The fact that more than 40 million U.S. citizens have no health insurance increases our country’s vulnerability to a bioterror attack, two public health experts have charged.
Furthermore, they say, the 1996 Welfare Reform Act, which prohibits federally funded clinics from providing most services to undocumented immigrants, discourages immigrants from seeking diagnosis and care for what may be highly contagious illnesses.
Experts put the blame squarely on the health care crisis, not those who are the victims of it. Lack of insurance or fear of requesting health care “must now … be recognized as a risk to the nation’s health,” Dr. Matthew Wynia, director of the Institute for Ethics, American Medical Association, and Lawrence Goslin, professor of health law at Georgetown University, wrote in the May 31 issue of Science magazine.
“An effective national defense against bioterrorism requires that all potentially infected patients can be at least evaluated without fear of deportation or other significant social or economic loss,” they wrote.
Although the Welfare Reform Act includes exceptions that allow undocumented immigrants to obtain emergency treatment, the act is widely misinterpreted, Wynia and Goslin said. The Texas attorney general, for example, stated last year that public hospitals and clinics cannot provide most services to undocumented immigrants, even though Texas public hospitals argued that early diagnosis and treatment is cost effective and necessary to protect the public’s health.
California’s Proposition 187, which required health professionals to report undocumented immigrants to the authorities, also “undoubtedly contributed to mistrust of the medical-care system among immigrants,” the authors said.
Tom Schaefer, spokesman for the Illinois Department of Public Health, told the World that to his knowledge people are not denied access to health care in Illinois because of their immigration status. But he said he did not have information as to whether immigrants or the uninsured avoid seeking treatment.
Early detection of infectious disease followed by appropriate treatment is essential to preventing epidemics. Any delay in obtaining care poses a public health risk, Wynia and Goslin wrote.
“We are spending billions and billions on homeland defense. We need a program to ensure that all U.S. residents can be seen by a doctor and evaluated for potentially contagious disease,” Wynia, who is also Clinical Associate in Infectious Diseases at the University of Chicago Hospitals, told the World.
If a “designer virus or designer bacteria” were engineered to ensure easy spread, many people could be infected, he said. “The last thing we need is for an ‘index case’ – the first person to catch an infectious disease – to avoid medical care for reasons we could have addressed.” If a person who has an infectious disease simply stays home, he or she can infect family and neighbors, who then go to work and spread the disease to others.
“Many of us would like to have a universal health care system,” Wynia told the World. But even without that, he said, it makes sense to ensure that everyone has access to evaluation and appropriate treatment to prevent the spread of infectious disease. A program to provide such access would help prevent potential epidemics from diseases like tuberculosis or smallpox, whether bioterror-related or not.
Wynia said the cost of providing emergency evaluation and treatment for symptoms of potentially contagious disease ought to be paid by the government out of homeland defense funds.
“Although additional funds will be required to evaluate uninsured patients, the investment in detection is the right thing to do – and it might even save money in the long run, as treatable and preventable illnesses are detected earlier and contained,” Wynia and Gostin wrote.
The author can be reached at suewebb@pww.org
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