Dr. Antonio Falcon, a physician in the border town of Rio Grande City, Texas, considers himself to be the "luckiest family doctor in the world." In his nearly 30 years of practice, he has worked in the emergency room as well as the operating room and has delivered at least 6,000 babies. Currently, he says he is a geriatrician, aging along with his patients.
Falcon, a member of the Texas Medical Association and the United States-Mexico Border Health Commission, is concerned about several health threats facing border communities, including tuberculosis, diabetes, obesity and the H1N1 virus that causes swine flu. He says the current efforts to overhaul the nation's health system will benefit both the Hispanic community, which has the highest rate of uninsured of any ethnic group; and Texas, which consistently fares among the worst for state health care measures. Still, he worries that lawmakers in Washington are failing to address several important border health issues, including illegal immigrants' health care.
KHN's Jessica Marcy recently spoke with Falcon, who warned that failure to recognize the high, unreimbursed costs of caring for this population could undermine hospitals and providers along the border and open the door to public health risks for the entire nation. Edited excerpts of the interview follow.
Q: Since you began practicing medicine in 1980, how has the health delivery system's approach to illegal immigrants' health care changed? What impact has the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) -- which requires hospitals to provide emergency services regardless of a patient’s ability to pay -- had on health care in border communities?
Where Dr. Antonio Falcon Works:
Rio Grande City is located in Starr County, one of the poorest counties in Texas and the nation. Statistics from the 2000 Census Bureau found that in Rio Grande City:
- 97.4 percent of the population is Hispanic or Latino
- 34.4 percent is foreign born
- 48.8 percent of individuals are below the poverty line
SOURCE: U.S. Census Bureau
A: Back in the 1980s, the patient from Mexico was usually the best paying patient because in order to get care here, they would have to pay for their deliveries up front. It was a system that worked very, very well. When EMTALA [was enacted], it basically caused a very large influx of patients from Mexico … because labor and delivery became an emergency and patients had to be seen whether they paid or not. What happened in a lot of communities along the border, where the Mexican patient was the best paying patient, [they] became a huge liability because they were no longer paying for their care. So all of a sudden, these hospitals and providers were faced with this huge volume of uncompensated care. After several years of struggle, Emergency Medicaid [which helps pay for such emergency treatment of immigrants] came in ... [and] alleviated some of the burden.
Interestingly enough, it seems that nobody can answer the question of what's going to happen to border providers and hospitals if illegals aren't covered under a new health care bill. If they're not covered and EMTALA continues to exist and providers and hospitals are going to have to provide the care without compensation, it's going to cause a catastrophic situation along the border, which already has a very fragile health care system.
Q: What do you think about provisions in some health overhaul measures that would prohibit illegal immigrants from purchasing insurance on proposed exchanges?
A: The biggest risk is the financial failure of [border] health care institutions. If illegal immigrants are not going to be covered under a national health plan, then there must be a mechanism for reimbursement for the care of those patients. If that doesn't happen, then all of a sudden border hospitals and providers have to take a 35 percent cut in their gross income and they're not going to make it.
As it is, the border area already has a much higher percentage of Medicaid patients than other areas in the country. Providers and hospitals are strapped with the bare minimum of financial resources because of the reimbursement mechanism that exists. I would venture to bet that one-fourth to one-third of the hospitals along the border would close and you would see an exodus of providers in a system that already has very, very poor ratio of patients to providers. Right now, as far as I know, there isn't a discussion on how to make up for the losses that would be incurred by border institutions.
Q: Do you think there are any other specific health risks from excluding illegal immigrants from the health care system and reform?
A: I think [the risk is] the spread of any infectious disease, especially tuberculosis. TB is actually on the rise along the border. I think that 70 to 80 percent of these cases we're seeing now are related to immigrants. It's a very high percentage. That, together with the fact that we're seeing more multidrug-resistant tuberculosis, causes an enormous amount of concern. If those patients are not going to get any treatment then public-health-wise we have a huge problem.
Q: What advice would you give to lawmakers in Washington about illegal immigrants' care and health reform?
A: Illegal immigrants live among us all over the country. We should have learned from H1N1 that the potential door for emerging illnesses could exist through the Mexican-American border. To allow something to come in that is not attended to because somebody in Washington didn't play close attention to border health issues would be lamented for a long time. We need to look at the border as a portal of entry for any of a number of diseases, including bioterrorism.
It seems like policy makers want to isolate [the issue of] illegal immigrants' care as something that's kind of standing out there on its own and it's not. It's mixed in with the rest of the soup. Like it or not.