It should probably go without saying, but health care in the United States is complicated, expensive and unequally accessible. It depends upon whether you happen to be lucky enough to have health insurance. I went without it for 10 years from 2002 until 2012. I have been a very happy recipient of the Affordable Care Act, and even when my monthly premium got as high as $225 per month in 2014, most years was well below that. From 2016-2018 I paid less than $25 per month, and that was for excellent coverage. Right now I pay $75 per month, but it covers all my prescriptions at only $3 per medicine per month, my maximum out of pocket is $500 for the entire year, and I can access quite a range of providers within my network. Like nearly everything else in this country, mental health is a glaring exception in all this, but overall it’s better than the alternative.

If you are a mental health care recipient, I would caution you specifically against a drug called Xyprexa. If your provider gives you this glibly, ask why. Using it from 2001-2002 put me unknowingly on a literal “Red List.” When I contacted Blue Cross Blue Shield of NC in 2010, I was told I would have to pay $1,000 per month, shoulder a $12,000 annual deductible, and that they would then cover only 20 percent. (Like, are you kidding me?) I asked why, and the woman said, “You have a pre-existing condition. You’re on a red list as a suicide risk because you took Xyprexa in the past.” Despite preexisting conditions no longer being allowed, unless you have no other option, be very careful about allowing yourself to be given this medication (which was largely ineffective and exacerbated my symptoms).

All this while being a citizen of this country. But what does this look like for undocumented immigrants or other residents who cannot access even that level of inadequate care? It is a strange argument to make, but many people criticize immigrants for using both free clinics, as well as emergency rooms. In both cases people will make the argument that it is too costly to afford marginalized people care. I did some preliminary digging, and this is what I found.

According to MedPageToday.com, the average community clinic operates on an annual budget of $460,000 — keeping in mind that half of clinics operate well below this level — and see an average of 6,000 patients in a year. This works out to $76.67 per visit. According to CBSNews.com, the average cost of a trip to the emergency room without insurance is $1,273.43. Debt.org puts it at $1,389.00, and GoodRx.com says it’s $2,000.00. Whatever the number, it is orders of degrees higher than clinics, which are really not equipped to handle most anything that is especially dire. They can treat most minor conditions, thus avoiding trips to hospitals.

According to PewResearch.org, there were 11.1 million undocumented immigrants in the United States in 2014. This amounted to roughly 3 percent of the nation’s population at the time. Given the severe immigration policies enacted during the Trump administration, it is plausible that these numbers are lower now. With this in mind, even if one were to make the unreasonable assumption that 30 percent of patients at a clinic are illegal aliens, it would amount to $138,006.00 per year ($76.67 x 1,800 patients). That percentage is probably patently absurd, but it makes the point that it actually costs very little to tax payers to fund clinics. If those 1,800 immigrants go to the emergency room, it could cost on average as much as $3.6 million to the people paying into insurance. It really cannot be logically compared.

In addition, especially during the pandemic, immigrants who cannot access care of any kind risk becoming spreaders of communicable infections. Those who cannot access or afford treatment — or refuse it for fear of deportation — not only sicken and show up in emergency rooms as a last resort, they also remain vectors for all sorts of preventable diseases. This in turn leads to more visits to more clinics and emergency rooms.

Whether from a spirit of compassion and empathy, or looking stoically at numbers, it seems clear that immigrants of any status really do need access to health care. The costs of denying care in terms of lives and treasure are simply too great. Immigrants already contend with trauma and stress before arriving and during their residence in a foreign land. It is an unnecessary burden and counterproductive obstacle to block them from getting the care many of them so desperately need.

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