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Head to Head: the ethics of vaccine passports and COVID passes

A professor of digital society and an ethics researcher discuss COVID passes and what they mean for the UK.

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2 years ago

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Gumbariya/Shutterstock

COVID passes for England were given the green light in parliament in December, with 369 MPs voting in favour and 128 against. From now on, people attending large events will be required to show proof of vaccination – two doses, to become three after a “reasonable” amount of time – or a recent negative lateral flow test. The schemes were already being used in other parts of the UK, with slight differences.

First mandated in Israel, COVID passports consist of a paper or digital document that provides proof you have been fully vaccinated against COVID, have recovered from the virus, or have recently tested negative. The vaccination certificates were adopted widely around Europe, for sole domestic use in some countries and as travel passes in others.

But some critics have questioned the need of enforcing a passport, on the basis that while vaccines have been proven to reduce the chance of falling seriously ill, they do not fully stop the spread of the disease. And an increasing number of commentators have leveraged ethical arguments, comparing vaccine passports to a form of state coercion. We asked digital society professor Helen Kennedy and ethics researcher Alberto Giubilini for their views.

Alberto Giubilini: We’ve never had to deal with a pandemic like this in our lifetime. For the last year and a half, we’ve undertaken all sorts of big experiments, some of which have yet to be proven to work. One is lockdowns: the huge costs involved hadn’t been predicted or taken into consideration, even when introduced for the second or third time.

Lockdowns might well reduce the number of infections, but if the aim is to protect public health and the NHS, we shouldn’t ignore the fact that very large public health costs are caused by such restrictions. Just a few examples of these are the impact on young people’s mental health, missed cancer diagnoses and the interruption of vaccine supplies to poor countries.

Similarly, we don’t know, and it is hard to predict, the gains and harms of enforcing vaccine passports. Ultimately, it comes down to doing a risk assessment. So how do you do that? The main problem is that it’s difficult to pin down the counterfactual. What would happen if a country like Italy, for example, didn’t have vaccine passports? Perhaps there would be more infections. But even if that was the case, would that necessarily be bad, given that vaccines are very good at preventing hospitalisations among the most vulnerable and that allowing infections to spread among the young can boost natural immunity? These are all very uncertain issues.

Perhaps vaccine passports result in a decrease in hospitalisation rates, and therefore a lesser burden on the healthcare system. But that still doesn’t resolve the question of whether they are ethically justifiable. Some people think that enforcing vaccine passports might not be ethically acceptable if it violates certain individual freedoms for the sake of certain public goods.

Woman holding a sign
Austria was the first country in Europe to make coronavirus vaccines mandatory, leading to widespread protests. Loredana Sangiuliano/Shutterstock

There is a coercive element to vaccine passports: some might feel forced to get vaccinated to avoid the onerous alternative of constant medical tests or, worse, reduced freedoms. A conflict is at play between bodily autonomy – the capacity and right to make one’s own decisions over what happens to one’s body – versus the collective level of safety necessary to protect vulnerable people and the healthcare system. What we need to figure out is how to strike a balance between individual rights and the public good.

But this conflict doesn’t just apply to vaccination. It applies to all discussions about the freedoms we have in society, including taxation, for example. Should we have the right to keep our money or should we give something to the state for the public good?

When considering giving priority to some people’s freedom to choose whether or not to get vaccinated over other people’s freedom to be safe, we should ask who would suffer the greater burden. In my opinion, the burden of mandatory vaccination is small compared to the burden of not being able to lead a normal life faced by those at high risk from COVID. A certain degree of safety is, after all, a precondition of freedom.

But at the same time, those at high risk from COVID have access to vaccines that are very effective at preventing serious illness. So one could argue that there is no reason to infringe on the autonomy of other members of society that would want to refuse the vaccines – especially given that current vaccines are not very effective at stopping transmission, a problem likely amplified by the new omicron variant.

You could call this a conflict of freedoms: between freedom of choice about a medical intervention like vaccination and the freedom of vulnerable people who cannot receive the vaccine for medical reasons, or for whom the vaccine is not effective, to have a normal life. Which infringement of freedom is the largest burden and which one is justified? That’s what we should ask.

We should not assume that this question would have the same answer for all groups. Maybe restrictions of freedom are justified for certain segments of society – say, vaccination requirements or passports for those at high risk from COVID-19 – but not for others – say, young people and children, who are at low risk from COVID-19. Especially if vaccines do not prevent transmission too well and so there is little public health benefit in vaccinating everyone.

