New study shows undocumented immigrants good for Arizona economy

We can now add Arizona to the long list of states in which recent studies prove that the current influx of immigrants, both legal and undocumented, have contributed far more in taxes than they receive in government services.

Joining studies from California, Texas, Florida, New Mexico, Washington DC, and Long Island, NY, a new report from Udall Center for Studies in Public Policy at The University of Arizona looks at the contributions and costs of Arizona's immigrant population and finds not only an overall net gain for the state, but that the loss of this population would likely cause long term economic problems.

At a time when states like Georgia, Oklahoma and Colorado, and municipalities large and small all over the country, are passing harsh legislation intended to drive off their immigrant populations, this Arizona study concludes that, in the long run, these restrictionist tactics will end up creating economic disaster for certain segments of the economy and an overall loss for all residents. These finding don't bode well for the state which already has some of the toughest anti-immigrant laws in the nation.

The study is also unique in that it breaks out the non-citizen population from the rest of the immigrant population and still comes to the same overall conclusions.

This is a important development, since one of the restrictionsts chief weapons in their war of misinformation has been the lack of information on the contributions of the undocumented versus the larger immigrant population.

This has allowed them to wrongly discount or discredit many of the previous studies by claiming that undocumented are somehow different than the broader immigrant population in their use of services or contributions.

Based on this study, the total state tax revenue attributable to immigrant workers was an estimated $2.4 billion, of which about $1.5 billion came from for non-citizens. Balanced against estimated fiscal costs of $1.4 billion (for education, health care, and law enforcement), the net 2004 fiscal impact of immigrants in Arizona was positive by about $940 million.

The 2004 total economic output attributable to immigrant workers was about $44 billion, $29 billion of that coming from non-citizens. This output included $20 billion in labor and other income and resulted in approximately 400,000 full-time-equivalent jobs.

The study also looks at what impact the removal of as little as 10-15% of the immigrant workforce would have on the state's economy. Over $.5 billion in tax revenues would be lost, 125,000 jobs and $13.5 billion of lost economic output.

Clearly, lawmakers from statehouses to city councils across the country should examine this study before they begin to contemplate the adoption of restrictionist tactics and harsh legislation when addressing this issue. …..like the old saying goes:
"Be careful what you wish for … or you just might get it."

Immigrants in Arizona: Fiscal and Economic Impacts
by Judith Gans
Udall Center for Studies in Public Policy at The University of Arizona.

Preface
Arizona’s foreign-born population has grown dramatically since 1990 when there were about 268,700 foreign-born persons in the state. By 2004, the foreign-born population had grown to 830,900. This is more than a 200 percent increase. The vast majority of these new immigrants are in the non-citizen category, which went from 163,300 to about 619,800, an increase of almost 280 percent. Most immigrants are of working age and have come to the United States seeking employment. This fact is central to their impacts in Arizona.

The likelihood that many of Arizona’s non-citizens are undocumented immigrants has fueled anger over lawlessness and made discussion of immigration in Arizona politically contentious. But Arizona’s experience is a specific case of a national problem, one that exists because large economic incentives in today’s global economy are overwhelming the U.S. immigration system – a system that is widely understood to be in need of reform. Public discourse that equates immigration and illegal immigration is narrowly focused and risks overlooking broader dimensions of the role of immigrants in the economy.

It is not the purpose of this study to address the myriad issues surrounding illegal immigration or to imply in any way that illegal immigration is not a problem. Rather, the objective of this study is to suspend, for the moment, discussion of this narrow topic and focus instead on a broader examination of all immigrants’ impacts on Arizona’s economic and fiscal health. By so doing, we hope to create a more thorough understanding of the economic costs and benefits of immigration and of the tradeoffs involved in setting and enforcing immigration policy.

In Brief

Arizona’s proximity to Mexico, the growth of its immigrant population, and the proportion of immigrants that are in the United States illegally have made immigration a contentious issue. This study is intended to step back from debates over illegal immigration and deepen our understanding of the costs and contributions of immigrants to Arizona’s economy.

Executive Summary

This report examines the costs and benefits of immigration in Arizona. It provides estimates of the of incremental fiscal cost associated with immigrants – education, health care, and law enforcement – and measures their contributions to Arizona’s economy both as consumers and as workers. The two categories of immigrants (naturalized citizens and non-citizens) are examined separately in order to disentangle the economic costs and benefits associated with each.

