Double-dipping: Low wage-paying companies force taxpayers to fund benefits, says report

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More than half of the billions of dollars spent on state and federal government assistance programs each year goes to benefit working Americans because their salaries are too low to make ends meet.

A study published out of the Center for Labor Research and Education at the University of California’s Berkley campus this week says 56 percent of the $226.8 billion used annually on assistance programs between 2009 and 2011 went to working families.

“When companies pay too little for workers to provide for their families, workers rely on public assistance programs to meet their basic needs,” Ken Jacobs, the chair of the labor center and co-author of report released this week, said in a statement. “This creates significant cost to the states.”

The researchers say that around $153 billion in taxpayer money is spent each year, on average, aiding families that otherwise depend on earned wages.

The economists studied the use of state and federal funds on Medicaid, the Children’s Health Insurance Program, Temporary Assistance for Needy Families, the Earned Income Tax Credit and the Supplemental Nutrition Assistance Program, or food stamps, and then looked to see how much of that money goes to families where at least one person has worked a minimum of 10 hours per week for half a year or longer.

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Poorest Americans left out of federal aid despite 74 percent spending surge

The report determined that working families make up roughly 61 percent of Medicaid enrollees and 74 percent of Earned Income Tax Credit recipients, and also reaped the benefits of food stamps and TANF around one third of the time.

Nearly three-quarters of those who receive earned income tax credit are in working families, and those funds are only available to people who hold down jobs but still make either near or below the standard of living.

In explaining his group’s findings, Jacobs says that consistently low wages have made it hard for families to meet the cost of living. The study determined that wages, adjusted for inflation, haven’t increased for anyone in the bottom 70 percent of earners between 2003 and 2013, and that those on the bottom 10 percent are actually making less now, after adjustments, than Americans were earning 35 years earlier.

“We’re subsidizing the profits of Wal-Mart,” SEIU 1199 New England President David Pickus, whose union represents healthcare workers, told the Hartford Currant. “They’ve lived this way as if this is the way things are. It’s an amazing sense of corporate welfare.”

ON OBAMACARE, IT’S THE PRESIDENT WHO REFUSES TO EMBRACE REALITY

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BY PETER SUDERMAN

Obamacare turns five years old this week, and to mark the occasion, President Obama took after critics of the health law, noting their ongoing opposition while briefly laying out the reasons he believes it to be a success. “It’s time to embrace reality,” he said, according to The Hill.

The president ticked off a string of points in support of the law: an additional 16 million insured, 50,000 fewer preventable deaths, slow growth in health premium costs, and lower deficit projections as a result.

The law, he said, is “working even better than expected.”

One could reasonably quibble with much of this, because not all of the points President Obama cited are clearly or fully attributable to Obamacare.

Health spending growth, for example, is indeed down, and this is driving much of the decline in the deficit, but at least a sizable portion of the decline—perhaps most of it—can be attributed to the recession. One study in Health Affairs last year concluded that about 70 percent of the health spending slowdown is a result of the economy, not any structural changes to health care delivery. Obamacare may be due some credit, but not too much.

Similarly, it’s true that a government report estimated that between 2010 and 2013, deaths from “hospital-acquired conditions” were reduced by about 50,000. But it’s hard to fully pin this on Obamacare when the report states up front that “the precise causes of the decline in patient harm are not fully understood.” 

Meanwhile, the 16 million insured figure comes from a March report by the Department of Health and Human Services, and it is a total of those who gained coverage through Obamacare’s exchanges, Medicaid, employment, and the individual market place, which means it’s not wholly attributable to the law. And it tallies those who signed up for coverage rather than those “effectuated enrollment”—those who have already paid their premiums. The actual number is probably not too far off from what President Obama stated, but, once again, Obamacare isn’t the entire story here.

So Obama is overstating the case, and, of course, leaving out points against the law.

For example: About half of the people who received subsidies through the law last year will have to pay them back through their taxes this year, according to a Kaiser Family Foundation study this week. On average, those who owe will have to pay a little more than a quarter of their subsidy back. A few will have to pay back the entire subsidy.

On the flip side, a little less than half will end up getting money back, but even that will be complicated by the fact that the federal government and California, which runs the biggest state exchange, sent out nearly a million tax forms related to the health law with incorrect information, leading the administration to ask many to delay filing their taxes as a result. California has already issued 120,000 correct tax forms, but there are still “tens of thousands” who haven’t gotten updated forms, according to the L.A. Times.

