Tag Archives: immigration

Immigrant Labor to Impact Care for America’s Elderly and Disabled

For all of those who support the efforts of the current fascist regime to stem the tide of immigration into this country, the following abstract and article from Health Affairs  from Zalman, Finnegan, Himmelstein, Touw, and Woolhandler, suggests that such policies will be detrimental to the care elderly and disabled Americans will receive in the future.

It is another example of the racist, wrong-headed, and neanderthal thinking on the right that will hurt millions of Americans who otherwise will not be able to care for their personal needs as they age, or should suffer a life-altering disability.

ABSTRACT As the US wrestles with immigration policy and caring for an
aging population, data on immigrants’ role as health care and long-term
care workers can inform both debates. Previous studies have examined
immigrants’ role as health care and direct care workers (nursing, home
health, and personal care aides) but not that of immigrants hired by
private households or nonmedical facilities such as senior housing to
assist elderly and disabled people or unauthorized immigrants’ role in
providing these services. Using nationally representative data, we found
that in 2017 immigrants accounted for 18.2 percent of health care
workers and 23.5 percent of formal and nonformal long-term care sector
workers. More than one-quarter (27.5 percent) of direct care workers and
30.3 percent of nursing home housekeeping and maintenance workers
were immigrants. Although legal noncitizen immigrants accounted for
5.2 percent of the US population, they made up 9.0 percent of direct care
workers. Naturalized citizens, 6.8 percent of the US population,
accounted for 13.9 percent of direct care workers. In light of the current
and projected shortage of health care and direct care workers, our
finding that immigrants fill a disproportionate share of such jobs
suggests that policies curtailing immigration will likely compromise the
availability of care for elderly and disabled Americans.

According to the article, the Institute of Medicine projects that 3.5 million additional health care
workers will be needed by 2030.

Currently, the authors state, immigrants fill health care workforce shortages, providing disproportionate amounts of care overall and particularly for key shortage roles such as rural physicians.

In addition, they report, Immigrant health care workers are, on average, more educated than US-born workers, and they often work at lower professional levels in the US because of lack of certification or licensure.

Finally, they work nontraditional shifts that are hard to fill (such as nights and weekends),6 and they bring linguistic and cultural diversity to address the needs of patients of varied ethnic backgrounds.

Along with the role immigrants play in the health care space, the size of the elderly population is expected to double by 2050, raising concern that long-term care workers will be in particularly short supply, according to the article.

Direct care workers—nursing, psychiatric, home health, and personal care aides—are
the primary providers of paid hands-on care for more than thirteen million elderly and disabled
Americans, the authors contend, and these workers help elderly and disabled people live at home, which is the preferred setting for most people, by providing assistance
with daily tasks such as bathing, dressing, and eating.

They also help elderly and disabled people in nursing or psychiatric facilities when living at home is not possible and during transitions home after hospitalization.

These workers are already in short supply, and the authors state that the Health Resources and Services Administration projects a 34 percent rise in the demand for direct care workers over
the next decade, equivalent to a need for 650,000 additional workers.

The projected shortages are compounded by high turnover and retention challenges, creating ongoing challenges to maintain a sufficient labor supply for-long-term care.

The rest of the article is divided into three main sections: Study Data & Methods, Study Results, and Discussion. Throughout the article are exhibits, and each section is further broken down into sub-sections.

The authors have done a serious effort to examine the impact current immigration policies will have on the future health care of the American people, but knowing this regime and their base of xenophobic, racist, paranoiac extremists, the American people will be the ones who will suffer, and many of them are the very people agreeing with these policies.

Immigrants Pay More In Private Insurance Premiums Than They Receive In Benefits | Health Affairs

A press release from Dr. Carol Paris of the Physicians for a National Health Program (PNHP) reported the following article from yesterday’s Health Affairs journal.

Two of the authors of the study, Steffie Woolhandler and David U. Himmelstein are regular contributors to many articles appearing in Health Affairs, and you may remember them from my review of the book they published along with Howard Waitzkin and others, Health Care Under the Knife: Moving Beyond Capitalism for Our Health.

Here is the press release in full:

FOR IMMEDIATE RELEASE:

Despite recent claims that immigrants are a drain on the American economy and health system, a study published yesterday in Health Affairs shows that immigrants make a net contribution to private health insurance plans. The research team, which included several PNHP members, found that as a group, immigrants paid $88.7 billion in private insurance premiums but used only $64.0 billion in insurer-paid health care, generating a surplus of $24.7 billion in 2014.

