Category Archives: Immigration Reform

When ICE comes knocking, healthcare workers want to be prepared | Healthcare Dive

Note: No matter where you come down on the issue of immigration and the undocumented, this process of rounding up men, women and children needing medical care is reminiscent of the tactics carried out not only by the Gestapo during the Nazi period in Germany, but every other authoritarian regime in history. We should be better than this. We are better than this.

 

Hospital staff are on the front lines in the fight against a growing threat to their patients’ health: fear.

Source: When ICE comes knocking, healthcare workers want to be prepared | Healthcare Dive

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Immigrants in construction — key facts « Working Immigrants

Peter Rousmaniere posted the following fact sheet about immigrants working in construction. While this has no bearing on health care at present, it does have some bearing on workers’ comp, especially in light of the current regime’s draconian policy towards immigrants from Central America.

As this “crisis” progresses, it may be harder for construction companies to find workers to employ on construction sites.

This, in turn would mean that they may be less construction work, and for the insurance industry, less risk and less profit to be made from insuring these projects.

In workers’ comp, that would translate into less frequency of losses, but it would also cut off revenue from carriers covering such risks.

And he promised to create jobs? Hardly.

Source: Immigrants in construction — key facts « Working Immigrants

The Cry of the Children

Taking a break from writing about health care, workers’ comp, and medical travel, I want to talk about something I saw, or rather heard yesterday afternoon on MSNBC.

It was an audio (furnished by ProPublica) of children crying at a detention center (more like Concentration Camp) that broke my heart. I was in tears, and very seldom do so. But those cries went right to me.

If they did to you, then you are a good human being. If not, then you have no soul. And please, don’t quote me that that’s the law, or it is in the Bible, or they are illegal and have no rights.

EVERY HUMAN BEING HAS RIGHTS.

And as for whether or not they are “illegal”, I guess you forgot that when your ancestors arrived on the Mayflower or whatever ship they sailed on, the landlords here for thousands of years knew you were “illegal” too.

The ancestors of all of these people now streaming to our border came to this hemisphere some 20,000 years ago, so by those standards, you, me, and all the rest of us are undocumented aliens. But no one tells us to leave. Or yanks our kids from our arms.

That we do this and many other things to minorities is a symptom of our greed, ignorance, and stupidity that never seems to die out. Take for example, our Confederate-era Attorney General, Jeff “Foghorn Leghorn” Sessions. That refugee from the set of “Gone With the Wind” is not only a religious zealot, but a full-out bigot and racist from a region of the nation that still has not given up its racism and hatred of non-whites, and non-Christians. In this case, non-Protestants from Catholic Latin America.

Too many of our fellow Americans have been poisoned by talk radio, Fox News, and local politicians to see that we are all immigrants and that at times in the long history of the human species, we were migrants too. Our prehistoric ancestors migrated, as did many more recent peoples. But none ever subjected to such cruelty, except during the 1930’s and 1940’s.

We were all taught in school to believe in the ideals of America as a shining city on a hill (incidentally, an idea the Puritans created), and was more about a religious view than a secular one. We were all taught about why we fought a revolution, why we have a Declaration of Independence, and why we have a Constitution that secures our rights and liberties.

And now we are throwing all that away because of a clique of neo-fascist, racist bullies and bigots, headed by a pathological liar and con man, who has conned a large segment of the American people (by which I mean White people) that he can make America great again, all the while cozying up to dictators and dissing our friends.

Folks, this is how Hitler and the Nazis began. And it ended with 6 million dead (my maternal great-uncle, aunt and their six children among them), so don’t tell me it is legal or biblical. You know where you can put that.

And those of you who say they have stolen our jobs or they are criminals and rapists, I have news for you…next time you are in a restaurant, or a family member is in a hospital, bus your own table, and clean up your family member’s dirty linen. Because if Herr Miller (Stephen) gets his way, there won’t be any bus boys, nurses’ aides, home health aides, janitors, and other occupations Americans won’t be filling begging for workers. Oh, and you can come to Florida and pick your own fruits and vegetables, because there won’t be anyone to do it for you.

