http://www.latimes.com/news/local/la-me-immighealth27-2009apr27,0,3560878.story

California counties cut healthcare to illegal immigrants

By Anna Gorman

April 27, 2009

Forced to slash their budgets, some California counties are eliminating nonemergency health services for illegal immigrants -- a move that officials acknowledge could backfire by shifting the financial burden to emergency rooms.

Sacramento County voted in February to bar illegal immigrants from county clinics at an estimated savings of $2.4 million. Contra Costa County followed last month by cutting off undocumented adults, to save approximately $6 million. And Yolo County is voting on a similar change next month, which would reduce costs by $1.2 million.

"This is a way for us to get through what I think is a horrible year for healthcare in California," said William Walker, director of Contra Costa Health Services.

Walker said the national ambivalence on immigration policy means that illegal immigrants are living here but without federal or state funding to provide essential medical services to them. Walker, who began his medical career treating undocumented farmworkers, said that deciding to cut their services was difficult.

"This is the community of people we have all relied upon for decades, providing work not only in construction but in service and child care," he said. "We all live and work here together."

Trend could spread

As the recession continues, property tax revenue decreases and the number of newly uninsured patients increases, other county health departments in California and the nation may make similar changes, said Robert Pestronk, executive director of the National Assn. of County and City Health Officials.

"Communities are having to make excruciating decisions about the services they fund," he said.

But Pestronk said that shifting costs isn't the answer.

"This is a balloon that just expands," he said. "If you squeeze it in one place, it's just going to expand somewhere else."

John Schunhoff, Los Angeles County's interim health services department director, said there is no plan to eliminate health services to the county's illegal residents, despite significant projected deficits and concern about further cuts in state funding.

Eliminating illegal immigrants from health services may enable counties to balance their budgets this year but won't solve the problem in the long term, said David Hayes-Bautista, professor of medicine and director of UCLA's Center for the Study of Latino Health and Culture.

"We are mortgaging the future to scrape through the present," he said.

And study after study shows that illegal immigrants are less likely than U.S.-born residents to go to the doctor or seek regular medical care, he said.

Anti-illegal immigration activist Barbara Coe said she was thrilled that counties are beginning to restrict services. Coe's group, California Coalition for Immigration Reform, sponsored Proposition 187, the initiative that tried to bar the state from providing public services to illegal immigrants before it died in federal court.

Illegal immigrants "have absolutely no right, No. 1, to be here and, No. 2, to take the tax dollars of law-abiding American taxpayers for anything," she said.

But the policy changes have angered immigrant rights advocates, who argue that restrictions could also cause a chilling effect on legal residents and U.S. citizens in mixed-status families.

"Even those people who qualify to get care won't," said Reshma Shamasunder, director of the California Immigrant Policy Center.

Shamasunder also said that denying healthcare to one segment of the population puts everyone else at risk as communicable diseases go untreated and emergency rooms become even more crowded.

Jose Suarez, who has asthma, said he now plans to go to the hospital if he gets sick. Suarez, 25, was born in Mexico but has been living in Contra Costa County for 10 years.

"It's unfair," he said. "We are real people. I understand they have to cut a few things here and there, but I believe they can do better."

Few options

Marina Espinoza, also an illegal immigrant in Contra Costa County, said she visits a county clinic a few times a month to monitor her diabetes and high blood pressure so that she doesn't end up in the hospital. Espinoza is considering returning to Mexico, where a relative has a lead on a job with health insurance.

"None of us choose to get sick," said Espinoza, 39. "I can't afford the medications. How can I pay for that? It's that or rent."

Before changing its policy on illegal immigrants, Sacramento County took several other steps to reduce healthcare costs, including closing three of its six clinics. But that wasn't enough, said Keith Andrews, chief of primary health services in the Department of Health and Human Services. Andrews said he was left with a choice between firing staff or reducing the number of patients. The county is continuing to treat everyone for communicable diseases.

Andrews said about 4,000 people without legal residency or citizenship were receiving healthcare in the county. Although some are immigrants who have lived and worked in the area for years, he said, others are foreign natives who came to the county to receive free medical treatment.

"This decision is going to impact all of our community," he said. "It's going to create other social problems because of the impact on emergency rooms."

Seeking solutions

In Contra Costa County, which will continue treating undocumented children and pregnant women, community groups mobilized against the proposal. They helped persuade county officials to allocate additional funds to the nonprofit community clinics to help treat the 5,500 undocumented patients who will no longer be eligible for county services.

Those patients will receive primary care at the clinics, but they won't have a place to go if they need to see a specialist, such as for cancer or heart problems.

"It's a major gap," said Soren Tjernell of the Community Clinic Consortium, which represents clinics in Contra Costa and Solano counties.

Yolo County's proposal, which goes before its Board of Supervisors on May 5, would affect about 1,200 undocumented patients. Joseph Iser, who heads the county health department, said he wished that he had another source of revenue to continue services for illegal immigrants.

"Except by helping us balance the budget, it doesn't help us, it doesn't help our citizens, it doesn't help our undocumented," he said. "But if we don't have the money, we just can't afford it."

anna.gorman@latimes.com