Day 4- Crossing the Border

Here we are, half way thru the Kenosha News' Crossing the Border series.

Day 4- Health care: Don’t ask or tell

A young Hispanic mother sits in the corner of the Kenosha Community Health Center on a late Monday afternoon, reading quietly to her son. She looks up briefly, then nervously averts her gaze.

Like most people, she’s probably waited more than two months for this appointment.

She might be an illegal immigrant. Or maybe not.

There’s a slightly more than 50 percent chance that she has health insurance.

But none of that matters to the small staff of the center, 4536 22nd Ave. They just want to treat her and move on to the next patient.

At the health center — which 19,425 people visited for medical care last year — there really isn’t a lot of time to worry about a patient’s personal history. Even if there was, Executive Director Rosanne McSherry said, that’s not the center’s mission.

An independent, not-for-profit organization, the Health Center’s mission is to provide care for the under-insured and uninsured. Most of the work at the federally-funded clinic is done by paid staff, but volunteers also offer support.

“It’s our job to provide quality health care, whoever walks through the door,” McSherry said. “I don’t care if the person is an illegal immigrant or not, and I don’t ask. My job is to help them and provide preventive medicine.

“The people who come here realize we’re not here to hurt them or get them in trouble,” she added.

How many of the health center’s 19,425 patients last year were undocumented immigrants is open to question, because the facility’s doors are open to everyone. Of that number, 11,987 were for medical visits, and 7,043 were for dental visits.

“A large portion (of the patients) are illegal, or people unable to get insurance,” said Maria Cervantes, a licensed practical nurse who works at the center. “But we don’t discriminate and we’ll treat anybody regardless of where they came from.”

In 1996, Congress enacted legislation that denied federally subsidized health care coverage in programs like Medicaid to the vast majority of undocumented residents. At the same time, it is estimated that most undocumented workers live at or below federal poverty levels, and according to the Wisconsin Division of Public Health, 54 percent of people who were uninsured in the state were either below or near the poverty level.

And, said many people interviewed for this story, that’s why illegal immigrants in and around Kenosha know they can come to the health center for care.

For those without insurance, seeking help in hospital emergency rooms, which are required to provide care, is the other local care option.

Meanwhile, trying to determine how Kenosha’s undocumented immigrant population affects health care availability and costs isn’t easy.

Health care providers don’t ask for citizenship status when providing care, so it is difficult to isolate the impact of undocumented workers on the health care system.

Also, lack of access to health insurance transcends ethnic boundaries — 16 percent of people in the United States are uninsured, according to 2004 statistics from the Census Bureau — but immigrant groups are far more likely to be without insurance.

According to the Census Bureau, about 33 percent of Hispanics in the U.S. are uninsured, and about 34 percent of all immigrants are uninsured, compared to 13 percent of native-born residents.

For hospitals, the number of uninsured residents of a community affects the amount of uncompensated care that is given, generally through emergency rooms, said George Quinn, vice president of the Wisconsin Hospital Association.

Statewide, hospitals provided $578 million in uncompensated care in 2004, the most recent data available.

That amounts to about 3 percent of the total patient revenues of all the hospitals in the state, a lower percentage than elsewhere in the United States where hospitals average 4 to 5 percent of patient revenues going toward uncompensated care.

Quinn said Wisconsin’s rates of uncompensated care are lower because the state has fewer uninsured residents than the majority of states, both because more companies here tend to offer insurance and because of state insurance programs like BadgerCare.

But he said the cost of providing charity care and writing off unpaid medical bills pushes up medical costs across the system. According to Quinn, about 7 to 8 percent of the cost of the average person’s medical insurance premium goes toward offsetting the cost of uncompensated care.

In Kenosha County, United Hospital System — which operates both Kenosha Medical Center and St. Catherine’s Hospital — provided $6.6 million in charity care and wrote off $5.5 million in bad debt in 2004, making up about 3.8 percent of the hospital’s total revenue.

Aurora Hospital in Kenosha provided $1.3 million in charity care and wrote off $5.6 million in bad debt in 2004, also 3.8 percent of its total patient revenues.

