The cancer of bad policy
Editorial, Boston Globe, October 1, 2007
NEW YORK State and federal officials are locked in a cruel battle over immigrants who have cancer. In 2005, the federal government told New York that it could no longer get federal Medicaid reimbursements for providing chemotherapy to poor, undocumented immigrants and even to legal immigrants who have been in the country for less than five years.
New York had accepted the ruling. But as public objections grow, the state is changing course, fighting a decision that is both medically and economically foolish.
The federal money that had been used to cover chemotherapy is designated for emergency care - something states largely had been left to define. But after an audit of New York's records, federal officials said chemotherapy did not constitute emergency care.
The federal ban on chemotherapy is unfair to recent legal immigrants and hypocritical given the country's wink-and-nod policy on illegal immigrants. While the law bans them, the economy welcomes them. Some even pay Social Security taxes, supporting a program from which they won't receive benefits.
Congress could have helped by passing comprehensive immigration reform that addressed healthcare. That never happened. The resulting vacuum has cities and states enacting a patchwork of often contradictory immigration policies.
New York Governor Eliot Spitzer soundly says the federal government should let doctors decide what constitutes emergency treatment. State officials say that for now New York will pay for immigrants' chemotherapy treatments on its own. But states shouldn't have to go it alone. Immigration is a national issue that should have federal attention.
Some have raised the specter of the United States becoming a healthcare "magnet" for immigrants. But a 2006 RAND Corporation study notes that, in general, immigrants use relatively few health services. In 2000, RAND researchers say, $430 billion was spent in public and private dollars on healthcare. While undocumented immigrants were 3.2 percent of the population, they only accounted for about 1.5 percent of medical costs.
Government could spend nothing on healthcare for the undocumented. But this would let illnesses spiral into expensive emergencies. And when it comes to cancer, federal officials should support doctors' efforts to screen for and treat the disease quickly - a humane and cost-effective approach.
New York isn't alone. Other states, including Massachusetts, use emergency Medicaid funds to pay for chemotherapy. The federal government shouldn't walk away from these states, too. Instead, Congress and the president must get back to crafting an immigration measure that modernizes the law and adequately addresses healthcare needs. It's bad federal policy to turn a blind eye on cancer
---