The bottom line

Based on this study, the total state tax revenue attributable to immigrant workers was an estimated $2.4 billion (about $860 million for naturalized citizens plus about $1.5 billion for non-citizens). Balanced against estimated fiscal costs of $1.4 billion (for education, health care, and law enforcement), the net 2004 fiscal impact of immigrants in Arizona was positive by about $940 million.

The 2004 total economic output attributable to immigrant workers was about $44 billion ($15 billion for naturalized citizens and $29 billion for non-citizens). This output included $20 billion in labor and other income and resulted in approximately 400,000 full-time-equivalent jobs.

Fiscal costs of immigration

Estimates of the incremental fiscal costs of immigration were derived from a variety of sources. In summary:

• Education: For this analysis, English Language Learner (ELL) enrollment was used as a proxy for the number of immigrant children in Arizona’s public schools. The 2004 cost of ELL education in Arizona was about $540 million of which about $350 million (65 percent) was incurred in Maricopa County.



• Health care: Total uncompensated care costs (reported as bad debt) for hospitals in Arizona was about $420 million, of which an estimated $150 million (32 percent) was incurred by immigrants. Of the $150 million in uncompensated care costs associated with immigrants, nearly $140 million was incurred by non-citizens.
  
  The total cost in 2004 of Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid program, was $4.3 billion, of which an estimated $640 million was incurred by immigrants. Of the $640 million in AHCCCS costs associated with immigrants, about $480 million was incurred by non-citizens.



• Law enforcement: In the area of law enforcement, the cost to the Arizona Department of Corrections of incarcerating immigrants in 2004 was $91 million, of which $89 million was for non-citizens.

Immigrants as consumers

As consumers, immigrants bring considerable spending power to Arizona’s economy. This spending contributes to Arizona’s overall economic performance, and, in turn, generates tax revenues for the state.

• Jobs and income: Consumer spending in 2004 by naturalized citizen households in Arizona was an estimated $6.1 billion. Approximately 39,000 full-time equivalent jobs can be attributed to this spending along with $5.9 billion of output in the state’s economy.
  
  This output included labor income of $1.2 billion, and other income (defined as rents, royalties, dividends, and corporate profits) of $900 million.
  
  Consumer spending in 2004 by non-citizen households in Arizona was an estimated $4.4 billion. Approximately 28,000 full-time equivalent jobs can be attributed to this spending along with $4.3 billion of output in the state’s economy. This output included labor income of about $930 million, and other income (defined as rents, royalties, dividends, and corporate profits) of $560 million.



• Tax revenues: Consumer spending in 2004 by Arizona’s naturalized citizens generated tax revenues of approximately $460 million, consisting of personal taxes of about $49 million, sales taxes of about $210 million, and business taxes of $190 million.
  
  Consumer spending in 2004 by Arizona’s non-citizens generated tax revenues of approximately $320 million, consisting of personal taxes of nearly $36 million, sales taxes of $150 million, and business taxes of about $130 million.
  Immigrants as workers
  
  Immigrants in 2004 were 14 percent of Arizona’s workforce, and were a larger proportion of low-skilled labor in agriculture, construction, manufacturing, and certain service industries. High-skilled immigrants were a large percent of the workers in specific areas of medicine and science.

In low-skilled occupations in Arizona:

• Agriculture: Immigrants were 59 percent of the workforce in farming occupations and 22 percent of the workforce in food-preparation-and-serving occupations.


• Construction: Immigrants were between 35 percent and 41 percent of the workforce in certain construction trades such as brick masons, flooring installers, and cement masons. They were 27 percent of the workforce in all construction trades.


• Manufacturing: Immigrants were 35 percent of the workforce in food-related manufacturing, 46 percent of the workforce in textile-related manufacturing, and 22 percent of the workforce in metal-working manufacturing.


• Service industries: Immigrants were 34 percent of the workforce in occupations providing services to buildings, 51 percent of the workforce in landscaping-services occupations, and 38 percent of the workforce in building-and-grounds maintenance. Immigrants were 26 percent of the workforce in traveler-accommodations occupations, 23 percent of the workforce in restaurant-and-food-serving occupations, and 33 percent of the workforce in private-household help.

In high-skilled occupations in Arizona:

• Medicine: Immigrants were 38 percent of medical scientists and 19 percent of physicians and surgeons.


