Meeting a moral, legal, obligation at an astronomical cost

He was in his 70’s and had lain in a hospital bed for more than three months when I first met him. Compared to my other patients, my daily visits with him were short. He could not speak English, but even without interpreter I knew his first question that had been repeated every day: “When can I go home?”It was a fair question. He was stable, after all, save for requiring dialysis three times a week. These services are routinely provided in the outpatient setting and don’t require a prolonged hospital stay. The situation was different for my patient, he was an undocumented immigrant.

The cost of dialysis can be as much as $89,000 per year as an outpatient but receiving dialysis treatment in the hospital can cost much more, around $1.5 million per year for the patient that needs dialysis three times per week. For American citizens, government-funded healthcare programs pick up the tab so that they can receive dialysis as outpatient no matter their insurance status. Some states like California, New York, and North Carolina allocates state funds to provide dialysis for undocumented immigrants as it was shown that it will not only reduce the costs but also decrease the mortality and morbidity of the patients who receive standard outpatient dialysis.

But this is not the case in Connecticut, and how easy it will be to relocate an undocumented immigrant and possibly his family?

After the implementation of the Affordable Care Act, the uninsured rate declined from 16 percent in 2010 to 8.8 percent in the first six months of 2018. However undocumented immigrants are excluded from all of the ACA’s core provisions, which means that the majority of estimated 11.3 million undocumented immigrants currently in the United States (US) still don’t have health insurance. At the beginning of the year, New York Mayor guaranteed universal health coverage for every resident of New York City, to become the second city after San Francisco in the US to provide care for everyone no matter of their socioeconomic and immigration status. This is while a recent federal court ruling out ofTexas has threatened to even overturn the Affordable Care Act.

My patient’s life-threatening illness came suddenly. He developed an acute illness that led to many medical complications, and ultimately, he needed to replace his failing kidneys with dialysis. Now he remained trapped within the cold walls of the hospital, as morally and legally we are bound to provide care for him even if this means to spend an astronomical amount of money the hospital’s safety net fund.

Although many political leaders and their followers are against spending their tax money on the undocumented immigrants, legally the health care system is obliged to provide care to patients in need of emergent situations. This means that we are providing healthcare for undocumented immigrants, but only in the most expensive way, in the hospital when the disease is advanced enough to cause a disaster.

Although protecting safety-net hospitals by obtaining funds for uncompensated care may seems to be a feasible answer, we need a better national solution that permit undocumented immigrants to have access to care in a preventive state, early stage of the disease, and follow up their care as outpatient, instead of waiting for a catastrophe to happen and then spend secure funds to help them. This is the time to find the best way, that would be feasible morally and financially, to make the US health care system inclusive and cost-effective.

Solmaz Ehteshami-Afshar is an internal medicine resident at Yale-New Haven Hospital. The opinions expressed here represent her views and not those of her employer. 

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