This is a Head to Head story


The Conversation’s Head to Head articles feature academics from different disciplines chewing over current debates. If there’s a specific topic or question you’d like experts from different disciplines to discuss, please email us.

Helen Kennedy: But the anxiety around vaccine passports is tied up with other tricky questions, too – what a vaccine passport might look like, whether it would be in the form of a paper or digital certificate, and what kind of technologies would be used to implement it. Will it use controversial biometric facial recognition technologies, or less controversial pieces of paper? All of those things contribute to whether these concerns are reasonable or not.

There are also concerns about what kind of future vaccine passports would take us towards. The concerns exist in part because of a lack of clarity around how long such measures would be in place for. There are concerns about data-gathering or data-sharing measures. Who gets access to data and for how long? At the beginning of the pandemic, for example, medical data was shared with supermarkets so they could deliver food to the extremely clinically vulnerable, but we would be concerned if that was still happening now.

With the NHS COVID data store, the concern is around the nature of the contracts with the private tech companies involved in building the infrastructure. What data do they get access to, for how long, and what can they do with it? In June 2020, OpenDemocracy coordinated a campaign based on widespread concern that the government was transferring personal health information to private companies. Understandably, where there is not clear information about the future, there is concern about the future.

Ultimately, there is a broader issue here: namely, whether ID systems are compatible with rights respecting societies. And this is a tricky one. A lot of privacy advocacy organisations, such as Big Brother Watch, would say that the two things are incompatible. But a number of countries have vaccine passports, and in the UK we’ve been providing evidence of our vaccine status for a while now – to travel and to get into large-scale events, for instance. Even though we don’t use the label “vaccine passports”, that is effectively what they are. I personally don’t think it is the case that countries with either vaccine passports or with full ID systems have worse civil liberties or are less democratic than the UK.

AG: I largely agree with everything you said – I think concerns about ID societies are a bit exaggerated. This does not necessarily mean population-wide vaccine passports are permissible. But if one wants to argue against them, it is important to focus on what are good objections and what are not.

Some countries already enforce vaccine passports in the form of school mandates. In the US, for example, children cannot go to school unless they can prove they’ve been vaccinated against certain diseases. Now, both the US and other EU countries are simply attempting to implement this on a larger scale. I come from Italy, which other than vaccine passports – which are labelled “green passes” there – has also had national IDs since 1931, and I wouldn’t say that there are fewer rights or civil liberties there than in the UK. And even if there were, the blame shouldn’t be pinned on IDs or vaccine passports. The concept of a national ID is much less controversial for Europeans than it is for British people.

The argument being made against vaccine passports often frames them as a slippery slope. They are rejected not so much or not only because they’re wrong in themselves, but because they’re seen as the first step towards something that is clearly unethical – some Orwellian dystopia where the state controls everything and there is no such thing as privacy. But we are very far from that.

HK: Except that the implications are not just about privacy. There are societal level issues, too. I’ve done surveys on public opinion about different types of data gathering, including a survey into people’s attitudes to data uses. This found that people are concerned about data being used in unfair ways in very high numbers.

So public concern is not so much about “me and my data and my privacy”, but rather the ways in which data collection and data-sharing through vaccine passports and other measures increases the already phenomenal power of private companies and governments. These companies have already got more access to said data than the rest of us, and use it to make decisions that affect our lives.

Another collective concern is how data collection risks reproducing inequalities. With vaccine passports enforced in England, people could end up being discriminated against. Some people can’t get vaccinated because of their age group, or because they’re clinically vulnerable. Others are undocumented migrants and some GPs won’t register them. In low income countries, only around 2% of people have been vaccinated so far. There is vaccine hesitancy in some groups and earlier data suggested that’s greater within some ethnic minority groups, religious groups and people on low incomes.

There are often good reasons why some people from low income and minority ethnic backgrounds distrust authorities trying to convince them that the vaccine is good for them. Investigating links between distrust and inequality will help us make sense of why some people don’t get vaccinated, and would therefore be disadvantaged by the use of vaccine passports.

AG: Indeed, one concern I have is around global inequality and inequity, as you mentioned. Travellers from countries that are still scrambling for vaccine doses could have their freedom of movement curtailed and would, in this sense, be discriminated against unfairly.