• Science: Immigrants were 36 percent of astronomers and physicists, 16 percent of computer-hardware engineers, 18 percent of computer-software engineers, and 17 percent of electrical and electronics engineers. Immigrants were 15 percent of economists.

Economic contributions of immigrant labor

Approximately $15 billion, or four percent, of the state’s output can be attributed to naturalized citizen workers, resulting in about 120,000 full-time-equivalent jobs. This output included $4.9 billion in labor income and $1.9 billion of other income in the state. State tax revenues resulting from this economic activity were approximately $860 million.

Non-citizens, for their part, contributed about $29 billion, or eight percent of Arizona’s economic output, resulting in about 280,000 full-time-equivalent jobs. Their output included $10 billion in labor income, and $3.3 billion in other property income. The state tax revenues resulting from this economic activity were approximately $1.5 billion.

The role of immigrants as workers can be further understood by analyzing the potential consequences of this source of labor not being available. In other words, what would be the impacts if immigrant labor were removed from the economy?

To this end, this study used a series of computer simulations to examine the impacts of reduced immigrant labor on the industries that employ relatively large numbers of immigrants. The study focused on industries employing low-skilled, non-citizen workers because this is where recent growth in Arizona’s immigrant population has occurred and because we know that significant numbers of these workers are in the country without authorization. Thus, the simulations are designed to estimate the economic consequences of eliminating this segment of the workforce.

• Agriculture: A 15-percent, immigrant-workforce reduction in the agriculture sector would result in direct losses of 3,300 full-time-equivalent jobs, and losses of about $600 million in output including lost labor income of about $200 million, and lost other income of about $110 million. The lost direct state tax revenue would be approximately $25 million.


• Construction: A 15-percent, immigrant-workforce reduction in the construction sector would result in direct losses of about 56,000 full-time-equivalent jobs, and about $6.6 billion in output including lost labor income of about $2.6 billion and some $450 million in lost other income. The direct lost state tax revenue would be approximately $270 million.


• Manufacturing: A ten-percent reduction in immigrants in the manufacturing workforce would result in direct losses of about 12,000 full-time-equivalent jobs, and about $3.8 billion in output including lost labor income of about $740 million, and lost other income of nearly $290 million. The lost direct state tax revenue would be approximately $100 million.


• Service industries: In the service sectors analyzed, a 16-percent reduction in the immigrant labor force would translate to direct losses of 54,000 full-time-equivalent jobs, and lost output of $2.5 billion including reduced labor income of about $900 million, and reductions in other income of about $270 million. The lost direct state tax revenue would be nearly $160 million.

Net fiscal impacts of immigrants

Total state tax revenue attributable to immigrant workers was estimated to be about $2.4 billion ($860 million for naturalized citizens plus $1.5 billion for non-citizens). Balanced against estimated incremental fiscal costs of $1.4 billion, the net 2004 fiscal impact of immigrants in Arizona was positive, by approximately $940 million.

As 14 percent of the workforce, immigrants make significant contributions to Arizona’s economy. There are also specific fiscal costs associated with immigrants. But, by virtue of their contributions as workers to Arizona’s economic output, their overall contribution to the state’s fiscal health is positive. Certainly, these impacts are changing over time, but looking at data for one year provides a snapshot of the extent and magnitude of the role of immigrants in Arizona’s economy.

Note: We have estimated the incremental (marginal) costs of immigrants as individuals. If the immigrants were not present in Arizona, these costs would disappear. Immigrants’ impacts on costs of social services, such as fire and public safety protection, are not estimated because it is not possible to measure the incremental costs attributable to immigrants for these services.

Read complete report

UPDATE: 10/16/07: 7:30 EDT

Some questions have been raised at various other sites about two aspects of this study. One is the standard question about breaking down the numbers for just the undocumented population as oppossed to the non-citizen population as a whole.

The other questioning the extrapolations made about the economic costs of losing a portion of the undocumented workforce and the possible replacement of those workers with US-born workers.

the study answers both those questions:

How much of Arizona's immigrant population is here illegally?

We do not know. The U.S. Census does not ascertain legal presence in the United States when conducting its surveys and so the non-citizen category includes both legal and illegal non-citizen immigrants. However, there are reasonable, statistically derived estimates. Research by Jeffrey Passel at the Pew Hispanic Center indicates that, in 2002, there were between 250,000 and 350,000 unauthorized immigrants in Arizona, most of whom came from Mexico, and that by 2005 their numbers had increased to as many as 500,000.