In “Immigrants Pay More in Private Insurance Premiums Than They Receive in Benefits,” researchers Leah Zallman, M.D., M.P.H., Steffie Woolhandler, M.D., M.P.H., Sharon Touw, M.P.H., David Himmelstein, M.D., and Karen Finnegan, Ph.D. found that between 2008 and 2014, immigrants generated a cumulative surplus of $174.4 billion for private insurers, heavily subsidizing the the benefits of U.S.-born enrollees and boosting the profits of insurance companies. On a per-enrollee basis, immigrants provided an average premium-over-payout surplus of $1,123 each, while U.S.-born Americans incurred an average deficit of $163 each. Undocumented immigrants, who generally use little medical care, generated the largest surplus at $1,445 per enrollee.

While recent studies have examined the financial impact of immigrants on public health programs like Medicare, this project was the first to look specifically at immigrants’ role in financing private health insurance. Since undocumented immigrants or those residing legally in the U.S. for fewer than five years are not eligible for Medicaid and Medicare, private insurance is often immigrants’ only coverage option. Even so, many immigrants are afraid to use the coverage that they earn and pay for.

“Almost every day I see immigrant patients who avoid seeking the care they need to stay healthy,” said lead author Dr. Leah Zallman, who is director of research at the Institute for Community Health, physician at Cambridge Health Alliance, and assistant professor of medicine at Harvard Medical School. “Political leaders have created a climate of fear by blaming immigrants for driving up health care costs. However, this study and our prior research shows that by paying more into the system than they receive, immigrants actually subsidize both private insurance and Medicare for U.S.-born citizens.”

Don McCanne added the following on his post this afternoon about immigrants and private health insurance premiums.

From the Discussion

Immigrants contributed far more in premiums for private coverage in 2014 than their insurers paid out for their care, with undocumented immigrants generating the largest per enrollee surplus. This net surplus offset a deficit incurred by US natives and exceeded total insurance industry profits by about $10 billion that year. Our 2014 findings were not anomalous: Immigrants made large net contributions in every year in the period 2008–14, with little change over time.

While immigrants’ premiums were similar to those for US natives, immigrants incurred much lower expenditures—a disparity that was present in analyses limited to working-age adults. Among immigrants, expenditures increased with duration of time in the US, a phenomenon documented previously. This may reflect worsening health habits related to acculturation, increased care-seeking behaviors, and increased educational standing with time in the US. However, because premium contributions also increased with time in the US, immigrants made a net contribution to private health insurance regardless of their length of residence in the US.

Our findings contradict assertions that people born in the US are systematically subsidizing the medical care of immigrants, particularly those who are undocumented. On the contrary, immigrants subsidize US natives in the private health insurance market, just as they are propping up the Medicare Trust Funds.

Immigrants’ subsidies to private insurance and Medicare likely reflect their relative youth and good health, as well as the reluctance of many to seek care. Policies that curtail the flow of immigration to the US are likely to result in a declining number of such “actuarially desirable” persons, which could worsen the private insurance risk pool.

Source: Immigrants Pay More In Private Insurance Premiums Than They Receive In Benefits | Health Affairs

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

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.

 

Number of Foreign Doctors Coming to US Dropping

As reported this morning in the weblog, Working Immigrants, the number of foreign born doctors wanting to come to the US is dropping, which may have a significant impact on the availability of doctors in certain parts of the country and in many hospitals and clinics, especially those that serve underserved and lower-income communities.

According to Working Immigrants, there are more than 247,000 doctors with medical degrees from foreign countries practicing in the US.

They make up slightly more than one-quarter of all doctors, and most are not US citizens, and are foreign-born as well.

One of the channels of immigration of foreign-born and foreign trained doctors is through graduate medical study. This year, just over 7,000 international medical graduates applied to study in the US, representing a downturn of 217 from last year, and nearly 400 from 2016.

Nearly 25% of residents across all medical fields were born outside the US in 2015, and in subspecialty residency programs, foreign medical graduates accounted for more than one-third of residents.

As I indicated above, foreign-trained doctors are more likely to practice in lower-income and disadvantaged communities than their American counterparts,

Where more than 30% of the population lives below the poverty rate, nearly one-third of the doctors are foreign-trained. And where per-capita income is below $15,000 per year, 42.5% of all doctors are foreign-trained. Finally, where 75% or more of the population is non-white, 36.2% of the doctors are foreign-trained.

This trend will most likely impact the predicted physician shortage that has been previously reported in this blog. In addition, it will add to the burden hospitals are facing in providing care as many of these immigrants work in hospitals to augment the staff shortages they already have.

If this trend continues thanks to current administration policy and xenophobia, the problem will only get worse. The reader should be aware that to even get into the US to practice medicine is a long and difficult process and many physicians do not get in to the country.

Instead of turning away good doctors from foreign countries, we should welcome them and keep them working in the areas of the country where they are practicing and providing care to those who otherwise would not have a doctor to go to.

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.