Whitehouse.gov

Beyond that, there are additional questions about whether the Internal Revenue Service is even equipped to handle all the new paperwork required by the law. According to the Chicago Tribune, roughly a quarter of tax filers will have extra filing requirements due to the health law.

And then there are the poll numbers for the law, which is still unpopular, just as it has been throughout the five years it has been law. Polls differ on the exact contours of public opinion about the law, but all the polls in the Real Clear Politics opinion survey show that oppositions outweighs support by at least seven points; on average, the opposition is 10.5 points higher than the support.

If the law is truly working so well for so many people, if it is, as Obama has now taken to saying, working better than expected or anticipated, then why does it remain so stubbornly unpopular?

When the law was being debated in Congress, many supporters of the law argued that it would grow popular once it passed. When that didn’t happen, Obamacare backers insisted that it polled poorly because the major benefits had yet to kick in.  When the major benefits kicked in, they argued that the botched launch of the exchanges was killing support.

These excuses no longer work. The coverage expansion has arrived, and while the precise numbers aren’t clear, there’s no denying that far more people are covered now than two years ago. The exchanges are still incomplete on the back end, but the consumer-facing part of the system works well enough. The health insurance subsidies have arrived, and are being doled out to millions, and so have the insurance rules restricting insurers from charging or denying coverage based on preexisting conditions.

Obamacare’s major benefits have gone into effect and had time to work their way through the system—and yet the law remains widely disliked. Obama’s message about the law, meanwhile, remains the same as always: It’s great, and people should stop resisting and recognize how great it is.

After five years, in other words, President Obama has not changed his message, even in the face of consistent broad public opposition, even as the various theories for why it remains unpopular have fallen away. Obamacare is simply not well liked. This is the political reality—and President Obama still refuses to embrace it. 

WHAT IF ILLEGALS LEFT?

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What if the illegals left?

Somebody really did their homework on this one. Best on the subject to present date.

What if 20 Million Illegal Aliens Vacated America?

Visit Obama Enemies for more on Illegal immigration

I, Tina Griego, journalist for the Denver Rocky Mountain News wrote a column titled, “Mexican Visitor’s Lament.”

I interviewed Mexican journalist Evangelina Hernandez while visiting Denver last week. Hernandez said, “Illegal aliens pay rent, buy groceries, buy clothes. What happens to your country’s economy if 20 million people go away?”

Hmmm, I thought, what would happen?

So I did my due diligence, buried my nose as a reporter into the FACTS I found below.

It’s a good question… it deserves an honest answer. Over 80% of Americans demand secured borders and illegal migration stopped. But what would happen if all 20 million or more vacated America? The answers I found may surprise you!

In California, if 3.5 million illegal aliens moved back to Mexico, it would leave an extra $10.2 billion to spend on overloaded school systems, bankrupt hospitals and overrun prisons. It would leave highways cleaner, safer and less congested. Everyone could understand one another as English became the dominant language again.

In Colorado, 500,000 illegal migrants, plus their 300,000 kids and grandchilds would move back “home,” mostly to Mexico. That would save Colorado an estimated $2 billion (other experts say $7 billion) annually in taxes that pay for schooling, medical, social-services and incarceration costs. It means 12,000 gang members would vanish out of Denver alone.

Colorado would save more than $20 million in prison costs, and the terror that those 7,300 alien criminals set upon local citizens. Denver Officer Don Young and hundreds of Colorado victims would not have suffered death, accidents, rapes and other crimes by illegals.

Denver Public Schools would not suffer a 67% dropout/flunk rate because of thousands of illegal alien students speaking 41 different languages. At least 200,000 vehicles would vanish from our gridlocked cities in Colorado. Denver’s 4% unem ployment rate would vanish as our working poor would gain jobs at a living wage.

In Florida, 1.5 million illegals would return the Sunshine State back to America, the rule of law, and English.

In Chicago, Illinois, 2.1 million illegals would free up hospitals, schools, prisons and highways for a safer, cleaner and more crime-free experience.