Given these numbers it's statistically safe to estimate that somewhere around 80% of the non-citizen population is in fact undocumented in Arizona. This allows us to extrapolate the statistics given on the "non-citizen" population to see what's occurring with just the undocumented portion of that population.

As to the extrapolations made about the effects of the removal of the undocumented population on the economy and the likelihood that US-born workers would step up to fill the gap:

Our analysis to this point has focused on measuring the portion of Arizona's economic activity attributable to immigrants in its workforce. This raises the following question: would the jobs filled by immigrants be taken instead by native-born workers if immigrants were not part of the labor force in Arizona? The answer to this question is complex but largely depends on the availability of native-born workers with skills similar to Educational attainment data, both for Arizona and for the United States, indicate that immigrants and native-born workers tend to have different skills, with immigrants filling specific gaps in the native-born workforce by providing needed low-skilled and high-skilled workers. Immigrants in Arizona are an important source of low-skilled labor and of specific high-skilled labor that is relatively scarce in the native-born population and thus are vital to the total output of the industries that employ them. It is difficult to make the case that all or even most jobs filled by immigrants would, instead, be filled by native-born workers if immigrant workers were not available.

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A look at Lou Dobbs' leprosy "expert"

Last Sunday, Lou Dobbs appeared on 60 minutes for an in-depth interview with Leslie Stahl, were he finally admitted that he believes the government could track down and deport millions of undocumented immigrants if it only made the commitment to do so.

But more importantly, after years of playing extremely loose with facts and figures in order to make his case, Dobbs was finally caught in one of his big fat lies in front of a national audience.

Both Media Matters and Dave Neiwert at Ornicus have done excellent jobs of dissecting the story, so I'll just cover the basic facts here and refer readers to those two stories to get more in-depth information.

It all started with the following exchange:

Following a report on illegal immigrants carrying diseases into the U.S., one of the correspondents on his show, Christine Romans, told Dobbs that there have been 7,000 cases of leprosy in the U.S. in the past three years.

60 Minutes checked that and found a report issued by the U.S. Department of Health and Human Services, saying that 7,000 is the number of leprosy cases over the last 30 years, not the past three. The report also says that nobody knows how many of those cases involve illegal immigrants.

"We went to try and check that number, 7,000. We can’t…," Stahl says.

"Well, I can tell you this. If we reported it, it’s a fact," Dobbs replies.

"You can’t tell me that. You did report it," Stahl says.

"I just did," Dobbs says.

"How can you guarantee that to me?" Stahl asks.

Says Dobbs, "Because I'm the managing editor. And that’s the way we do business. We don’t make up numbers, Lesley."

link

So it came as no surprise that the following day, Dobbs took time out of his nightly hate-fest to answer 60 minutes charges. He reiterated numerous times that despite the obvious discrepancy between his figures and those of the U.S. Department of Health and Human Services - he never "makes up numbers":


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So there it was for all his loyal viewers to see. According to Dobbs, a doctor writing in a medical journal had reported those statistics, so obviously 60 min (and the US Dept of Health and Human Services) were wrong….case closed …if he reports it, it's a fact.

But as Media Matters and Ornicus report, it's not quite so cut and dry.

Madeleine Cosman does in fact hold a doctorate degree… but it's in English and comparative literature. …Dobbs' minion, Christine Romans, neglected to mention that when she descibed Cosman as a " a respected medical lawyer and medical historian writing in the "Journal of American Physicians and Surgeons".

So exactly where did this doctor of English literature get her hard medical data?
From medical studies or research? … of course not. She got her figures from a story gleaned from the New York Times.

But there was just one problem with Cosman's excellent research work. Dobbs' expert academic source had managed to actually misquote the Times in her article in the Journal of American Physicians and Surgeons, skewing the numbers to make her case.

According to Cosman:

Leprosy, Hansen's disease, was so rare in America that in 40 years only 900 people were afflicted. Suddenly, in the past three years America has more than 7,000 cases of leprosy. Leprosy now is endemic to northeastern states because illegal aliens and other immigrants brought leprosy from India, Brazil, the Caribbean, and Mexico.

Illegal Aliens and American Medicine, Dr Madeline Cosman, Journal of American Physicians and Surgeons, Spring 2005

A quick check of Dr. Cosman's footnotes reveals her source was a New York Times Article from February 2003 that actually said something quite different.