Children’s Hospital of Wisconsin, which operates a small pediatric hospital within Kenosha Medical Center, provided $4,279 in charity care and wrote off $82,290 in bad debt, for a total of 1.6 percent of its patient revenue.

Memorial Hospital of Burlington, operated by Aurora, gave $730,695 in charity care and wrote off $1.7 million in bad debt, for 2.3 percent of its total patient revenue.

McSherry, of the community health center, said it would be easy for her to determine who was and wasn’t a legal resident, but she has no interest in doing so.

Most of the patients who come to the health center are Hispanic — 49 percent last year. White patients make up the next biggest number at 32 percent, followed by blacks at 17 percent and other races the remaining 2 percent.

Just 4 percent of those coming through the door had private insurance. Forty-four percent had no insurance at all, while 49 percent had Medicare and 3 percent had Medicaid.

All of those people are treated by three family practice doctors and several nurses; or on the dental side, four general dentists and one pediatric dentist.

The center is always packed, and there’s usually an eight- to 10-week wait for a doctor’s appointment and a month for dental care.

“One thing that is important is we are not a free clinic,” McSherry said. “If you have the ability to pay, you must pay.”

It’s not cheap to run such a place. The center has a $2.5 million yearly budget, and the government picks up only about 35 percent of that tab. The rest comes from grants, third-party billing for those who have some form of insurance and the hope that those who don’t have any insurance will still pay something.

“Patients pay on a sliding scale, and get discounts based on family size and income,” McSherry said. “People are pretty good about paying. Our collection rate is about 70 percent.”

That’s because with each appointment, patients are also set up with a financial counselor to come up with a payment plan. Or if a patient needs a prescription, the center can make sure they’re enrolled in a program that can cover some or most of their expenses.

One of the goals is to take the burden off of hospitals in the area. “Obviously, if we’re closed, and there is an emergency, people are going to use one of the emergency rooms,” McSherry said. “But at the health center, it’s about prevention. We’d rather treat someone before they get sick, so they don’t have to end up in an emergency room somewhere else. In doing that, we build a genuine relationship with the people who come here.”

It’s tough work, she said, but it gives you a good feeling at the end of the day.

McSherry spent the first 28 years of her career as an emergency room nurse, where listening to a daily litany of patients demands was the norm.

“That’s why I left that kind of work, because we worked so hard and the people we treated didn’t seem to care,” she said. “Here, the patients are very appreciative, because we’re interested in them and their families. And they show us their appreciation by bringing us food. We get to see their kids grow up, and it’s very rewarding work. It’s much different than (at a hospital). You feel good working here because people are genuinely thankful of the care they receive.”

Cervantes, more than most people, has intimate knowledge of what it’s like to live somewhere illegally. After a few minutes, she admits that she entered the U.S. illegally 27 years ago, and then became a resident two years later.

"But even when I wasn’t legal, I was a very hard worker,” she said. “People automatically assume that if someone is illegal they aren’t working hard and contributing with taxes, and that’s not true. If anything, people here illegally work even harder because they want to make it and they want to be successful. I have worked hard every day that I have lived in this country.”

Her own background helps deal with patients who come in with severe medical issues. Occasionally, she said, the center treats women who were sexually abused while trying to cross the border.

“They won’t say anything at first because they’re embarrassed, but when they see us, we’re Latinos, and when they learn about our background that gives them security and reassurance,” Cervantes said. “I tell them, ‘When you talk to me, it’s like talking to a priest. I won’t repeat what you say.’”

Cervantes, and her coworker, Lili Ochoa, a medical assistant, say it’s easy to figure out who is a legal citizen, and who isn’t.

“Most of the people (who are illegal) know you are helping them, and they are just very thankful. They bring us food, they make clothes for us. They’re just happy to have us here,” Ochoa said. “Some of the Americans have a different attitude. They want to be seen, and seen now. People will accuse us of ignoring them because of their ethnicity, and that’s not true. Sometimes you can’t let it bother you.”

But sometimes, Cervantes said, it can get to be too much.

“And when that happens, once in awhile, you have to remind them of who we are. I’ll tell someone, ‘Listen, we’re here to help you, without judging you, so don’t treat me like that.’”

Today, I have only one question:

Should Americans being paying for the health costs of illegal immigrants?