If 20 million illegal aliens returned ‘home,’ the U.S. Economy would return to the rule of law. Employers would hire legal American citizens at a living wage. Everyone would pay their fair share of taxes because they wouldn’t be working off the books. That would result in an additional $401 billion in IRS income taxes collected annually, and an equal amount for local, state and city coffers.

No more push ‘1’ for Spanish or ‘2’ for English. No more confusion in American schools that now must contend with over 100 languages that degrade the educational system for American kids. Our overcrowded schools would lose more than two million illegal alien kids at a cost of billions in ESL and free breakfasts and lunches.

We would lose 500,000 illegal criminal alien inmates at a cost of more than $1.6 billion annually. That includes 15,000 MS-13 gang members who distribute $130 billion in drugs annually would vacate our country.

In cities like L.A., 20,000 members of the ’18th Street Gang’ would vanish from our nation. No more Mexican forgery gangs for ID theft from Americans! No more foreign rapists and child molesters!

Losing more than 20 million people would clear up our crowded highways and gridlock. Cleaner air and less drinking and driving American deaths by illegal aliens!

America’s economy is drained. Taxpayers are harmed. Employers get rich. Over $80 billion annually wouldn’t return to the aliens’ home countries by cash transfers. Illegal migrants earned half that money untaxed, which further drains America ‘s economy which currently suffers an $8.7 trillion debt. $8.7 trillion debt!!!

At least 400,000 anchor babies would not be born in our country, costing us $109 billion per year per cycle. At least 86 hospitals in California, Georgia and Florida would still be operating instead of being bankrupt out of existence because illegals pay nothing via the EMTOLA Act. Americans wouldn’t suffer thousands of TB and hepatitis cases rampant in our country – brought in by illegals unscreened at our borders.

Our cities would see 20 million less people driving, polluting and grid locking our cities. It would also put the ‘progressives’ on the horns of a dilemma; illegal aliens and their families cause 11% of our greenhouse gases.

Over one million of Mexico’s poorest citizens now live inside and along our border from Brownsville, Texas, to San Diego, California, in what the New York Times called, ‘colonias’ or new neighborhoods. Trouble is, those living areas resemble Bombay and Calcutta where grinding poverty, filth, diseases, drugs, crimes, no sanitation and worse. They live without sewage, clean water, streets, roads, electricity, or any kind of sanitation.

The New York Times reported them to be America’s new ‘Third World’ inside our own country. Within 20 years, at their current growth rate, they expect 20 million residents of those colonials. (I’ve seen them personally in Texas and Arizona; it’s sickening beyond anything you can imagine.)

By enforcing our laws, we could repatriate them back to Mexico. We should invite 20 million aliens to go home, fix their own countries and/or make a better life in Mexico. We already invite a million people into our country legally annually, more than all other countries combined. We cannot and must not allow anarchy at our borders, more anarchy within our borders and growing lawlessness at every level in our nation.

It’s time to stand up for our country, our culture, our civilization and our way of life.

Interesting Statistics!

Here are 14 reasons illegal aliens should vacate America, and I hope they are forwarded over and over again until they are read so many times that the reader gets sick of reading them:

1. $14 billion to $22 billion dollars are spent each year on welfare to illegal aliens (that’s Billion with a ‘B’)

3. $7.5 billion dollars are spent each year on Medicaid for illegal aliens.

4. $12 billion dollars are spent each year on primary and secondary school education for children here illegally and they still cannot speak a word of English!

5. $27 billion dollars are spent each year for education for the American-born children of illegal aliens, known as anchor babies.

6. $3 Million Dollars ‘PER DAY’ is spent to incarcerate illegal aliens. That’s $1.2 Billion a year.

7. 28% percent of all federal prison inmates are illegal aliens.

8. $190 billion dollars are spent each year on illegal aliens for welfare & social services by the American taxpayers.

9. $200 billion dollars per year in suppressed American wages are caused by the illegal aliens.

10. The illegal aliens in the United States have a crime rate that’s two and a half times that of white non-illegal aliens. In particular, their children, are going to make a huge additional crime problem in t he US.

11. During the year 2005, there were 8 to 10 MILLION illegal aliens that crossed our southern border with as many as 19,500 illegal aliens from other terrorist countries. Over 10,000 of those were middle-eastern terrorists. Millions of pounds of drugs, cocaine, meth, heroin, crack, guns, and marijuana crossed into the U.S. from the southern border.