While there were some 900 recorded cases in the United States 40 years ago, today more than 7,000 people have leprosy, or Hansen's disease, as it is now called.
New York Times, Leprosy, a Synonym for a Stigma, Returns, Feb 18, 2003 ( alternate link to cited article)

There's no mention of "the last three years" in the original article. It says there were 900 cases 40 years ago not "900 cases in 40 years". It also said that in the following 40 years that number had increases to 7000 cases, not "more than 7000 in the last three years."

But then again if Dobbs reports it –it's a fact.

(To see the complete 60 minutes segment on leprosy and Dobb's reaction - see this great video from Media Matters)



The question now raised seems to be - beside the fact that she supplied numbers that he liked and that made his case - why would Dobbs ever want to stake his reputation on the faulty scholarship of Dr Cosman?

Because, like many of Dobbs' guest experts - she' s clearly a NUTJOB:


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Oh Yeah, I remember why Dobbs would rely on Dr Cosman's research ….

Because once Dobbs reports it -it becomes fact

Related
Truth, Fiction and Lou Dobbs, New York Times, May 30,2007

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Texas Comptroller reports undocumented immigrants good for economy

A report released this week by the Texas Comptrollers Office found that undocumented immigrants contributed $17.7 billion to that states economy and that state revenues collected from undocumented immigrants exceeded what was spent on services for them by $424.7 million.

The report found that undocumented immigrants in Texas generated more taxes and other revenue than the state spends on them. These findings run in direct contradiction to a recent report from The Federation for American Immigration Reform (FAIR), “The Cost of Illegal Immigration to Texans” which claimed that "Texas’s illegal immigrant population is costing the state’s taxpayers more than $4.7 billion per year for education, medical care and incarceration."

Comptroller, Carole Keeton Strayhorn, was quick to point out that this was the first time any state agency in the country presented "a comprehensive financial analysis of the impact of undocumented immigrants on a state’s budget and economy, looking at gross state product, revenues generated, taxes paid and the cost of state services."

The report titled "Undocumented Immigrants In Texas: A Financial Analysis of the Impact to the State Budget and Economy" found that "“the absence of the estimated 1.4 million undocumented immigrants in Texas in fiscal 2005 would have been a loss to our gross state product of $17.7 billion. Undocumented immigrants produced $1.58 billion in state revenues, which exceeded the $1.16 billion in state services they received."


tags: immigration, Texas comptroller study

Much has been written in recent months about the costs and economic benefits associated with the rising number of undocumented immigrants in Texas and the U.S. as a whole. Most reports tie the costs of the undocumented population to education, medical expenses, incarceration and the effects of low-paid workers on the salaries of legal residents. Revenue gains to governments resulting from undocumented immigrants consist primarily of taxes that cannot be avoided, such as sales taxes, various fees and user taxes on items such as gasoline and motor vehicle inspections.

This financial report focuses on the costs to the state of Texas; that is, services paid for with state revenue, including education, healthcare and incarceration. What government- sponsored services are available to undocumented immigrants is often determined by federal restrictions on spending (Exhibit 1). The report also identifies areas of costs to local governments and hospitals. Finally, it analyzes the $17.7 billion impact on the state’s economy as well as state revenues generated by undocumented immigrants.

The Comptroller’s report estimates that undocumented immigrants in Texas generate more taxes and other revenue than the state spends on them. This finding is contrary to two recent reports, FAIR’s, “The Cost of Illegal Immigration to Texans” and the Bell Policy Center’s “Costs of Federally Mandated Services to Undocumented Immigrants in Colorado”, both of which identified costs exceeding revenue.

-snip-


The immigration debate has become more heated in 2006. Congressional hearings were held across the U.S. to discuss the impact of undocumented immigrants on the economy and the culture. At the same time, two distinctly different pieces of legislation were voted out of the U.S. House and Senate.

The Comptroller’s office estimates the absence of the estimated 1.4 million undocumented immigrants in Texas in fiscal 2005 would have been a loss to our Gross State Product of $17.7 billion. Also, the Comptroller’s office estimates that state revenues collected from undocumented immigrants exceed what the state spent on services, with the difference being $424.7 million (Exhibit 18).

The largest cost factor was education, followed by incarceration and healthcare. Consumption taxes and fees, the largest of which is the sales tax, were the largest revenue generators from undocumented immigrants.