As for concerns about state discrimination, I find them misplaced. Again, this does not necessarily mean that population-wide passports are acceptable, but that we need to identify the good objections and not focus on the weak ones. One could talk about discrimination if, among people living within a country with a vaccine passport scheme, it was either difficult or impossible for some people to access the vaccine. That would definitely be a form of discrimination, as they wouldn’t be the ones responsible for not being able to get vaccinated.

But countries that either have introduced or are planning to introduce a vaccine passport scheme do not have this problem. In the UK, vaccines are widely available to everyone who is eligible – namely, everyone above the age of 12. To say that people who do not observe a law that is justified are being discriminated against simply because they suffer the legal consequences of not observing it, makes very little sense. According to this logic, every law would be discriminatory. The law must be unjustified in order for the discrimination charge to be a real ethical issue. But whether it is justified is precisely the issue at stake.

As for groups who are reluctant to get the vaccine for cultural or social reasons – I agree with you that there might be far-reaching reasons why they might not trust the medical system. But if a vaccine passport may be something that further exacerbates inequalities, or highlights the existence of inequalities, it is still not at their origins. The answer is not to avoid the vaccine passport, but rather to address the underlying reasons why certain people don’t get vaccinated. The problem you’re describing didn’t start with vaccines.

I don’t see why an underlying structural problem should itself be a reason against a specific measure that might have a large collective benefit as well as a benefit for those individuals, as opposed to being a reason for addressing the problem.

If we do come to the conclusion that vaccine passports are justified, at least for certain segments of the population, and there is no discrimination being directed against a specific group, then I don’t think it matters if they go on forever or for one year. But of course, that is a big “if”.

HK: I disagree with you on the idea that everyone can have a vaccine if they want to because they’re available for everyone. It assumes an equality that doesn’t exist. Maybe by law and maybe technically they’re available, but as I said, some people are distrusting and some people are hesitant.

Inequalities related to poverty or ethnicity that lead some people to distrust and others to be hesitant are feeding into who gets vaccinated and who doesn’t. Some people’s experiences of life are shaped by social inequalities. I don’t think you can ignore them because, in theory, there’s a vaccine for anyone who wants it.

I think the concern about where this is heading is valid. And it’s been there since the beginning of the pandemic with any kind of data gathering process. Things that have been introduced ostensibly because of the pandemic, are being pushed to be carried on after the pandemic. And those are the sorts of things that should worry us, I think.

I always refuse to make predictions, but the future is where the concern lies, isn’t it? It’s the concern of privacy advocates and of organisations like Big Brother Watch that vaccine passports may lead us to a checkpoint society or a more surveillance-based state. And even if there was a policy that guaranteed it isn’t going to happen, that could change in the future. Policies change, circumstances change.

What’s interesting is that maybe a year and a half ago, the language of crisis could be mobilised to justify measures that people might not find acceptable in normal times. But a year and a half later, it is still mobilised as a justification for things.

The philosopher Giorgio Agamben talks about the state of exception. His argument is that if you always describe things as a state of exception, you can try to get away with murder all of the time.

Alberto Giubilini receives funding from the Wellcome Trust.

Helen Kennedy currently receives funding from The Nuffield Foundation and the Arts and Humanities Research Council, and previous research has been supported by other funders.

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Copper Soars, Iron Ore Tumbles As Goldman Says “Copper’s Time Is Now”

Copper Soars, Iron Ore Tumbles As Goldman Says "Copper’s Time Is Now"

After languishing for the past two years in a tight range despite recurring…

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15 hours ago

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March 15, 2024

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Copper Soars, Iron Ore Tumbles As Goldman Says "Copper's Time Is Now"

After languishing for the past two years in a tight range despite recurring speculation about declining global supply, copper has finally broken out, surging to the highest price in the past year, just shy of $9,000 a ton as supply cuts hit the market; At the same time the price of the world's "other" most important mined commodity has diverged, as iron ore has tumbled amid growing demand headwinds out of China's comatose housing sector where not even ghost cities are being built any more.

Copper surged almost 5% this week, ending a months-long spell of inertia, as investors focused on risks to supply at various global mines and smelters. As Bloomberg adds, traders also warmed to the idea that the worst of a global downturn is in the past, particularly for metals like copper that are increasingly used in electric vehicles and renewables.

Yet the commodity crash of recent years is hardly over, as signs of the headwinds in traditional industrial sectors are still all too obvious in the iron ore market, where futures fell below $100 a ton for the first time in seven months on Friday as investors bet that China’s years-long property crisis will run through 2024, keeping a lid on demand.