12. The National Policy Institute, estimates that the total cost of mass deportation would be between $206 and $230 billion, or an average cost of between $41 and $46 billion annually over a five year period.

13. In 2006, illegal aliens sent home $65 BILLION in remittances back to their countries of origin, to their families and friends.

14. The dark side of illegal immigration: Nearly one million sex crimes are committed by illegal immigrants in the United States!

Total cost a whopping $538.3 BILLION DOLLARS A YEAR !

How One Nebraska Woman Lost Her Health Insurance Three Times Under Obamacare

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Dec. 26, 2014, was strike three for Pamela Weldin.

The day after Christmas, Weldin, of Minatare, Neb., had logged on to Facebook to find a message from a friend of hers. Included in the note was a link to anarticle from the Omaha World-Herald announcing that CoOportunity Health, a nonprofit health insurance company offering plans in Nebraska and Iowa, had been taken over by state regulators.

The insurer, one of 23 Consumer Operated and Oriented Plans, or co-ops, started with the backing of the federal government and received $145 million in loans from the Centers for Medicare and Medicaid Services. But, CoOportunity’s expenses and medical claims would far exceed its revenue for 2014.

“Merry Christmas to me,” Weldin, a dental hygienist turned Pampered Chef director, said in an interview with The Daily Signal of when she read the article.

A month later, Iowa Insurance Commissioner Nick Gerhart announced his intent to liquidate CoOportunity Health and encouraged those who were covered by the nonprofit to seek insurance elsewhere.

“I’ve been pulled into the middle of all this through no fault of my own, and there’s nothing fair about it. It is what it is, and you move forward,” said Pamela Weldin, who lost health insurance coverage three times.

For Weldin, 58, the insurer’s liquidation marked the third time she would lose her health insurance under Obamacare, the third time she would head to HealthCare.gov to shop for coverage, and the third time she would have to purchase a brand new plan.

“I’ve been pulled into the middle of all this through no fault of my own,” she said, “and there’s nothing fair about it. It is what it is, and you move forward.”

Obamacare’s Co-Ops

Co-ops are no stranger to the insurance market, and lawmakers hoped the nonprofit insurance companies would help infuse competition and choice into markets where there were limited options.

However, the co-ops created under the law would be slightly different from those already in existence—to help the new insurers get off the ground and meet state reserve requirements, the federal government provided $2 billion in startup and solvency loans.

>>> One Year After Obamacare’s Implementation, Taxpayer-Funded Co-Ops Struggle to Survive

Twenty-three co-ops serving 26 states were ultimately licensed and received federal loans including CoOportunity.

According to the latest quarterly filings, more than 520,000 people enrolled in insurance coverage through the co-ops through September.

An analysis conducted by The Daily Signal earlier this month, though, found that all but one of the co-ops experienced operating losses through September.

Centers for Medicare and Medicaid Services did not return The Daily Signal’s request for comment.

Photo: Paul Hennessy/Polaris/Newscom

Strike One

In the months leading up to the Affordable Care Act’s implementation on Oct. 1, 2013, millions of Americans began receiving notices from their health insurance companies informing them their policies had been cancelled.

Weldin was one of them.

The Nebraska woman, who was diagnosed with carpal tunnel syndrome 15 years ago, had purchased catastrophic coverage through Humana after moving from San Diego, Calif., which she kept until 2013—right before Obamacare’s implementation.

That year, she received a cancellation notice from the insurance giant. The company had decided to pull out of Nebraska and wouldn’t sell plans to Nebraskans through HealthCare.gov, the federal government’s health insurance exchange. Eight other insurance companies followed suit.

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By the start of 2014, Weldin would be left without insurance.

Like millions of other Americans who also received cancellation notices, she logged on to HealthCare.gov on Oct. 1, 2013, to browse and purchase new health insurance. But, like millions of other Americans who attempted to sign on to the site, she was a victim of its disastrous launch.

For two months, Weldin attempted to complete her application and was successful by mid-December.

Through CoOportunity, Weldin purchased a platinum level plan with premiums costing $307 a month.

>>> Obamacare Co-Ops Cost Taxpayers $17,000 Per Enrollee

Strike Two

Weldin’s insurance with CoOportunity went into effect Jan. 1, 2014, and she had the insurance for most of that year.

