Student Voice: Immigration Policy Limits Access to Care

By Elissa Poorman

A few months ago, I drove the four hours from Emory University to Valdosta, Georgia to provide health care to migrant farm laborers. A handful of other medical students and around a hundred physician assistant students made the journey. Over two weeks we saw 1,403 patients who worked the fields, primarily from Mexico, Guatemala, and Haiti. The numbers were down from previous years, as word about a new immigration law, House Bill 87, spread fear amongst workers. Some had returned to their homelands, and some had gone to neighboring states with more friendly immigration policies. Others were still at home but too afraid to seek care, thinking that our makeshift clinic would report them to the authorities.

One evening we sat under a tent, trying to shield ourselves from the harsh South Georgia sun, with a father and his three children. He had come to the US ten years ago, when his eldest daughter was an infant. He and his wife spent years in the fields, where they had earned enough to survive, send money to their parents in Mexico, and paid taxes. They couldn’t afford health insurance for themselves or their eldest daughter, and didn’t qualify for government aid without citizenship. The father and daughter had teeth that were rotting. The daughter’s only health care had been receiving all her childhood vaccinations the day she began school, and she understandably looked at our stethoscopes and blood pressure cuffs with terror. The two youngest qualified for Medicaid. Their teeth were beautiful.

Like many other immigrants, and the vast majority of farmworkers, the father and his wife paid taxes every year they were in Georgia. Contrary to popular belief, most immigrants do pay taxes. Though some immigrants may escape IRS scrutiny with cash-only jobs, these are few and far between. Most jobs, including in the crucial agriculture sector, are large enough that under-the-table payments are impossible in practice. Immigrants pay payroll taxes, regardless of immigration status, and income tax with Individual Taxpayer Identification Numbers, which is explicitly designed to bring taxpayers without legal immigration status into the taxpayer system. When filing for a return on this income, there is scrutiny of immigration status, so many immigrants do not file for a return. Therefore, much of the federal income that is collected and should be returned under current tax law instead pads government budgets.

Combining ITIN revenue with unmatched SSN (which are likely to be taxes filed by illegal immigrants), state and federal governments collected $91.2 billion from 1996 to 2003, or around $13 billion a year. Given that 1/12th of the nation’s immigrants are estimated to live in Georgia, the state likely collected $1.1 billion in income taxes per year in that period. This number is likely an underestimate, as Georgia’s immigrants earn slightly more and tend to be more educated than their counterparts in other states. This figure does not include the taxes that this father paid when buying school supplies, food, and clothing for his children, the gas taxes he paid to get to work, or any of the other revenue sources built into our transactions. The food he and his wife picked in turn lowered costs for people like myself, so we could eat the fresh fruits and vegetables that his family could barely afford.

Luckily for this family, they did not have any chronic health conditions. It is almost impossible to imagine how they would have paid for basic medical services. As knowledgeable as they were about their health risks, it is likely that they, like others without insurance, would instead forgo the basic services that have been shown to save lives and keep productive people in the work force instead of in a hospital bed. Even in Atlanta, immigrants no longer qualify for subsidized care at Grady, the state’s last true safety net hospital. Instead, they would have to wait until hypertension became a stroke, or diabetes became kidney failure, to demand too little, too late.

The consequences of unemployment and uninsurance are now familiar to far too many Georgians, and the state government is increasingly strained as demand increases and budgets shrink. Georgia faces a projected budget shortfall of $1.94 billion and a 10.1% unemployment rate. House Bill 87 will push the economy further over the edge: the shortage of farm labor alone will lead to the loss of $391 million to the economy, and 3,260 jobs, according to a report by the Georgia Department of Agriculture. Its provisions require small agencies to spend money they don’t have to root out the undocumented. The family we spoke to had already decided to return to Mexico, tired of hiding and fearful that they would be separated from their children by local police officers who are now required to enforce federal law. When they go, at our state’s request, and our situation becomes even worse, we will have to look around for others to blame.

Elissa is an MD/MPH student at Emory University School of Medicine and Rollins School of Public Health.  Her opinions do not necessarily reflect the those of her institution or Health Students Taking Action Together.