But some hospital industry representatives in Arizona and California say that the problem of treating illegal immigrants has lessened in recent years as a result of the weakened economy and tighter restrictions on the border. Pew's estimate of their population nationally has declined slightly from a peak of 12 million in 2007.
“When Arizona's economy was peaking before the Great Recession ... there was a heightened awareness about illegal immigration,” said Pete Wertheim, a spokesman for the Arizona Hospital and Healthcare Association. But a lot of that attention diminished quite a bit during the recession, he said.
In San Diego County, Calif., stricter control of the border helped ease the problem of treating illegal immigrants, said Steven Escoboza, president and CEO of the Hospital Association of San Diego and Imperial Counties. “Our emergency room directors, I would think they would say there's not as many immigrants crowding the EDs as some people think,” he said. Nevertheless, treating them is still a problem, with the two counties providing about $125 million worth of care to illegal immigrants in 2011, he said.
And demand for hospital care in the ER could increase if immigration reform is passed, even without the inclusion of health insurance assistance, some say. The new legal status could make some immigrants less fearful of being deported as a result of going to the hospital, said Dylan Roby, an assistant professor of health policy and management at UCLA and researcher at the UCLA Center for Health Policy Research.
“We have seen suppressed levels of care among the undocumented. You could see an increase in the likelihood of using those services,” Roby said. “They're no longer illegal,” he said.
Some of that suppressed use of healthcare services also may be tied to the belief that the illegal immigrant population is younger, and for that reason, healthier than the general population. If true, then insurance companies would have an incentive to get them covered.
Immigrant advocates say that keeping the status quo regarding illegal immigrant healthcare would be a mistake. “The current system leads to a lot of problematic care on the ground,” said Michael Gusmano, research scholar at the Hastings Center, a not-for-profit research group focused on bioethics. “It leads to strange decisions about the management of disease.”
Patients with chronic or severe conditions who could be treated by a specialist go without care until they have to go to an emergency room. They can then be stabilized, but will likely be back in the ER at some point, Gusmano said.
And immigrant advocates also point to what they would see as unfairness in having immigrants live and often work legally, performing jobs for low wages, yet being denied the ability to get affordable insurance coverage. “If we're talking about bringing immigrants out of the shadows, and wanting them to fully integrate, that includes giving them access to healthcare,” said Sonal Ambegaokar, health policy attorney for the National Immigration Law Center.
But the president and Congress appear ready to keep healthcare out of immigration reform. “I think that gives immigrants a mixed message about how welcome they will be,” Ambegaokar said.
TAKEAWAY: Immigration reform won't offer the healthcare help that some providers and immigrant advocates were hoping for.