ON June 15, Florida Gov. Lawton Chiles (D) wrote President Clinton asking that the federal government absorb all related costs associated with people seeking refuge in the United States.
Mr. Chiles's request followed a decision by US District Judge Sterling Johnson ruling that 190 Haitian refugees held at Guantanamo Bay Naval Base, Cuba, must be admitted to the US. They have tested positive for HIV or have been diagnosed as having AIDS.
Although it is difficult to know how many Haitians will seek public help, their medical needs could cost up to $20 million if all new immigrants qualify for Medicaid. At least half of this expense would be picked up by state Medicaid funds.
"That is just the medical cost. There are other costs such as food, shelter, employment training, and other social services," says Ron Sachs, Chiles's communications director. For example, Haitian families arriving might be eligible for the Aid to Families with Dependent Children program.
In addition, the Community Relations Service, part of the Department of Justice, automatically dispenses $2,000 in cash to each refugee. Each state has its own package of benefits usually mirroring the state welfare policy.
But not all immigrants are eligible for this package. Congress limited eligibility for Medicaid to political refugees. Benefits have a time limit of eight months.
However, Bruce Bushart, director of New York's Bureau of Refugee and Immigration Affairs, says the Haitians will be encouraged to apply for Supplemental Security Income, a part of Social Security that is geared toward the elderly, needy, blind, and disabled.
"The Department of Health and Human Services is committed to helping to expedite that process," he explains.
The additional costs will hit state Medicaid funds at a time of extraordinary growth. In New York State, for example, Medicaid costs are growing at a rate of 12 percent a year. "It would have grown by 20 percent if we had not cut back on benefits," says Claudia Hutton, a spokeswoman for the state budget department.
And there is a new debate over whether the huge new influx of immigrants from all countries is a net plus or minus for the US. According to a recently released study by Donald Huddle, professor emeritus of economics at Rice University in Houston, the net cost of new immigrants over the next decade will be $450 billion.
Nancy Wittenberg, refugee programs administrator for the state of Florida, points out that the new immigrants will not necessarily be a drain on taxpayers. All of the Haitians who settled in Florida are joining families. "There is no reason to assume that person will add an additional burden," Ms. Wittenberg says.
Haitians, in fact, do not generally seek public assistance but instead seek work. Also, she says, they are not familiar with welfare since it does not exist in Haiti.
However, Haitians may have no choice but to seek help from Medicaid for their medical care. According to Peter Arno, a health economist at Montefiore Hospital in the Bronx, the lifetime public medical expense of treating someone who is HIV positive is about $100,000 - about $40,000 per year for an AIDS patient, and about $10,000 per year for one who is HIV positive. New figures will be released in the next month which are expected to show higher costs, says Mr. Arno, author of "Against the Odds," a book about AIDS.
In fact, one major reason why Judge Johnson ruled that the Haitians could not be held at Guantanamo was the paucity of medical services. "The military doctors believe that the medical facilities on Guantanamo are inadequate to treat such AIDS patients because there is no CAT scanner or a variety of specialists that are necessary to diagnose and treat those with AIDS," she wrote.
The medical issue is important because the US has always had health standards that immigrants had to meet for admittance. The standards were designed to screen out immigrants with diseases believed to be infectious, such as AIDS. In fact, in a recent appropriations bill Congress reaffirmed AIDS as a bar to immigration, after the administration had indicated it would remove it from a list of infectious diseases.
Once the government found that there were 300 HIV-positive Haitians (of 10,738 with credible asylum claims), it decided that this group must pass a stiffer test, demonstrating "a well-founded fear" of political persecution, not just a "credible claim." The government was then sued by activist immigration and Haitian groups. They maintained that the asylum-seekers had the right to have a lawyer present during administrative hearings.
Johnson agreed with the activists, ruling that the government had violated the rights of Haitians, whom he said could not return to Haiti but must be released from Guantanamo. Now, the government is trying to decide whether or not to appeal.
However, some Immigration and Naturalization Service officials believe the appeal is too late since the Haitians are already here. Appeals courts usually consider such appeals moot since there is no relief sought. Instead, says Duane Austin, an INS spokesman, "The Judge's decision is making the INS asylum decision a judicial process instead of an administrative process."
In other words, any time a potential political refugee is interviewed anywhere in the world, he could ask to have a lawyer present.
"Does this decision extend to anywhere in the world and to all executive powers?" Mr. Austin asks.
"It could have a far-reaching impact," he says.