Aging undocumented immigrants pose costly health care challenge

Early on a recent morning, men huddle in the Home Depot parking lot, ground zero for day laborers on the hunt for wor...

Posted: Jan 4, 2018 8:17 PM
Updated: Jan 4, 2018 8:17 PM

Early on a recent morning, men huddle in the Home Depot parking lot, ground zero for day laborers on the hunt for work. Cars pull into the lot, and the men swarm.

Among them is Marcos, at 65, wiry and bronzed with a silvery smile. He's been in the country illegally for 20 years. When he's sick, he just rests, because - like most undocumented workers - he doesn't have insurance.

"I don't know if I have high blood pressure," he said. "Because I don't check. Doctors, you know, are expensive."

For decades, the United States has struggled to deal with the health care needs of its undocumented immigrants - now an estimated 11 million - mainly through emergency room care and community health centers. But that struggle will evolve. As with the rest of America, the undocumented population is aging and developing the same health problems that plague other senior citizens.

Many undocumented adults lack health insurance, and even though they're guaranteed emergency care, they often can't get treated for chronic issues such as high blood pressure. What's more, experts predict that many forgo preventive care, making chronic conditions worse - and more expensive to treat.

"They're hosed. If you're an undocumented immigrant, you're paying into Social Security and Medicare, but can't claim it," said Steven Wallace of the UCLA Center for Health Policy Research.

When uninsured people end up in the hospital, that pushes up rates for those who have insurance. Or public programs like Emergency Medicaid pick up the tab. This contributes to a game of shifting costs, Wallace said.

"It'll place a strain on the entire health care system," Wallace said.

Growing numbers

Approximately 10% of the undocumented population is over 55 now, according to the Migration Policy Institute, but researchers agree that their numbers will rise.

"The unauthorized immigrant population has become more settled, and as a result is aging," said Mark Hugo Lopez of the Pew Research Center.

Estimates vary on how many undocumented immigrants lack insurance. The Kaiser Foundation estimates 39 percent are uninsured, while the Migration Policy Institute, which analyzes U.S. Census data, estimates as many as 71 percent of undocumented adults do not have insurance.

Like Marcos, older undocumented people tend to be poor. The Affordable Care Act doesn't cover them, and they don't qualify for Medicaid, Medicare or Social Security, even though many pay taxes. Few can afford private insurance.

Related: How the GOP tax bill hurts undocumented immigrants

That means most must turn to emergency rooms or community health centers, which provide primary care to poor people, regardless of immigration status. But community health centers can't provide extensive care, Wallace said. And because Congress has yet to fund them, their future is precarious.

Leighton Ku, professor and director of the Center for Health Policy Research at George Washington University, said immigrants, both authorized and unauthorized, are much less likely to use health care than are U.S. citizens. Until, that is, they're quite ill.

"Their numbers are going to grow and we're going to have an epidemic on our hands," said Maryland state Del. Joseline Pe-a-Melnyk, a Democrat. "Who's going to pay for it?"

A 2014 report published by the journal of the Texas Medical Association found that undocumented immigrants with kidney disease face considerable barriers to care. By the time they do get help, they need dialysis, costing Texas taxpayers as much as $10 million a year.

Stepping in to help

Many cities have tried to step in. A 2016 Wall Street Journal story noted that 25 counties with large undocumented populations provide some non-emergency health care to these immigrants, at a combined cost of what the paper estimated is more than $1 billion each year.

Washington, D.C., Los Angeles and San Francisco are among the places where undocumented immigrants can usually get routine care, thanks to locally funded programs.

In Los Angeles, Dr. Christina Hillson, a family practice doctor at the Eisner Health Clinic, said she's seeing a growing number of elderly undocumented patients, whom she's treated for everything from ovarian cancer to amputations resulting from untreated diabetes.

Patients who are critically ill are considered emergencies and can get treated at hospitals, she said. Sometimes Hillson will send patients who aren't as ill to the ER, because it's the only way they can see a specialist.

Snapshot of a population

Most undocumented people immigrated here when they were young and tended to be healthier than native-born citizens, Wallace said. But as they age, they lose that advantage.

Undocumented women are more likely to have family in the U.S., who can help care for them as they age, said Randy Capps of the Migration Policy Institute. But men are more likely to be single. Because they often work as manual laborers, they're more likely to get hurt on the job, Capps said.

"They're going to age faster and become disabled at higher rates," Capps said. "It's going to make for a much tougher old age."

There's no one easy solution to helping older residents who live in the United States illegally, health and immigration experts say.

"The policy solution for illegals is to enforce the law and encourage them to return home, thereby avoiding the problem," said Steven Camarota of the Center for Immigration Studies, which favors limiting immigration.