Like some consumers, Weldin had issues with the coverage she received through the law. Her original doctor, located seven hours away in Colorado, was no longer in network, and Weldin’s plan included services she would never need. At 58 years old, the former dental hygienist had a difficult time understanding why she would need maternity coverage, but it was included in her plan.

Her new platinum plan included a $2,500 deductible, and Weldin qualified for the tax credits touted by the administration.

Then, in November 2014, CoOportunity notified Weldin that they would no longer be offering platinum plans.

(Photo: Pamela Weldin)

For the second time, Weldin “muddled through” HealthCare.gov to purchase a new health insurance plan. Again, she encountered issues with the website and had to wait until December before securing coverage with CoOportunity. Weldin ultimately selected a silver-level plan for $165 a month.

“Here you are, trying to do the right thing, trying to be responsible and have coverage and be diligent,” she said. “And still, I have all these problems and glitches and everything.”

Photo: Polaris/Newscom

Strike Three

It wasn’t long after purchasing her new insurance with the co-op that Weldin learned CoOportunity was in financial trouble.

One day after Christmas, she read that Iowa state regulators had taken over the nonprofit insurance company, and officials warned it could go under.

CoOportunity originally expected just 12,000 consumers to purchase coverage through the nonprofit. They ended up enrolling 120,000, many of whom were sicker and had costly health issues.

As a result, CoOportunity’s expenses and medical claims exceeded their revenue from monthly premiums, which were priced too low.

The state asked the Centers for Medicare and Medicaid Services for additional money, but the agency denied its request.

“You had a perfect storm happen here,” Gerhart said.

For Weldin, the new year brought grim news. She learned that CoOportunity would be liquidated. She would be out of health insurance yet again.

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“The CoOportunity people were helpful and wonderful,” Weldin said. “They answered questions. I really didn’t end up dealing with people who were adversarial or contentious. They sincerely wanted to help people and give out new information, and now they’re going to be unemployed.”

Gerhart told The Daily Signal the state acted quickly in notifying consumers about CoOportunity’s liquidation to ensure no one would have a lapse in coverage. So far, more than 80,000 have moved to other plans.

“They faced a crisis, and their claims were eating up all the surplus and reserve [money],” he said. “It was an unfortunate situation, but we had to step in.”

For the third time in less than two years, Weldin had lost her health insurance. And for the third time, she went to HealthCare.gov to select a new plan from a new company.

Now, Weldin has health insurance through Blue Cross Blue Shield. The “silver lining,” she said, is that Weldin is able to see her original doctor and nurse practitioner in Colorado. But the cost of her monthly premiums increased to $235.

“We have a president who said, If you like your plan, you can keep it. If you like your doctor, you can keep it. You will have choices,’” Weldin said. “All three things were an outright lie.”

Obamacare program costs $50,000 in taxpayer money for every American who gets health insurance, says bombshell budget report

It will cost the federal government – taxpayers, that is – $50,000 for every person who gets health insurance under the Obamacare law, the Congressional Budget Office revealed on Monday.
The number comes from figures buried in a 15-page section of the nonpartisan organization’s new ten-year budget outlook.
The best-case scenario described by the CBO would result in ‘between 24 million and 27 million’ fewer Americans being uninsured in 2025, compared to the year before the Affordable Care Act took effect.
Pulling that off will cost Uncle Sam about $1.35 trillion – or $50,000 per head.

The numbers are daunting: It will take $1.993 trillion, a number that looks like $1,993,000,000,000, to provide insurance subsidies to poor and middle-class Americans, and to pay for a massive expansion of Medicaid and CHIP (Children’s Health Insurance Program) costs.
Offsetting that massive outlay will be $643 billion in new taxes, penalties and fees related to the Obamacare law.
That revenue includes quickly escalating penalties – or ‘taxes,’ as the U.S. Supreme Court described them – on people who resist Washington’s command to buy medical insurance.
It also includes income from a controversial medical device tax, which some Republicans predict will be eliminated in the next two years.
If they’re right, Obamacare’s per-person cost would be even higher.
President Barack Obama pledged to members of Congress in 2009, as his signature insurance overhaul law was being hotly debated, that ‘the plan I’m proposing will cost around $900 billion over 10 years.’
It would be a significant discount if the White House could return to that number today.

