Two weeks ago Sheriff Ed Prieto made a vigorous defense of his department arguing that law enforcement would be hamstrung by the proposed cuts.
“I am the Lorax, I speak for the trees, for the trees have no tongues.”
In many ways, those most vulnerable in this county and this state face a similar problem. They have no voice and few advocates like the Sheriff who can muster the political will to rescue them. We have learned that even lifelong health advocate Supervisor Helen Thomson, was on the committee that recommended these cuts.
Still those who read the editorial section of the Davis Enterprise may have read the poor, indigent, and undocumented’s version of the Lorax, Dr. Lisa Baumeister.
She is a Woodland-based family physician who serves many YCHIP patients.
“I believe it has been wise public health policy to provide safety net health care to poor, undocumented immigrants, and Yolo County should continue to do so, despite current economic challenges.”
She cites Pew Research Center data that estimates roughly 95 percent of undocumented immigrants are employed and contributed to the local economy through low-skilled positions in agriculture, construction, food service or maintenance. Yolo County’s agricultural economy, in particular, depends on the inexpensive labor of undocumented farm workers.
“Nearly half of undocumented immigrants (47 percent) are married, and many have children who are U.S. citizens. Children growing up with parents who are medically or mentally impaired are at higher risk for abuse, and stressful home environments. Children from such unstable homes would be more likely to drop out of school, use drugs, develop mental illness and engage in crime.”
She cites a key example of an adverse consequence of such a policy shift:
“One of my patients is a 34-year-old poor, undocumented woman, a mother of two children, who works as a house cleaner and whose husband works in construction. She has been diagnosed with a benign brain tumor.
Owing to the relatively inexpensive specialty care financed by the YCHIP program, her condition is well-controlled by medication, and her prognosis is excellent. As long as she has access to this medication, she is able to continue working. If her eligibility for YCHIP ceases, she will lose access to specialty care and will be unlikely to afford her medication, putting her at serious risk for permanent loss of vision.”
For me one of the key points that I tried to make in my Saturday column is that cutting back coverage may not save money.
“From a strictly fiscal standpoint, one might argue that Yolo County cannot afford to pay for this patient’s chronic medical care, regardless of her contribution to the local economy. But denying her coverage won’t necessarily save money. Studies show that when access to primary care is reduced there is a predictable increase in emergency care and hospitalizations for a range of conditions.
In my patient’s case, without medication, enlargement of her brain tumor eventually could lead to the need for emergency neurosurgery. As with care for all uninsured, we would all bear the costs of this expensive care, because the costs of emergency care for uninsured patients eventually are passed on to insured patients in the form of high premiums.”
There are also as cited on Saturday, broader health implications beyond that community.
“I am also concerned about the broader public health implications of using immigration status to allocate medical care. Immigrants have legitimate, deep-seeded fears of immigration authorities. Many immigrants may avoid clinics if they know they will be asked for their legal status because of fears that this could endanger themselves or an undocumented family member.
When Proposition 187 was passed by California voters in 1994, it had a prolonged chilling effect on health care use within immigrant communities. Yolo County’s decision to check immigration status may similarly deter health care use among both documented and undocumented immigrants.
Delays in or avoidance of care could lead to the spread of infectious diseases like tuberculosis or swine flu. Indeed, a California survey of tuberculosis patients showed that fear of deportation was associated with delays in treatment of tuberculosis, which has a high prevalence rate in immigrant communities.”
I understand the implications of the budget crisis. We will need to cut back on vital and needed services. But we also have a lot of decisions make about what services are most important. People have suggested well what would you cut instead. I have often been a critic of the Yolo County Criminal Justice system that I think is a bit too quick to charge people and prosecute relatively minor crimes. This is a real opportunity to look at what we prosecute and see if there are better ways to do it. If we just make cuts to make cuts, then the vulnerable will get harmed. If we take a bit longer and make cuts where we should make them anyway, we can all benefit in the long run. There is little doubt that we would still have to cut important programs, but we also have to be careful that budget cuts today do not mean greater expenditures in the future.
—David M. Greenwald reporting