"Undocumented Immigrants In Texas: A Financial Analysis of the Impact to the State Budget and Economy"

The study did show that unlike the state, local governments and hospitals incur costs that are not reimbursed by the state or federal government.

While not the focus of this report, some local costs and revenues were estimated. State-paid health care costs are a small percentage of total health care spending for undocumented immigrants. The Comptroller estimates
cost to hospitals not reimbursed by state funds totaled $1.3 billion in 2004. Similarly, 2005 local costs for incarceration are estimated to be $141.9 million. The Comptroller estimates that undocumented immigrants paid more than $513 million in fiscal 2005 in local taxes, including city, county and special district sales and property taxes.

While state revenues exceed state expenditures for undocumented immigrants, local governments and hospitals experience the opposite, with the estimated difference being $928.9 million for 2005.

The $1.3 billion in uncompensated costs to local hospitals attributed to undocumented immigrants represents 14% of the total $9.2 billion in uncompensated care reported for uninsured and underinsured individuals who could not pay for the services they received. As healthcare professionals are quick to point out, the problem of uncompensated care is systemic and not limited to the undocumented. Studies show that the undocumented generally utilize health services at a much lower rates than legal residents and that the chief causes of increasing rates of uncompensated costs are the ever increasing numbers of uninsured coupled with limited payment schedules of government programs such as Medicaid and Medicare.

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Healthcare professionals weigh in on cost of undocumented

A few weeks ago the health care policy journal "Health Affairs" released a study looking at the use of hospital emergency rooms as primary care facilities by undocumented immigrants and Hispanics in general. Contrary to popular opinion that states that immigrants "crowd our emergency rooms" running up costs for all American tax payers, the study found that undocumented immigrants, and Hispanics on a whole, used emergency services at a considerably lower rate than any other demographic group. It was native-born recipients of government funded healthcare programs such as Medicare and Medicaid who were chief cause of rising emergency department costs according to the study.

Weighing in on the debate, the Hospital Association of Southern California recently released a statement on the effects of the undocumented on healthcare costs. The Association, which represents 170 different hospitals in a state that contains the largest number of foreign born residents in the country, asserted that blaming immigrants for increased healthcare cost takes focus away from the true root causes of the current healthcare crisis.

tags: immigration, healthcare, HASC , uninsured, hospital closings



From James Lott, Executive Vice President of the Hospital Association of Southern California comes this statement:

(Reprinted with permission.)

FOCUSING ON HEALTHCARE COST OF ILLEGAL IMMIGRATION DRAWS ATTENTION AWAY FROM THE REAL PROBLEMS

Too many illegal immigrants are overwhelming the healthcare system and driving up health insurance costs. That's the latest sound bite in the war of words over immigration reform. In a recent poll, a majority of the respondents thought that illegal immigrants were responsible for 50 percent or more of the uninsured treated in Southern California hospitals. But is that really the case?

While it is true that providing treatment to undocumented immigrants creates a drain on hospital resources, the question is: How much of the problem can reasonably be attributed to the undocumented? And if we solved the problem of illegal immigration tomorrow -- which we won't -- would healthcare costs return to "reasonable" levels?

Illegal immigrants are responsible for roughly 20 percent of the $2 billion in unreimbursed care that Southern California hospitals deliver each year. Even if you consider that factor, you have to conclude that it's the larger problem of just simply having so many uninsured patients that is a key driver of rising hospital costs.

In order to receive federal Medicare and Medicaid payments, a hospital must agree to treat and stabilize everybody who shows up to a hospital ER regardless of their ability to pay or their immigration status. That means undocumented immigrants who show up at the emergency room will receive treatment regardless of their immigration status or whether they're insured. But so will legal immigrants, naturalized citizens and native-born Americans.

It is a matter of law that these people receive treatment. Indeed, we may have an ethical responsibility to do so as well. The problem is that most hospitals in California end up being paid for only about 5 percent of the medical care given to uninsured patients. And that leads to the question: So, who's going to pick up the tab?

In the absence of strong political leadership on the question of insuring the uninsured, the answer, inevitably, is that hospitals and those patients with insurance, as well as those uninsured who do pay, will end up paying for those who seek care without insurance -- regardless of whether they are here legally or not.

Mr. Lott, in another article, took a look at a recent study of the spate of hospital closings in California. Between 1995 and 2000, 23 hospitals were forced to close their doors. Common wisdom would dictate that the increase in undocumented immigration played some role in these closings. A popular argument in the "blame the immigrants for healthcare problems" camp has always been that because of rising costs incurred due to undocumented immigrants, hospitals all over the country have been forced to close. The study commissioned by California Attorney General Bill Lockyer found that the situation is far more complex than that and villains numerous.