In that same speech, Obama claimed that there were ‘more than 30 million American citizens who cannot get coverage.’
$900 billion spent on those people would equate to no more than $30,000 each – less than two-thirds of what the CBO now says the program will cost when the dust settles.
The CBO and the Joint Committee on Taxation, a group of members from both houses of Congress, prepared Monday’s report on the overall direction of the federal budget.
They estimated that ‘the net costs of the coverage provisions of the ACA [Affordable Care Act] will rise sharply as the effects of the act phase in from 2015 through 2017.’
Those costs will ‘rise steadily through 2022′ before leveling off for three years, the groups’ economists determined. But even at that point, the Obamacare program will cost the governemnt ‘about $145 billion’ each year.
That number doesn’t include the insurance premiums and out-of-pocket health care costs paid by Americans – only the government’s role in implementing the law and paying for its guarantees.
And the law will still leave ‘between 29 million and 31 million’ nonelderly Americans without medical insurance, says the CBO.

CBO January 2015 Outlook on Obamacare

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CBO: Obamacare to cost $2 trillion over the next decade

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BY: Philip Klein

President Obama’s healthcare law will spend about $2 trillion over the next decade on expanding insurance coverage but still leave 31 million Americans uninsured, according to an analysis from the Congressional Budget Office released on Monday.

When Obama pitched the healthcare law to Congress, he said it would cost “around $900 billion” over 10 years. But his statement was misleading because the way the law was designed, the major spending provisions didn’t kick in until 2014. This meant that 10-year estimates at the time the law was passed in 2010 were artificially low, because they included four years (2010 through 2013) in which spending was negligible.

Story continues below

The new CBO analysis finds that between fiscal years 2016 and 2025, spending on the law’s expansion of Medicaid will cost $920 billion and insurance exchange subsidies will cost nearly $1.1 trillion. The major spending provisions, taken together, will total $1.993 trillion.

Obamacare does include tax increases and Medicare cuts that previous CBO reports have found would offset the new spending, but CBO is no longer providing a full budgetary analysis of the law.

The CBO also said it expected the law’s exchanges to cover 21 million by the end of the 2016 fiscal year and for Medicaid to cover an additional 13 million — gains that it projects will be partially offset by a reduction of 11 million people in employer or other existing coverage.

By 2025, the end of the projection period, the CBO projects that Obamacare will increase insurance coverage by a net of 27 million, while 31 million will remain

Immigrants in state of Illinois illegally to get state-funded kidney transplants

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“Immigrants in state illegally to get state-funded kidney transplants”

And we wonder why America is broke! Liberals that’s why!

By Meredith Rodriguez
Chicago Tribune

Immigrants in Illinois without legal permission can get state-paid kidney transplants
When he was diagnosed with renal disease almost two years ago, Gustavo Galvez had never heard of dialysis. Doctors told Galvez, who had been working in the United States 17 years without legal residency, that it would help his failing kidneys function and allow him to live.

“But after one month, two months, I learned, and I did not like it,” said Galvez, 35. “I did not want dialysis.”

After each treatment he felt dizzy, nauseated, tired and achy, he said. The excruciating routine depressed him, but Galvez hopes the pain will soon end.

A new state law will for the first time provide funding for kidney transplants for immigrants in Illinois without legal permission, as well as the annual medications needed to maintain the transplanted organs. With the state’s help, Galvez may finally get on a waiting list for a transplant. That has changed his outlook on his life.

“I felt that there was hope,” he said.

Since the law went into effect in October, transplant centers in Illinois have been evaluating some of the 686 immigrants here illegally in the state’s kidney dialysis program to see whether they are healthy enough to receive kidney transplants and placing some on kidney transplant waiting lists.

Those opposed to spending tax dollars on such immigrants, however, say the program will unfairly saddle legal citizens with health costs better spent on Americans. Even proponents of the program worry that such immigrants from other states may try to take advantage of Illinois’ new program, which could heavily inflate costs.

While a representative for the federal Medicaid office said it does not track related laws in other states, lobbyists, lawmakers and officials in Illinois say this is likely the first law of its kind in the country.