Related: Why undocumented immigrants pay taxes

Joe Caldwell of the National Council on Aging, an advocacy group, said federal immigration legislation providing a pathway to citizenship would allow seniors to access care.

Such legislation is unlikely any time soon.

Outside the Home Depot, Marcos and his friends gather in the cold sunshine. He's been paying taxes for years, Marcos said, and he's got pages of documents to prove it. He'd love to become documented, "but that's practically impossible," he said.

A year ago, Marcos said, he had tightness in his chest. He had no choice but to go to the ER, but he hasn't followed up. He'd rather stalk the parking lot here, looking for work.

"No work," Marcos said, "no money."

The Pew Charitable Trusts funds both the Pew Research Center and Stateline.

Indiana Coronavirus Cases

Data is updated nightly.

Cases: 595436

Reported Deaths: 9466
CountyCasesDeaths
Marion822851311
Lake44626670
Allen32165543
Hamilton28684308
St. Joseph26917378
Elkhart24173343
Vanderburgh18856236
Tippecanoe17638125
Johnson14687289
Porter14513163
Hendricks14010242
Madison10715216
Vigo10540177
Clark10349135
Monroe9189108
Delaware8956134
LaPorte8867158
Howard7982140
Kosciusko791380
Warrick652994
Hancock646999
Bartholomew631096
Floyd6205107
Wayne5984159
Grant5874110
Dubois547175
Boone538867
Morgan524192
Henry497764
Marshall495384
Cass475362
Dearborn464545
Noble463157
Jackson417846
Shelby405680
Lawrence383876
Clinton367840
Gibson360058
DeKalb339163
Montgomery338152
Harrison333643
Knox329839
Miami312743
Steuben309343
Adams297435
Whitley297225
Wabash294947
Ripley294345
Putnam288047
Jasper285234
Huntington284959
White269138
Daviess263073
Jefferson253838
Decatur243482
Fayette242948
Greene237062
Posey234427
Wells231347
LaGrange225061
Clay219032
Scott218538
Randolph209845
Jennings193935
Sullivan189632
Spencer184319
Fountain180527
Washington179321
Starke172743
Jay163922
Fulton161130
Owen161137
Carroll153915
Orange152933
Rush151618
Perry149327
Vermillion145833
Franklin144433
Tipton129232
Parke12918
Pike114326
Blackford109222
Pulaski95337
Newton89821
Brown85931
Benton85310
Crawford7719
Martin70713
Warren6637
Switzerland6235
Union6146
Ohio4727
Unassigned0374

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 836049

Reported Deaths: 10323
CountyCasesDeaths
Franklin98533705
Cuyahoga831801065
Hamilton61931441
Montgomery42028399
Summit33849736
Lucas30524605
Butler30003228
Stark25093419
Warren19083140
Lorain18418212
Mahoning16931337
Lake15592136
Clermont15335105
Delaware1403077
Licking12819132
Trumbull12515307
Fairfield1232480
Greene11729135
Medina11286165
Clark10672264
Wood10081156
Allen9639126
Portage9006107
Miami895273
Richland8910116
Marion7377113
Tuscarawas7177174
Columbiana7164124
Pickaway710350
Wayne6855165
Muskingum678241
Erie5976118
Hancock542990
Ross535287
Scioto527063
Geauga491755
Darke459489
Ashtabula443172
Lawrence439353
Union437028
Sandusky427462
Mercer427387
Seneca417357
Auglaize416259
Huron416138
Shelby413521
Jefferson409066
Belmont403740
Washington375940
Putnam367872
Athens36759
Madison343429
Knox340122
Ashland336838
Fulton328543
Defiance322578
Crawford316371
Preble313836
Brown298819
Logan296529
Ottawa283934
Clinton281243
Williams272866
Highland266018
Jackson259043
Guernsey245325
Champaign244427
Fayette229729
Morrow22574
Perry223318
Holmes220362
Henry213547
Hardin206433
Coshocton199620
Van Wert198744
Wyandot192549
Gallia192126
Adams167415
Pike167417
Hocking165523
Carroll151316
Paulding141121
Noble118740
Meigs105021
Monroe97229
Harrison8598
Morgan79728
Vinton67613
Unassigned00
Fort Wayne
Cloudy
24° wxIcon
Hi: 29° Lo: 23°
Feels Like: 14°
Angola
Cloudy
21° wxIcon
Hi: 25° Lo: 21°
Feels Like: 11°
Huntington
Cloudy
23° wxIcon
Hi: 28° Lo: 22°
Feels Like: 15°
Fort Wayne
Cloudy
24° wxIcon
Hi: 29° Lo: 24°
Feels Like: 14°
Lima
Cloudy
25° wxIcon
Hi: 29° Lo: 23°
Feels Like: 18°
Light Snow Overnight, Colder Wednesday
WFFT Radar
WFFT Temperatures
WFFT National

Community Events