A day laborer since 1986, Mr. Cedillo has received notice from a Los Angeles County hospital that he must start paying out of pocket for the treatment he will need. "I have no choice because I have no insurance and can't work while I'm taking these treatments," he says, sitting in the tiny apartment he shares with his wife, a janitor.
The recession – and a big state deficit – is leading some California counties to cut back on nonemergency health services to illegal immigrants. In others, cutbacks in services for the uninsured are hitting illegal immigrants especially hard.
The problem is socking California because it is home to the lion's share of US immigrants, both legal and illegal. The latter are often eligible for healthcare provided to the poor. But health departments across the country are facing budget pressures that are leading to slashed services – and that could reignite the debate over providing medical care to illegal immigrants.
"There simply isn't enough revenue to support the network of services which heretofore has been expected," says Robert Pestronk, executive director of National Association of County and City Health Officials (NACCHO).
In many states, budget cuts mean reduced funding for the uninsured, many of whom are immigrants and low-income families. In Arizona, a $13 million cut from the state budget eliminated funds partly used to reimburse hospitals for caring for the uninsured.
"The states and local governments tend to bear the brunt of illegal immigration," says Steve Camarota, statistician and demographer for CIS. Now, with revenues falling well short of predictions, services to undocumented immigrants are getting the ax in an effort to preserve other programs, from infrastructure to schools to the environment.
The cutbacks could potentially refire the debate over providing social services such as healthcare for illegal immigrants. In 2007, several state legislatures introduced bills that sought to limit social service benefits including healthcare to illegal immigrants. An LA Times/Bloomberg survey in December 2007 found that one in three Americans wanted to deny social services, including public schooling and emergency-room healthcare, to illegal immigrants.
In California, two counties are pulling back on health services for illegal immigrants.
Sacramento County closed two health clinics that serve the poor and ended services with various mental health contractors in early February, saving nearly $6 million in an effort to close a $55 million general fund shortfall.
In Contra Costa County, a proposed plan would screen out illegal immigrants – except for children and pregnant women – from nonemergency healthcare services that are provided to low-income residents who cannot get insurance. The county is looking at cutting services to an estimated 5,500 illegal immigrants they serve annually, to tally a savings of $6 million.
"The pressure is purely economic," says Dorothy Sansoe, senior deputy county administrator for Contra Costa County. Her county has already cut $90 million from its general purpose budget and has to cut another $56 million by July 1.
"Here, many hospitals are cutting services and staff just to survive," says Randy Ertll, who has served on the board of several Los Angeles County hospitals and is now Executive Director of the El Centro de Accion Social, or Center for Social Action, a nonprofit agency that promotes cultural understanding in Pasadena.
The issue is not just one of documented vs. undocumented immigrants, he says, but one of affordability in an economy where more and more people are losing their jobs and often their insurance, too.
"Even many US citizens can't afford health insurance in the current recession," Mr. Ertll says.
But such cuts are shortsighted, immigrant support groups say, because neglecting primary healthcare only means that hospitals will have to spend more on emergency or acute-care treatment in the future. "[I]f you send someone home who is ill, that person is only going to get worse or infect others in which case you have a larger, more expensive situation on your hands," says Angelica Salas, executive director of the Coalition for Human Rights of Los Angeles (CHIRLA).
The dilemma highlights the costs of illegal immigration to society, immigration reform groups counter.
"We would like to give great healthcare to everyone but we just can't," says Ira Mehlman, spokesman for the Federation for American Immigration Reform. "Cheap labor is only cheap to the employer, while everyone else has to pay the social costs – such as education and healthcare – and they can be enormous."
"Most societies say their first obligation is to serve citizens and those in the country legally."
At the state and local level, illegal immigrants cost more in public services than they pay in taxes, according to a 2007 Congressional Budget Office paper. But the CBO also found that spending for illegal immigrants accounted for less than 5 percent of total state and local spending for those services. In California, spending was higher but less than 10 percent of total spending for those services.
Back in his small apartment, Cedillo says he believes that healthcare is a "basic human right." He says he is "confused and afraid." Fortunately, his three adult children are independent. But his wife's janitor salary barely covers the couple's monthly rent and food expenses.
So much is spent on healthcare in America – the most per capita in the world – there should be enough to go around, says Mr. Pestronk of the National Association of County and City Health Officials.
"This crisis points up the need to have political will and courage to use what we know to create the conditions in which we can all be healthy," he says.