“I think it’s an amazing thing that the state of Illinois had the courage to do that,” said Dr. Jose Oberholzer, chief of the Division of Transplantation at the University of Illinois at Chicago, who helped lobby for the new law along with state Rep. Cynthia Soto. “It’s medically the right thing to do, ethically the right thing to do.”

Cost savings of transplant

The cost savings ultimately persuaded legislators and the Illinois Department of Healthcare and Family Services to support the law, according to the department’s director, Julie Hamos, and Dr. Arvind Goyal, who oversees the department’s Medicaid program.

After federal bills passed in the 1980s that barred the use of federal money for immigrants in the country illegally, except during emergency care, such immigrants in the United States with kidney failure could receive dialysis only when complications sent them to the emergency room. The practice is outrageously expensive and causes other health problems, Oberholzer said.

“In Illinois … they said, ‘That doesn’t make sense. If you have kidney failure, that is a constant emergency,'” Oberholzer said.

Illinois is one of several states that designated dialysis as an emergency treatment, Oberholzer said. Yet because the same states did not allow immigrants in the country illegally to be placed on organ donor waiting lists or conduct the roughly $100,000 procedure to transplant kidneys offered by their loved ones, the state invariably committed to offering dialysis — estimated at about $60,000 per year in Illinois — for the rest of such a patient’s life.

“The statistics are compelling,” said Kevin Cmunt, president and CEO of Gift of Hope, the organization that coordinates organ and tissue donations in the northern three-quarters of Illinois and northwest Indiana. “Life expectancy on dialysis is not great, and quality of life is just awful.”

A transplant pays for itself in reduced cost for dialysis in about 21/2 years, officials who support the law said. The state will also pay $10,000 to $20,000 per year for generic anti-rejection medication as long as patients remain state residents, Goyal said.

Hunger strikes and roundtables

A few years ago, people without Social Security numbers who sought transplants were quickly discharged from hospitals, according to Kim Ziyavo, a deacon at Our Lady of Guadalupe Anglican Catholic Mission in Chicago. Although there is no provision barring them, hospitals said immigrants in the country illegally without access to insurance or Medicaid likely did not have the money to properly care for the scarce resource.

“We can get the kidney in. That’s not the point,” said Yolanda Becker, director of the kidney and pancreas program at the University of Chicago Medical Center. “The point is, how do you keep the kidney?”

Those in need of a transplant were told they had to first prove they had $80,000 in their bank account, enough to cover a few years of anti-rejection medication needed to keep the kidney functioning for several years, activists at Our Lady of Guadalupe Mission said.

Hunger strikes and marches followed. The Rev. Jose Landaverde of Our Lady of Guadalupe Anglican Catholic Mission, a longtime activist, was part of those protests.

“It was very radical at the time,” Landaverde said of the campaign he and other activists started five years ago. “The fight for transplants was not an easy one.”

The protests gained media attention with weekslong hunger strikes outside the city’s major hospitals. Protesters marched from Little Village to UIC and then to Northwestern. They conducted a funeral march for one woman who had died after not receiving a liver transplant.

There were also success stories, like that of Jorge Mariscal, of Melrose Park, who was diagnosed with kidney failure at age 16 while a junior at West Leyden High School in Northlake. Mariscal waited eight years while on dialysis for a kidney transplant.

Doctors told him his chance for a transplant in the United States was low and suggested he go back to Mexico, a prospect he never considered, he said, as he has lived virtually his entire life in the United States. Instead he raised thousands of dollars from family and friends, and his mother joined a hunger strike. In 2012, Loyola University Medical Center agreed to transplant a kidney donated by his mom.

“I immediately felt a difference in my body,” Mariscal said. “People who saw me said my color changed. They said I actually looked alive.”

Eventually, Landaverde said, administrators at major hospitals in Chicago, including Rush, Northwestern and Christ, began meeting with activists and doctors at roundtables to discuss ways they could facilitate transplants for people without insurance, including creating a nonprofit pharmaceutical company.

None of that happened, Landaverde said, but behind the scenes, doctors and legislators were also working, placing a provision in a larger Medicaid bill that passed this year.

“I think this was a unique situation in which the legislators, the community and the physician advocates for this group of people came together and were able to forge an unusual piece of legislation,” said Dr. David Ansell, chief medical officer of Rush University Medical Center and a vocal advocate of the measure.

