Talk about a one-two punch to the U.S. health care system's gut. First there's the widely publicized 40 million new clients that will enter Medicare's ranks by 2050 as Baby Boomers age into the system. Then, there's the much less publicized, but still ominous, aging undocumented worker wave about to hit the system.
This group, representing millions of illegal immigrants, is for the most part uninsured. To date, its members have made few demands on a system they don't trust and can't afford. But as they age and their health breaks down, they will find the system, and in all likelihood, enter through its most expensive doors: the ER or hospital admissions. Unable to pay for the care they receive, their cost will be shifted to the same health systems and insurers already panicking about how to care for those with coverage.
The Pew Charitable Trusts outlined this quietly building demand in its Stateline publication. An article entitled Aging, Undocumented and Uninsured Immigrants Challenge Cities and States reviewed research on the health care needs these estimated 11 million undocumented residents will have as they grow older in America. Because most don't even quality for Medicaid, they will be forced to go to hospitals and emergency rooms for treatment as conditions that have gone untreated worsen with age. And, the article concluded, the current health care model in the U.S. makes no provision for covering the cost of their care beyond shifting it to those with coverage.
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"… Senior citizens without documentation don't have access to care for chronic issues such as kidney disease and high blood pressure. What's more, experts predict that many will … forgo primary preventive care even when it is available, likely making their chronic health problems worse — and more expensive to treat," the article said.
Author Teresa Wiltz noted that there are pockets across the U.S. where local communities have addressed this coming crisis with local dollars. Washington, D.C., Los Angeles and San Francisco have developed funding streams for programs that make regular health check-ups and treatment available and affordable to immigrants regardless of their status.
But throughout most of the U.S., the health of undocumented workers remains invisible. That is, until somebody puts a number on it.
The Pew article cites statistics from Texas, an especially difficult state for undocumented workers to receive regular or preventive health care. There, a 2014 report found, undocumented immigrants who needed kidney dialysis and couldn't pay for it cost state taxpayers $10 million—much of which could have been avoided, had the immigrants been able to treat their disorders upstream.
What's the solution? Conservatives tend to default to the "go back to from where you came" strategy. "The policy solution for illegals is to enforce the law and encourage them to return home, thereby avoiding the problem," Steven Camarota, director of research for the Center for Immigration Studies, a conservative think tank that favors limiting immigration, told Stateline.
For others of a more liberal bent, the answers aren't so off-the-shelf. Community health centers could be expanded and encourage more illegal immigrants to get regular care. Federal policies could be loosened to open up Medicaid or other options. Becoming a citizen should be made easier, especially for seniors, say others.
Meantime, hospitals and insurers play the cost-shifting game and hope for help from the nation's capital—where the political wrangling over individual health care access seems unaffected by the looming crisis brought on by aging Americans.
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
