Commentary: Is it Wise to Cut Health Services For Undocumented Residents?

The cuts will be broader than just services to undocumented workers, it will be roughly 1.5 million dollars in savings by reducing and modifying eligibility for patients.  YCHIP (Yolo County Healthcare for Indigents Program) currently servces about 2,500 Yolo County residents, they estimate about half of those are undocumented.

“The effect of the local and national economy and the ever increasing demand for healthcare services has required the Health Department to review the YCHIP program services and eligibility requirements and make the above recommendations to preserve the financial viability of the program and serve the medically indigent residents to the best of our ability. Yolo County does not directly deliver healthcare and is dependent on the community of healthcare providers to provide medical services to the eligible residents. The changes in eligibility and the reduction of services will have real impact on these providers. Reform of the healthcare system is urgently needed now to ensure the uninsured and medically indigent have adequate access to medical services.

The Health Department looked at various alternatives to bring the YCHIP program back into alignment with the available resources within the Health Department and believes these recommendations are the best options available to the county. The counties adjacent to Yolo have taken similar steps in reducing coverage, reimbursement and eligibility to ensure their programs are sustainable. Yolo County cannot maintain policies that vary from either the state programs or the policies of near-by counties. The impact of having differing policies would create an attraction for the medically indigent to relocate to our county and disproportionately consume the limited resources available to eligible residents.”

On the other hand, there are other ways to prevent the concerns expressed by the county about residents from other counties taking advantage of their services.

“The county will require applicants to have established a minimum residency of between 10 and 15 days and have not relocated to Yolo County for the purpose of enrolling in the YCHIP program. Residents who have extenuating medical circumstances may apply for membership and be granted an exception by the director or his designee.”

On the one hand, the county is in a huge budget deficit facing cuts of $24 million which represent 36% of its operating budget.  For many it would appear common sense that we would stop expending public funds to treat people who are in this country without proper documentation.

However, as the story regarding swine flu at Holmes Junior High illustrates, this may in fact be a very foolish policy.

The Enterprise article from Wednesday sites Robin Affrime from CommuniCare:

Robin Affrime, CEO of CommuniCare Health Centers, which provides health care, dental services and preventive care to low-income Yolo County residents, said the cuts will have a terrible impact on families and community health care providers.

For the undocumented, who will receive no coverage:

‘What happens when you start asking people if they’re undocumented, when you start asking for citizenship, they get scared,’ Affrime said. ‘They stop coming into the clinics, where they can come (even if the cuts are adopted). They stop bringing their children, and children are covered in Yolo County. That’s really a problem.’

The bottom line is that not only will this policy impact undocumented workers, it may also scare legal residents away from coming into health clinics.  It will cut off the county’s ability to try to combat the swine flu because that strategy will rely on the ability for the county to identify possible cases and isolate them from the rest of the population.

To put this another way, we see what has happened at Holmes Junior High when a student was disagnosed by the county as a possible case of swine flu.  Now imagine that student was the child of an undocumented worker.  The child may be sick and kept home, but the authorities would have no way of knowing that the child may have had swine flu.

To make matters worse is that some of the people most likely to be carriers or victims of this pandemic, are the very individuals who under this policy would be least likely seek the proper medical attention.  Our policy then which makes fiscal sense on the surface could actually put the entire population at great risk.

That’s the immediate concern.  The longer term concern is the impact that individuals in this community will have if they do not receive basic medical treatment.  This policy is not going to remove them from our community, and therefore there may be severe health ramifications for all involved.

The county is facing a crisis in terms of general fund cuts.  However, cutting $1.5 million for health care, especially as we see the rise of a potetential new threat to public health, seems to be the wrong approach.

—David M. Greenwald reporting