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Part 3: Undocumented and Uninsured – A Health Care Challenge

[Editor’s Note: Click this link for an overview of the series and an interview with the author.]

Tammy Worth — Special correspondent to The Hale Center for Journalism

Kansas City may have the largest number of Hispanics in the metropolitan area, but Olathe has the largest percent compared to its total population.

Much like other cities, its Latino population has risen dramatically in the past decade. In 2000, 5.4 percent of Olathe’s residents were Hispanic; by 2010, that number had grown to 10.2 percent. The growth is likely due to an increase in industries like food service and landscaping, said Consuella McCain-Nunnally, Olathe’s human relations manager.

A few years back, city officials attempted to “embrace and celebrate” Olathe’s diversity and re-evaluated services it offered with the Hispanic community in mind, she said. The Housing and Neighborhood services department went into the community to educate tenants about their rights and the responsibilities of landlords.

They reached out to immigrant families in the school district, where more than 70 languages are spoken. An entire department was dedicated to providing services to families with children in ESL programs. When the recession hit, many of these services were cut.

“This is not new to the area,” McCain-Nunnally said. “Either you see communities shy away from embracing it or they see it as an opportunity as a way to celebrate differences and learn from them and grow into one community.”

El Centro, Inc., an organization that provides health and educational services to Latinos and Hispanics, opened an office in Olathe to help this population. Aude Negrete-Banos is the health navigator at the organization.

Negrete-Banos counsels a lot of pregnant women without health care. She sees patients needing treatment like gallbladder surgery – painful but not life-threatening – that can’t find help. She found funding so a woman with a tumor the size of a cantaloupe in her uterus could receive surgery. She tells cancer patients that the only way they will receive treatment is to return to their native country.

“At the end of the day, most of the time, they have to go back to Mexico if they want something that big done,” she said. “I say they can go back and do it there or die here … and sometimes they choose to die here. They don’t think they can make it there. They think, ‘I can risk my life coming back again or I can just know I will die but stay here with my family until then.’”

Safety net clinics

The Health Partnership Clinic in Olathe is where Negrete-Banos sends most of her patients. The provider is one of a handful of safety net clinics in the metropolitan area that act as an entrée into the health system for low-income populations.

Undocumented immigrants tend to be comfortable at safety nets because the clinics are known in the communities as safe places. Most don’t require Social Security numbers and offer sliding-scale payment systems.

The Health Partnership provides primary preventive care to more than 7,000 patients a year, 75 percent of whom are uninsured and most of whom live well below the federal poverty level. Jason Wesco, the partnership’s president and CEO, said they don’t know how many patients are undocumented, but about 43 percent need Spanish translation.

“We don’t ask if people are here legally or not,” Wesco said. “We don’t want to know …. We know we do take care of some that are, and we are proud of it, so I’m not ashamed of it at all.”

Though he can provide primary care services to immigrants, Wesco said he sees too many patients diagnosed with chronic diseases or needing surgery with nowhere to go for help.

“It’s really all other things people need in the world outside of our doors,” Wesco said. “Others don’t provide services with no regard for ability to pay.”

Other safety nets have similar experiences as the Health Partnership. Samuel U. Rodgers Health Center has translators that speak 11 different languages for the 21,000 patients they see each year. At Cabot Westside Medical and Dental Center, about 98 percent of the population is Hispanic, and 35 percent of the adults are undocumented.

But even safety net clinics don’t have the capacity to provide all the care that is needed. Maria Reyes, who helps with emergency assistance at Catholic Charities of Northeast Kansas, said safety nets are good, but “they are swamped.” She has patients who call and can’t get in to see a physician for months.

Wesco said the community on the whole is “severely, massively under-resourced” to provide all of the primary care for low-income patients. There are about 100,000 people in Johnson County with incomes 200 percent below the federal poverty level, which is approximately $47,000 for a family of four, and he sees less than 10 percent of them annually.

Some clinics wouldn’t talk about the issue for the series, and Wesco said it is likely for fear of losing money. Safety net clinics typically are funded through an amalgam of Medicaid, private grants, foundations, state and local dollars and a small amount of patient payments. They know that, at any moment, a donor or angry legislator could pull funding because they are treating undocumented patients, Wesco said.

“It is easy for people to get mad and wave their arms around and say ‘those people.’ but if you come into a clinic they are just like us,” he said. “We need to be taking care of people for the right reasons: number one because they are human beings, and number two, it is awfully expensive when they don’t get the treatment they need.”

Impact of immigration 

For most of America’s history, the nation has looked at immigrants with ambivalence – legislators have alternately embraced and hindered immigration, sometimes simultaneously. The earliest legislation allowed white immigrants to take an oath of citizenship after living in the country for two years. The Homestead Act of 1862 offered land to settlers, drawing immigrants to populate the barren Western United States.

Twenty years later, a tax was levied for any immigrant moving to the country. Restrictions were placed on people from different areas including the Philippines, China and Japan. In the early 1900s, an act passed declaring that any U.S. woman marrying an immigrant would lose her citizenship.

Immigrants have historically helped build the communities in which they live. They constructed the first Transcontinental Railroad and picked cotton in the fields; they put meat on tables and landscape cities. All the while the rally cry has been that they are here to take. They purloin jobs and government money, and inhabit space in our schools and hospitals. But statistics bear that these immigrants, on the whole, contribute to communities more than they take from them.

“Overall, they don’t take jobs, they create economic activity and they stimulate and create other jobs,” said Steven Wallace, chair of the Department of Community Health Sciences at the UCLA School of Public Health. “Looking at the broader economy, they created more jobs than they took.”

A 2010 study for the Federal Reserve Bank of San Francisco found that immigration leads to greater specialization and productivity in the workplace. The study authors suggest that employers absorb immigrants by expanding jobs rather than displacing American workers. The study found that, between 1990 and 2007, immigration was responsible for a $5,100 annual increase in income of the average U.S. worker.

Studies have shown that the economic affects of immigration to rural communities – in particular those with meatpacking plants – are somewhat neutral. A report created in 2005 by professors at Iowa State University found that opening a meatpacking plant increases payroll and employment in manufacturing and other service and retail industries. The job growth tends to come in lower-paying jobs, however, and wages on the whole tend to decrease.

The authors noted that other reports have shown an increase in crime rates, child abuse cases and a strain on education and social services. They didn’t find such an impact in their research, but this was the case originally in Milan, according to James Onello, Milan’s city manager. The first wave of workers at the plant was comprised of young single men, which caused a ruckus in a rural, quiet town like Milan.

“We’re a small community, and there is not a whole lot going on,” Onello said. “So we had a couple of bars, and they hit the bars and drank, and you know what can happen there.”

Initially the police department, hospitals and schools were taxed, keeping up with the changes. Onello said things calmed when the plant began recruiting families instead of single men.

“Milan is a good old redneck community, and some people had no experience or exposure to another culture,” he said. “And then you have guys up here getting into mischief… I still get a sense that the minority population isn’t embraced 100 percent, and that’s just a tough one.”

The town’s Chamber of Commerce, with the help of community organizer Axel Fuentes and students at Truman State University in Kirksville, hosted its first multicultural fair in October 2012 – a mere 18 years after the plant opened its doors.

Worth reported this special series during a year-long Association of Health Care Journalists Reporting Fellowship on Health Care Performance supported by The Commonwealth Fund.

Major Funding for Health coverage on KCPT provided by Assurant Employee Benefits and the Health Care Foundation of Greater Kansas City.

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