AMERICA IS A NATION OF IMMIGRANTS, SO WE NEED THESE PEOPLE.

 

In-bound Medical Travel and Immigration

U.S. Domestic Medical Travel.com published the following article this morning that discusses the impact of in-bound medical travel on an individual’s immigration status.

http://medicaltraveltoday.com/spotlight-renata-castro-founder-of-castro-legal-group/

Russian Anchor Babies: Has Putin Already Begun the Invasion?

As loathe as I am to address anything from the MTA, this item caught my attention just now, as I am an hour north of Miami, and with all the talk about Dreamers and immigration from so-called “s**thole” countries, why is it not on the GOP’s radar that Putin is sending us his women to give birth so that they can claim American citizenship for the children born here?

Not that I am opposed to legal immigration and a path towards legalization for those who came here undocumented, either willingly or because their parents brought them here as children.

What impact this will have on the health care system cannot be determined just yet, but with all the problems we have, this will add to it in greater numbers.

Here is the article.

Let’s hope that Special Counsel Robert Mueller finishes his investigation into Russian interference into the 2016 election. Then he can turn his attention to Russian anchor babies.

 

Immigration Reform Revisted

Tomorrow evening President Obama is to unveil his plan to grant millions of undocumented immigrants a form of legal status by executive action.

As reported in two articles today, one in Health Affairs blog, and the other in The New York Times, access to health care will not be a part of the President’s plan.

In “The Case For Advancing Access to Health Coverage And Care For Immigrant Women and Families”, Kinsey Hasstedt said that a web of policy barriers to public and private insurance options effectively keeps millions of immigrant women and their families from affordable coverage and the basic health care, including sexual and reproductive health services that coverage makes possible.

Of course, this sounds all too familiar to anyone who has read my articles in the past about immigration reform, medical tourism/travel, and its implementation into workers’ comp.

Ms. Hasstedt also said that many lawful immigrants are ineligible for coverage through Medicaid and CHIP (Children’s Health Insurance Program) during their first five years of legal residency. And as reported in today’s New York Times, undocumented immigrants are barred from public coverage, and the ACA prohibits them from purchasing any coverage, subsidized or not, through the exchanges.

In The New York Times article, Obama’s Executive Order on Immigration Is Unlikely to Include Health Benefits, the president will use his executive authority to provide work permits for up to five million people who are in the US illegally, and shield them from deportation. But his order will not allow them to be eligible for subsidized, low-cost plans from the government’s health insurance marketplace.

Ms. Hasstedt noted in her article that past immigration policy reforms, both executive (something the GOP forgot about because it was Saint Ronnie who did it) and congressional have failed to address the health care needs of immigrants.

I know there are many in the immigrant community, and among their supporters in the rest of the country who applaud the President for taking this long-overdue action due to the inaction of a Congress more in tune with the sentiments of those who like wearing white sheets, than a party whose last occupant of the White House preached “Compassionate Conservatism”.

And there are many within the Insurance and Risk Management and Workers’ Comp industry who downplay the impact immigration reform and the granting legal status to undocumented workers will have on the number of claims filed under workers’ comp.

But as I said in many previous posts, there is no way that workers’ comp can handle all of the claims that will be filed not only by legal residents, but by immigrants and those who are granted legal work status, as the President will do tomorrow night.

The medical tourism/travel industry is not perfect. Name me one industry that is. But the reality is that I have found, having attended three different conferences in the span of two years , that there are highly professional and dedicated people out there, physicians, hospitals and clinics who not only are seeking patients for private pay or group health insurance, but would probably consider taking on patients under workers’ comp, especially in the areas of orthopedic surgeries from work-related accidents, repetitive motion injuries such as Carpal Tunnel, and even weight-loss surgery, as I mentioned in my last post.

So while many in the industry are gambling in Las Vegas this week, which as the commercial says is where their money is going to stay, and where many Hispanics once called home before we showed up, it is high time to seriously consider medical tourism/travel as an option.

The influx of immigrants, and the soon-to-be announced legal status of the undocumented will put a terrible strain on an already strained health care system. It’s time to open the safety valve and let injured workers, many of them Latino, receive care in their home countries and in neighboring countries so that there are no language or cultural barriers to contend with.

