As the Colorado General Assembly gathers at the state Capitol in Denver this week, legislators are debating the issue of prohibiting state funds for services to illegal immigrants.
The governor’s executive order calling the assembly back into session would allow lawmakers to enact a law prohibiting use of state funds for illegal immigrants at both the state and local level, excluding only emergency medical care, prenatal services and public education.
We applaud the idea that prenatal services would continue to be available to all. Data has shown that every dollar spent in prenatal care saves $3.38 in newborn care and another $4 in childhood care.
However, we believe it would be unwise to exclude from primary care services a sizable portion of the population (250,000 in Colorado, according to the governor’s proclamation).
There are important public health reasons why other developed countries provide care for all those living within their borders. People who have communicable diseases, whether they are in the country legally or illegally, spread such illnesses to others.
Nobody – insured, uninsured, illegal, living in an apartment or gated community – can keep communicable diseases at bay without appropriate vaccination, diagnosis and treatment. Sexually transmitted diseases, tuberculosis and flu are a few examples of this core issue. There were 1 million cases of chlamydia in the United States last year, and more than 14,000 in Colorado. Syphilis is on the rise; there were 33,400 cases in the U.S. last year and 40 cases in Denver last year. We at Denver Public Health are now seeing one case a week in our STD clinic.
There are 40,000 new cases of HIV in the nation each year. Hepatitis B affects 6 million people worldwide. The risk of acquiring an STD is quite high – 30 percent for syphilis, for example. So while someone with symptoms of an STD would not meet the standard definition of an emergency, we would consider it as such if one of our family members acquired such a disease. Early intervention or immunization is necessary to prevent the spread of STDs.
Tuberculosis, which is transmitted through airborne droplets, is increasing in the world again, with 14,000 cases nationwide and 101 in Colorado last year. Whooping cough and mumps are childhood diseases that are re-emerging in America. Last year, 95,000 cases of influenza were reported. While not emergencies, if one of our family members died from TB or the flu, it would be a tragedy.
Refusing to provide treatment, vaccinations and other primary care services to adults living among us simply enhances the risk that our teens, our elderly parents, our neighbors, friends, and ourselves will be infected from something carried by an untreated or non-immunized person.
Moreover, the notion that primary care services are too expensive to provide also does not fit with well-known data. A beta blocker for a heart patient costs as little as pennies a month. But charges for treating a heart attack victim, including emergency department intervention and subsequent procedures, will be upwards of $87,000. Insulin costs are in the range of $10 to $35 a month. A diabetic amputation runs $73,000 or more, and then the patient joins the ranks of the disabled.
Clearly, the country needs a cohesive, coordinated strategy for immigration. We are not experts in immigration policy, but we know that providing high-quality primary and preventive care keeps people out of emergency rooms.
We hope the Colorado General Assembly will recognize the importance of public health and cost considerations as it debates Colorado immigration policy.
Patricia A. Gabow, M.D., is chief executive officer and medical director of Denver Health. Christopher Urbina, M.D., is director of public health at Denver Health.