HOSPITAL CLOSURES: AN UPDATE

...The researchers concluded "…that financial hardship was the common reason cited by all the [23] hospitals that closed [between 1995-2000], a claim which is supported by an examination of their financial performance. In each case, we found declining reimbursements, income per bed and utilization present prior to closure."

The researchers went on to say they "…learned that urban, Southern California hospitals, located in close proximity to other hospitals, were the ones that most frequently closed."

It's as simple as that and the villains are easy to identify:

• Health plans and their predatory payment practices


• Government and its inadequate Medicare and Medi-Cal payments


• Unfunded mandates (e.g. seismic safety, nurse staffing, etc.)


• Labor shortages and out-of-control labor costs


• Spiraling construction costs


• Uninsured and underinsured Californians


• Unbridled demand for services


• Non-general acute care hospital competitors (e.g. specialty hospitals)

Since this report was published in 2001, another 17 hospitals closed in Southern California, 11 of which were located in Los Angeles County....

Link

Obviously, like all other problems blamed on increased immigration from school overcrowding to high taxes, the problems of our healthcare system are complex and have multiple causations, not the least of which is the government's inability to supply the leadership necessary to ensure a system that can provide adequate healthcare for all its citizens. The number of uninsured in the United States has surpassed the 45 million mark and is expected to reach 56 million by 2013. Moreover, 15.6 million Americans are "underinsured."

Given the fact that California ranks number 1 in the nation in immigrant population by a large margin, we can assume that the situation there represents the most extreme case scenario in the country. According to 2000 census, 8.9 million people - 26.2 % of the population were foreign born while the national average is 11.1 percent. Of the foreign born, 60.8% are not US citizens.

When the largest organizations of healthcare professionals in California maintain that to blame immigration for the failing healthcare system only takes attention from the real problems ... Somehow you would think people might listen.

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Study shows immigrants play no role in healthcare crisis.

Contrary to popular opinion, and the propaganda coming from anti-immigration advocates in Washington, a new study released in health care policy journal Health Affairs found that undocumented immigrants are not the cause of a public health crisis defined by over-crowded emergency departments, higher health care costs, and lower-quality primary care.

The study of 46,600 people living in 60 different communities found that the communities with high levels of Hispanics and undocumented immigrants had far lesser rates of emergency department use than communities with low undocumented representation. By far the largest cause of emergency department overcrowding was found to be an increased use of them as primary care facilities by native born Medicare and Medicaid recipients.


[Editors Note:] The link to the study in Health Affiars is now expired. A MS Word file of the study is available at: http://83.149.77.10/Docs%20EFPR/What%20Accounts%20For%20Differences.doc

tags: immigration, emergency room use, undocumented immigrants




The supposed stress put on our healthcare system by the undocumented has been a cornerstone in much of the anti-immigrant rhetoric coming out of Washington.

According to the official Republican talking points on immigration, Respect for the Law & Economic Fairness: Illegal Immigration Prevention, Republican pollster Frank Luntz suggests that candidates should stress that "... as a matter of principle, we should not use our tax dollars to pay for services for illegal immigrants until we take care of the hard-working, tax-paying Americans. This shows voters that you have compassion but that you also understand where your priorities are – and should be."

He suggest that a good way to express this point is to use the following language:

"If we stop people from successfully getting across the border, then our schools won’t be as overcrowded, the hospital waiting rooms and emergency rooms won’t be as overcrowded, our highways and our streets won’t be as overcrowded, our social services won’t be as abused, and taxpayers won’t be as punished.” .... Frank Luntz

This kind of rhetoric works because between 1993 and 2003 there's been a 26 percent increase in the number of hospital emergency department (ED) visits, totaling about 114 million visits each year. Up to one third of these visits were classified as nonurgent or semi-urgent and could have been taken care of by regular primary care physicians.

It has long been assumed that these increases had been caused by the increasing population of undocumented immigrants and the growing number of uninsured Americans using emergency rooms as their sole source of medical treatment.