Opening up a safety valve and immigration is nothing new. It’s how millions of Europeans came to America in the 19th and 20th centuries. I would not be here writing this today if my grandparents could not use the safety valve of immigration to escape what would have been a terrible fate. Thousands of Irish would have starved if they could not immigrate to the US and other countries. And millions of Chinese would have died in labor camps, famines and revolutions in the early 20th century.

But so long as the US workers’ comp system is locked away in a “padded cell”, the increased number of legal and undocumented workers with legal work status will add more demand on an already overburdened health care system.

The choice is yours. You can go with the flow of history, or stay in Las Vegas and party your way to irrelevance.

Primary Language-Speaking Physician Ruled Not Medically Necessary

I came across an interesting article today from David DePaolo on his blog, DePaolo’s Work Comp World. The article, Comunicación No Es Médicamente Necesario, discussed a recent workers’ compensation case in Florida that involved the right to bilingual treatment.

A roofer in 2012, suffered a head injury when he fell 30 to 40 feet off of a ladder. His employer accepted the compensability of the injury and authorized treatment from several doctors, including a neurologist, Dr. Angelo Alves.

Dr. Alves recommended that the claimant undergo a neuropsychological evaluation for his memory, cognition and emotional state. The employer then arranged an appointment with Dr. Arthur J. Forman. Because Dr. Forman did not speak Spanish and the claimant only spoke limited English, his employer arranged for an interpreter for the claimant’s office visits

The claimant objected to the interpreter, and filed a petition for benefits, seeking authorization for an evaluation by a Spanish-speaking neuropsychologist. His reasoning was that he did not want to do it through an interpreter and talk about the intimate details of his life through another person.

Dr. Alves supported the claimant’s claim and testified that the claimant needed to have a neuropsychological evaluation performed by a Spanish-speaking psychologist. It was Dr. Alves’ position that having the evaluation through an interpreter was not the same as with a Spanish-speaking doctor, because the doctor could get the wrong information.

However, the Judge of Compensation Claims was not persuaded by that argument. The claimant appealed, but a split panel of the First District Court of Appeals agreed with the JCC.

The finding of the court was that while a Spanish-speaking provider was preferable, the evidence did not establish medical necessity.

Judge Scott Makar, an appointee to the First District Court of Appeals by current Tea Party-backed Florida governor, Rick Scott, in a concurring opinion, addressed the challenges of meeting health care expectations within the limited resources of any health care delivery system.

According the Judge Makar, “In an ideal world with unlimited resources patients would have health care information published in their own primary languages, and their health care service providers would speak their primary languages.” He went on to add, that since this ideal is “unattainable”, “the trajectory of the language access movement in the United States currently has gravitated to the use of translators (for written communication) and interpreters.”

The dissenting opinion, by Judge Bradford Thomas, an appointee of former governor Jeb Bush (who by the way speaks Spanish and is married to a Hispanic woman), argued “that no medical testimony supported the JCC’s view that the Spanish-speaking psychiatric evaluation was not medical necessary, and that the JCC had failed to give a “reason” for rejecting Dr. Alves’ opinion.”

David pointed out that Judge Thomas had the burden of proof backwards and ignored the substantial evidence standard. But, he also pointed out that the majority opinion seemed to take the position that Spanish is a “minority” language, which David points out in the rest of his article, it isn’t.

Before I tackle that issue, I would like to explain why I mentioned who appointed the concurring and dissenting judges, and what struck me as I read the court’s ruling in this case. Had Judge Makar been appointed by any other governor besides Rick Scott, I would have been puzzled as to why they would go out of their way to annoy a growing segment of Florida’s population such as Latinos, especially since they are sensitive to any form of discrimination against their community, such as restricting their right to vote.  This is especially true of non-Cuban Latinos who generally vote for Democrats.

That Rick Scott is a Tea Party-backed politician, and knowing that the Tea Party has elements in it that despises immigrants, both legal and illegal, who are usually Hispanic, Judge Makar’s opinion shows obvious Tea Party bias towards Spanish-speaking people in the state.

