The SCHIP could reduce the number of uninsured children—now estimated at 8.9 million—to provide care for 4.1 million children. Though there are now 47 million uninsured Americans like José and David, the qualifications for Medicaid still require legal status and an income of less than $12,920 per individual or $17,321 per married couple.

José’s persistence to pay for medicine for his son is unwavering. Refusing to deny his son a healthier life, he still battles with the school board to help keep his son healthy enough to be in school and works over 70 hours a week to support his family. As of now he can barely afford the medication. David’s daughter is in and out of the emergency room, the only place she can steadily receive insulin because he is unable to pay for the primary care necessary to treat her diabetes. For individuals like David and José, it is truly a struggle to survive, all the while worrying that without primary care, their children will not have the same opportunity as other American children have to become educated, and pursue a healthy life.

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