The right timing

State Rep. Soto, D-Chicago, put off Oberholzer and his boss, Enrico Benedetti, head of the University of Illinois at Chicago Department of Surgery, for several years, she said, saying the political climate for such a bill was not right. After assessing a couple of recent laws passed in favor of immigrants in the country illegally, she said, the timing was right.

“It was long-overdue,” Soto said.

Aiding their cause was legislation passed last year in Illinois that allowed immigrants here illegally to get driver’s licenses. About 45 percent of such immigrants who signed up for driver’s licenses have also agreed to be organ donors, Ansell said.

“The Hispanic community as a whole is obviously a very important and growing part of our constituency,” Gift of Hope’s Cmunt said. “We’ve been supporters to finding ways to make access to transplants fair, and (Soto’s) bill is certainly one of those things.”

Soto said the Illinois law passed without debate or controversy. But the issue of providing transplants has not been universally welcomed across the country.

“Obviously if someone is in a life-threatening situation, you have to provide the care no matter what,” said Ira Mehlman, a spokesman for the Federation for American Immigration Reform, which advocates for enforcement of immigration laws and reductions in immigration levels. “But people do have the option of having this surgery done back in their home countries. We have finite resources here to deal with all the medical needs. … It’s perfectly reasonable to say we are going to place the interests of American citizens ahead of citizens of other countries who are here in violation of our laws.”

About 200 to 300 of the immigrants here illegally on the state’s kidney dialysis program will be suitable for a transplant, Oberholzer estimated. A handful will get transplants this year, he said, and an additional 20 or so next year.

A study at the University of Illinois estimated conservatively that at least half of them could receive a living donor kidney transplant without affecting the organ pool for U.S. citizens and legal residents, Oberholzer said. The other half will be added to a waiting list, he said, that in this region is about five to seven years.

A Catch-22

There is concern among even supporters of the new law, however, that immigrants from other states who are in the country illegally will move to Illinois to take advantage of it.

Landaverde said he has heard of a handful of people who moved to Illinois so they might eventually receive transplants. While some may object to that practice, Landaverde believes there’s a greater responsibility to treat those in need.

“People in Illinois will get upset, but there has to be a conscience also,” he said. “Every human being — we should deserve to be treated with dignity.”

Other supporters of the bill contended that if more people move to Illinois to take advantage of its program, it could spell long-term trouble.

“We support that law. … But we don’t want to be abused by people around the country who will see Illinois as a magnet for these kind of procedures,” Hamos said. “We’ve already alerted the General Assembly members who are promoting this, as well as the transplant advocates, that it’s very important to monitor this because at some point the General Assembly may want to revisit this.”

Aside from a strict residency requirement to get the transplant, Hamos said, pharmacies will not be allowed to mail anti-rejection medication. The Department of Healthcare and Family Services will monitor not only how each patient fared after the transplant but how much of an expense it was compared with what dialysis would cost.

The key, Cmunt said, will be watching the number of patients on emergency dialysis in the state.

Hospital payments

If handled responsibly, the program will be a money-saver, according to Oberholzer. But either way, hospitals may see it as a financial burden, particularly because payment from the state will be made in one bundle, he said.

The state will pay $60,000 to $70,000 for each transplant, the same as it pays for citizens enrolled under Medicaid, Goyal said. Unlike for citizens, however, ancillary services such as donor costs, surgeon and provider fees, evaluations and tests will be paid for in one lump sum of $15,000.

“It’s like, well, what if something happens? If there’s a complication?” said Becker University of Chicago Medical Center.

Hospitals would have to eat extra costs, Oberholzer said.

Becker said she is cautiously optimistic that the new law will allow the state to do something good for immigrants here illegally but pointed out that the issue of fairness in doling out organs extends beyond the immigrant community. She said she has been working with legislators to find ways to help citizens who have difficulty getting insurance and paying for anti-rejection medications.

Advocates of the law believe that if carried out properly, Illinois’ solution for a complicated medical issue will be a model for the country.

“I think everybody is looking for a solution to these problems,” Cmunt said. “I think if we can be successful and reduce our dialysis rolls and get these people back to work, then other states will say, ‘Wow, that totally makes sense. That would be great for the country.'”

Tribune reporter Annie Sweeney contributed.

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