His characterization of Spanish as a “minority” language is certainly not true to this former New Yorker who had gone through several areas of Miami, Fort Lauderdale and many other cities in South Florida and felt like I was in the minority. Also, his statement about an ideal world is typical of right-wing conservatives who are opposed to any accommodations to non-English speaking people.

I say this as the grandson of four immigrants who had to learn English and had to speak their native language, Yiddish, at home amongst themselves and other family members and friends, so that the “kinder” would not know what they were talking about. And since my family also came from what was once the Russian Empire, they had to know a smattering of Russian and maybe Polish to converse with neighbors and officials of the government.

But that was a different time in the US, when the National Civic Federation sponsored night classes in English to newly arrived immigrants so that they can assimilate. But it is different now with Latinos, and as has been pointed out before, the younger generation of Latinos already here, speak English and Spanish. I have had classmates in my MHA classes, and have met many others in all areas of South Florida who do.

On the other hand, Judge Thomas’s appointment by Jeb Bush did not surprise me, given his dissenting opinion. It recognizes the reality of life in Florida, and in other states, with regard to Hispanics, and does not, like the Tea Party often does, seek to turn the clock back to a time in the US when only one language was spoken.

Going back to David’s article, demographic research he points out, shows that the Hispanic population has outgrown that of the white population in David’s home state of California and New Mexico, as well as a few other states, according to a Pew Research Center study. The projections, David cites, are that these demographics will be reflected in the overall US population by 2040.

California has about 14 million Hispanics out of an overall population of 33 million. 47% of New Mexico’s population is Hispanic, and while the white population of Texas is still the majority that is projected to change soon, as the Hispanic population growth represents nearly 64% of all population growth since 2000.

Florida, by contrast, David states, has 4.5 million Hispanics, which represents 23% of the population. He notes that because workers’ compensation is state specific, relative to the overall population of the state, the decision by the First District Court of Appeals makes sense. However, that he says can change.

I have discussed the issue of immigration reform and its impact on workers’ compensation and medical tourism in earlier posts, and have cited statistics about the Hispanic population growth in such articles as Immigration Reform on the Horizon: What it means for Medical Tourism and Workers’ Compensation, Immigration and Workers’ Compensation: Round Two, and E PLURIBUS UNUM: Latin American and Caribbean Immigration, Workers’ Compensation and Medical Tourism.

It also occurred to me that the court that decided this recent case was the same court that decided an earlier case that I mentioned in Legal Barriers to Implementing International Providers into Medical Provider Networks for Workers’ Compensation: A White Paper.

In that case, AMS Staff Leasing, Inc. v. Arreola, FL 1st DCA, 2008, the First District Court of Appeals ruled that Arreola, who had been injured loading a truck, was entitled to get treatment in his hometown in Mexico.

The court ruled that “that state law did not preclude the foreign physician’s treatment of the claimant in Mexico. They stated that Florida workers’ compensation law contemplates coverage for non-citizens, and they cited an earlier case in which the court held that undocumented workers were entitled to workers’ compensation coverage in Florida…”

The court “also stated that Florida law indicates that an injured worker is not prohibited from moving from his pre-injury residence in the state, and receiving treatment outside of the state.”

This would appear to indicate that the court in 2008, before Rick Scott became governor, was willing to have workers’ compensation claimants get treated by physicians in their home country who could speak their language, but the court in 2014, with an appointee of Tea Party-backed, Rick Scott, ruled that the claimant in this case had no right to a physician who could speak his language, even if the claimant was seen here in Florida and not in his home country.

It would appear that judges appointed by Tea Party-backed governors, especially in a state like Florida, are trying to deny the rights of Hispanic claimants to Spanish-speaking doctors. Such a ruling in light of future increased Hispanic population growth is not only unconscionable, it smacks of racism and discrimination. But David DePaolo is correct in citing Bob Dylan’s song, “The Times, They Are A Changing.” Hopefully, future courts in Florida and elsewhere will correct this travesty of justice, and when medical tourism in workers’ comp becomes a reality, evaluations by Spanish-speaking physicians will be commonplace occurrences.