SAN DIEGO – In two new position papers, the American College of Physicians declared support for both Medicaid reform and legislation that would provide broader health care access for immigrants – regardless of their legal status.
Although not suggesting that U.S. taxpayers support the health care costs of undocumented aliens, the policy statement does recommend open access to comprehensive primary and preventive care – including vaccinations, prenatal and obstetrical care, and screening for preventable illness. Providing these services would not only reduce the cost burden associated with emergency room treatment when undocumented immigrants are acutely ill, it would help protect citizens who might be exposed to untreated, communicable disease, Dr. J. Fred Ralston Jr., immediate past president of the American College of Physicians, said at the group’s annual meeting
Tuberculosis is a case in point, he said at a press briefing. "Under the current system, [illegal immigrants] may be afraid that going to a hospital to seek treatment would place them at risk of deportation. If they delay care because of this fear, it could increase the number of people exposed to the diseases exponentially."
The 18-page paper is not a broad-based effort to address the overall problem of illegal immigration. Instead, Dr. Ralston said, it asks for a national policy that upholds the ethical responsibility of both physicians and the government to provide nondiscriminatory care to all people within U.S. borders.
"Any national immigration policy will need to balance the legitimate needs and concerns to control our borders and to equitably differentiate publicly supported services for those who fully comply with immigration laws and those who do not," he said. "However, access to health care for immigrants is crucial to the overall population of the U.S. We all have a vested interest in ensuring that all residents have access to necessary care."
The paper does not address the financial means by which such recommendations might be implemented. It does, however, stress that "[Immigrants without legal status] should not be prevented from paying out-of-pocket to cover their expenses, including the ability to purchase coverage at their own expense from the state health exchanges that will be created under the Affordable Care Act."
Further, Dr. Ralston, an internist in Fayetteville, Tenn., said that any national health policy should automatically cover native-born children of illegal aliens. "U.S.-born children of illegal residents should have the same access to purchased insurance and government-subsidized health care as any other U.S. citizen," according to the policy paper.
The college also unveiled recommendations for reforming Medicaid, focused on improving access to care for the millions who are, and will shortly become, eligible for its benefits.
‘The need for an improved Medicaid program was made evident during the recent recession, when almost 4 million people – the largest increase ever – found themselves relying on Medicaid for health care coverage," Dr. Ralston said. "Medicaid faces the potential of increasing enrollment of up to 18 million by 2019, with 10 states projecting a 50% increase."
But, he said, "With challenge comes the opportunity to improve Medicaid, with regard to its access and future sustainability."
The 38-page paper puts forth 12 recommendations, some of which concentrate on improving Medicaid payments to physicians. These, the paper says, are the foundations upon which a sound Medicaid program must be rebuilt. Among the paper’s recommendations:
• Standardize Medicaid minimum eligibility and fully subsidize federally mandated Medicaid coverage expansions. Without this, states will be forced to make up the gap, and patients will take the financial hit, said Robert B. Doherty, senior vice president of governmental affairs and public policy for the ACP;
• Offer more flexibility in long-term care choices, since alternatives can be less expensive than nursing homes;
• Streamline and improve the Medicaid waiver process, to ensure timely approval or rejection of waiver requests. Doing so may help ensure that more eligible patients enroll and take advantage of the program;
• Focus more on Medicaid programs that improve quality of care to minorities and effectively manage chronic disease and mental health disorders;
• Institute countercyclical funding to increase the amount of federal dollars available during economic downturns;
• Reduce enrollment barriers by state and federal cooperation. Such an effort would make enrollment easier and help ensure timely access to health care.
"The Medicaid system provides vital health services to vulnerable populations," Dr. Ralston said. "But like the health care system as a whole, Medicaid needs to be improved to emphasize preventive and primary care."
The paper calls for permanent Medicaid payment increases to primary care physicians and other specialist services, to at least the level of Medicare reimbursement