Health officials lobby
against proposed cuts

Budget concessions could lead
to greater problems for migrants

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By Helen Altonn
haltonn@starbulletin.com

Public health advocates predict serious consequences if legislators don't restore about $7.9 million for immigrant and migrant health care programs chopped from the proposed state budget.

The issue, now before House-Senate budget conferees, involves health care provided to low-income immigrants and migrants from nations under the Compacts of Free Association, including the Republic of the Marshall Islands, Federated States of Micronesia, and Palau.

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The Senate cut funding for the Hawaii Immigrant Health Initiative, providing outpatient care to nearly 1,400 immigrants per year, and state Med-QUEST coverage for about 1,500 migrants from the Freely Associated States.

Beth Giesting, Hawaii Primary Care Association executive director, said cutting these programs "will have a devastating economic effect" on community health centers. "This will take $1.4 million away from their revenues and suddenly leave several thousand more of their patients without any payment source."

Richard E. Meiers, president and chief executive officer of the Healthcare Association of Hawaii, said reducing access to primary care for the immigrant population "will be the start of a devastating domino effect."

While the amount involved "isn't insignificant," he said, "a cut to these 'front end' appropriations would result in health conditions becoming more severe and, ultimately, much higher 'back end' health care costs."

President Bush's proposed budget for the fiscal year beginning Oct. 1 includes $15 million a year for the next 20 years to Hawaii, Guam, the Commonwealth of the Northern Mariana Islands and American Samoa to help offset the cost of services to migrants under the Compacts of Free Association.

Senate Health Chairwoman Rosalyn Baker (D, Honokohau-Makena) said she believes the state funding was deleted because "there was some belief that we'd already gotten the federal money.

"I know both the House and Senate have resolutions urging the federal government to step to the plate and provide some dollars because it's costing us an enormous amount of money to pay for basically federal obligations."

But the federal money hasn't been appropriated; it wouldn't take effect until October even if approved by Congress, and it must be divided among health care, education, public safety, housing, employment preparation and other services, health officials point out.

Hawaii has one of the highest immigration rates per capita in the nation, with about 6,000 to 8,000 immigrants arriving per year. They're ineligible for federal health benefits under the 1996 federal welfare reform act, so the state created the Immigrant Health Initiative to ensure they receive basic services.

If the state money is abolished, Meiers said, uninsured people who go to community health centers will end up in hospitals and emergency rooms. Hospitals will have to cover the soaring costs by increasing payments of patients able to pay, he said.

Health advocates also fear the spread of communicable diseases if immigrants and migrants are unable to get medical care.

Baker said the kind of diseases brought here from the Marshall Islands and Federated States of Micronesia in many ways are much more serious than severe acute respiratory syndrome because they can be much more widespread.

"If there are not efforts to really deal with it, the greater population is at risk," Baker said.

Giesting said the state Department of Health reported several outbreaks of pertussis and hepatitis A within Free Association migrant communities in recent years.

Immunization rates among migrants may be as low as 64 percent, she said.

House Health Chairman Dennis Arakaki (D, Alewa Heights-Kalihi) said "shredding of the safety net is happening. There is nothing below them (immigrants and migrants) unless you want to consider the emergency room ...

"It may seem like we're saving money, but I think in the long run it will end up costing us more," he said.

In a letter to senators, Patricia McManaman, chief executive officer of Na Loio, a nonprofit organization that provides legal services to low-income immigrants, emphasized the dangers of the proposed budget cuts.

"The willful abandonment of these programs is calloused and cruel," she said.

Without state funding for immigrant and migrant health care services, she added, "we are inviting a health care disaster for individuals and health care businesses alike."