An unfair denial of healthcare for aliens
TODAY'S HYSTERIA is tomorrow's headache for Bill Walczak and a larger hole in America's wallet and soul.
Walczak is director of the Codman Square Health Center in Dorchester, which sees lots of immigrants. On July 1, a new law will force patients to prove US citizenship for Medicaid. One of the law's sponsors in the US House is Representative Charlie Norwood, a Republican from Georgia. His website screams that the new law ''cracks down" on the ''theft" and ''fraud" of Medicaid benefits by ''illegal aliens."
This plays into the worst side of America, glowering at undocumented workers while gleefully benefiting from their low-wage labor. It is labor that is disproportionately dangerous. Latinos, the most significant source of the nation's undocumented labor force, make up 13 percent of all workers in the United States, but 23.5 percent of nonfatal injuries in construction and 26.4 percent of nonfatal injuries in janitorial work and housecleaning, according to federal statistics.
Data from the Occupational Safety and Health Administration show that between 1992 and 2002, the percentage of fatal work injuries suffered in the United States by Latinos has risen from 8.6 percent to 15.2 percent.
Despite this ultimate sacrifice for our standard of living, 75 percent of Americans, egged on by the likes of Norwood, told a Time magazine poll last month that the undocumented should be denied healthcare and food stamps. Walczak said the idea of turning healthcare centers into de facto immigration centers is political barbed wire that needs to be ripped down before it tears into people's lives.
''It puts more paperwork in the way of what we're supposed to be doing," Walczak said this week over the telephone. ''All this talk about fraud is wrong. People don't walk into our health center for the first time without a reason. They have a pain that does not go away. They might be pregnant. All that turning them away will do is make everything more expensive later for taxpayers."
A study in this month's American Journal of Public Health delivers a serious reminder of what is already happening along the lines of citizenship and healthcare. Using data from the National Survey of America's Families, the study found that three times as many noncitizens as citizens reported only fair or poor health. Not surprisingly, this correlates to their access to healthcare.
In the United States, 15 percent of families where the children and at least one parent are citizens lack health insurance. That increases to 34 percent for families where the children are US-born citizens but the parents are not, and 52 percent of families where everyone is foreign-born. Twenty-eight percent of families where everyone is foreign-born and noncitizen had no other usual source of healthcare other than the emergency room. That compares with only 6 percent for US-born families and 12 percent for naturalized families.
Only 52 percent of foreign-born, noncitizen families had seen a physician in the prior year, compared with about 77 percent for both US-born and naturalized families.
Walczak said using the law to disappear families from federally funded primary care has obvious ramifications. He cited this winter's New York Times series on diabetes, which found that insurance companies often deny payments of $75 or $150 to see a nutritionist or a podiatrist for early help, but will pay $315-a-session for dialysis or $30,000 for an amputation.
''You think people are really going to commit fraud for things like that?" Walczak said.
All of this of course is made worse by poverty, with 69 percent of the poorest, foreign-born noncitizen children and parents lacking medical insurance, according to the study in the American Journal of Public Health. Walczak said the impact of the new law might be muted somewhat in Massachusetts, where access to healthcare is a relatively prominent part of the political and economic landscape. He said it is likely to be ''a disaster" in big states like Texas, where he can already see the sight of millions either scrambling to fake documentation or just disappearing until they are dreadfully ill.
This is their reward for doing some of our most dangerous work. ''Healthcare should be a humane process where a person in pain can walk in and trust the provider," Walczak said. ''It is already complex enough as it is. But to create a situation where the first thing the healthcare provider is asking you about is not how you're feeling but your citizenship, that is not a good thing. Where is the trust?"
Derrick Z. Jackson's e-mail address is jackson@globe.com. 