According to the study What Accounts For Differences In The Use Of Hospital Emergency Departments Across U.S. Communities? by Peter Cunningham, a senior fellow at the Center for Studying Health System Change in Washington, D.C., "communities with the lowest ED use tended to have a higher percentage of Hispanics and noncitizens than communities with high ED use." The blame for the increase in ED usage falls not at the feet of the undocumented or the uninsured but rather on those who are the recipients of various government healthcare programs.

This study examines the extent to which differences in populations and health system factors account for variations in ED use across U.S. communities. Contrary to popular perceptions, communities with high ED use have fewer numbers of uninsured, Hispanic, and noncitizen residents. Outpatient capacity constraints also contribute to high ED use. However, high ED use in some communities also likely reflects generic preferences for EDs as a source of care for nonurgent problems.

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There is much concern that some of the increase will be driven by illegal immigration, which is cited as straining ED capacity in some hospitals, especially along the U.S./Mexico border. However, given the very low levels of ED use among poor noncitizens in general (many of whom are likely to be undocumented immigrants), it is very unlikely that these highly localized problems with ED crowding will affect the nation more generally as the Latino population increases and migrates to other parts of the country. Low use of the ED among noncitizens reflects low use of health care services in general and perhaps fear among undocumented immigrants about being asked about their immigration status.

...as our findings indicate, communities have high rates of per person ED use in part because they have fewer, rather than greater, numbers of Hispanics and noncitizens

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Insurance, demographic, socioeconomic, and health factors are strongly related to individuals’ ED use, although some of these results run contrary to popular perceptions. For example, in 2003, the uninsured had about sixteen fewer visits on average (per 100 people) compared to Medicaid enrollees, about twenty fewer visits compared to Medicare enrollees, and roughly similar levels of use compared to privately insured people (Exhibit 3). Noncitizens had much lower levels of ED use than citizens did (about 17 fewer visits per 100 people, on average), and the difference between poor citizens and non-citizens was almost twice as large. In terms of racial/ethnic differences, blacks had higher ED use levels than whites and Hispanics did in 2003. More in line with expectations was the higher ED use by poor people (less than 100 percent of poverty) compared to other income groups, and higher ED use by people in fair/poor health and with chronic medical conditions.

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Although uninsured people rely on EDs to a greater extent than insured people do because of a lack of access to other outpatient care, their actual use of hospital EDs is no greater than that of the privately insured, probably because fear of incurring the entire cost of an ED visit acts as a constraint on how frequently they visit EDs. Although rising uninsurance rates might not raise ED visit rates among the population, higher levels of uncompensated ED visits in many hospitals are likely to result, especially in public hospitals and other safety-net hospitals that tend to serve a high proportion of uninsured people

The survey found that the one group that accounts for most of the increased usage of emergency departments are those on government programs such as Medicaid and Medicare. This is in part due not only to the general health issues of the elderly and poor, but the lack of other services available to this segment of the population. Many physicians are unwilling to take on new low-income patients due to Medicare and Medicaid's limited payment schedules. Ethnically, the study found that blacks were the most likely group to use emergency room services. This would be due to a combination of lack of services in low-income black neighborhoods and a resulting "generic preference for EDs as a source of care" amongst members of this under-serviced community.

High levels of ED use among Medicare beneficiaries and Medicaid enrollees are a potential source of increases in ED visit rates in the future. The aging of the population and retirement of the baby-boom generation will greatly increase Medicare enrollment and the proportion of the population who are elderly, who tend to have higher levels of ED use compared to other age groups.

Also, continued increases in private insurance costs could result in increases in both Medicaid and other public coverage of nonelderly people, as well as increases in the number of uninsured people. High use of EDs in Medicaid likely reflects in part little or no cost sharing for health services use, and perhaps lack of access to office-based physicians (because of low physician reimbursement rates under Medicaid)

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This study also shows that longer waiting times for appointments with physicians and a higher number of physician office visits relative to the number of physicians in a community increased ED visit levels, and the effects were greatest for poor people (Exhibit 2). In part, this may reflect the fact that physicians with full practices and constrained reimbursement from Medicaid and other payers were less willing to see low-income patients in their offices and more likely to refer such patients to the ED.

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As is the case with many of the "problems" attributed to the "immigration crisis", the overcrowding of emergency rooms and the subsequent economic strains put on the healthcare system, can be attributed more to governmental failure to properly administer its public health programs to assure proper care for all Americans than on the influx of undocumented immigrants. It's just another of the many false preconceptions perpetuated by the anti-immigration proponents to further their agenda of misdirection and blame shifting.

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