Indeed, while the mood surrounding copper has turned almost euphoric, sentiment on iron ore has soured since the conclusion of the latest National People’s Congress in Beijing, where the CCP set a 5% goal for economic growth, but offered few new measures that would boost infrastructure or other construction-intensive sectors.

As a result, the main steelmaking ingredient has shed more than 30% since early January as hopes of a meaningful revival in construction activity faded. Loss-making steel mills are buying less ore, and stockpiles are piling up at Chinese ports. The latest drop will embolden those who believe that the effects of President Xi Jinping’s property crackdown still have significant room to run, and that last year’s rally in iron ore may have been a false dawn.

Meanwhile, as Bloomberg notes, on Friday there were fresh signs that weakness in China’s industrial economy is hitting the copper market too, with stockpiles tracked by the Shanghai Futures Exchange surging to the highest level since the early days of the pandemic. The hope is that headwinds in traditional industrial areas will be offset by an ongoing surge in usage in electric vehicles and renewables.

And while industrial conditions in Europe and the US also look soft, there’s growing optimism about copper usage in India, where rising investment has helped fuel blowout growth rates of more than 8% — making it the fastest-growing major economy.

In any case, with the demand side of the equation still questionable, the main catalyst behind copper’s powerful rally is an unexpected tightening in global mine supplies, driven mainly by last year’s closure of a giant mine in Panama (discussed here), but there are also growing worries about output in Zambia, which is facing an El Niño-induced power crisis.

On Wednesday, copper prices jumped on huge volumes after smelters in China held a crisis meeting on how to cope with a sharp drop in processing fees following disruptions to supplies of mined ore. The group stopped short of coordinated production cuts, but pledged to re-arrange maintenance work, reduce runs and delay the startup of new projects. In the coming weeks investors will be watching Shanghai exchange inventories closely to gauge both the strength of demand and the extent of any capacity curtailments.

“The increase in SHFE stockpiles has been bigger than we’d anticipated, but we expect to see them coming down over the next few weeks,” Colin Hamilton, managing director for commodities research at BMO Capital Markets, said by phone. “If the pace of the inventory builds doesn’t start to slow, investors will start to question whether smelters are actually cutting and whether the impact of weak construction activity is starting to weigh more heavily on the market.”

* * *

Few have been as happy with the recent surge in copper prices as Goldman's commodity team, where copper has long been a preferred trade (even if it may have cost the former team head Jeff Currie his job due to his unbridled enthusiasm for copper in the past two years which saw many hedge fund clients suffer major losses).

As Goldman's Nicholas Snowdon writes in a note titled "Copper's time is now" (available to pro subscribers in the usual place)...

... there has been a "turn in the industrial cycle." Specifically according to the Goldman analyst, after a prolonged downturn, "incremental evidence now points to a bottoming out in the industrial cycle, with the global manufacturing PMI in expansion for the first time since September 2022." As a result, Goldman now expects copper to rise to $10,000/t by year-end and then $12,000/t by end of Q1-25.’

Here are the details:

Previous inflexions in global manufacturing cycles have been associated with subsequent sustained industrial metals upside, with copper and aluminium rising on average 25% and 9% over the next 12 months. Whilst seasonal surpluses have so far limited a tightening alignment at a micro level, we expect deficit inflexions to play out from quarter end, particularly for metals with severe supply binds. Supplemented by the influence of anticipated Fed easing ahead in a non-recessionary growth setting, another historically positive performance factor for metals, this should support further upside ahead with copper the headline act in this regard.

Goldman then turns to what it calls China's "green policy put":

Much of the recent focus on the “Two Sessions” event centred on the lack of significant broad stimulus, and in particular the limited property support. In our view it would be wrong – just as in 2022 and 2023 – to assume that this will result in weak onshore metals demand. Beijing’s emphasis on rapid growth in the metals intensive green economy, as an offset to property declines, continues to act as a policy put for green metals demand. After last year’s strong trends, evidence year-to-date is again supportive with aluminium and copper apparent demand rising 17% and 12% y/y respectively. Moreover, the potential for a ‘cash for clunkers’ initiative could provide meaningful right tail risk to that healthy demand base case. Yet there are also clear metal losers in this divergent policy setting, with ongoing pressure on property related steel demand generating recent sharp iron ore downside.

Meanwhile, Snowdon believes that the driver behind Goldman's long-running bullish view on copper - a global supply shock - continues:

Copper’s supply shock progresses. The metal with most significant upside potential is copper, in our view. The supply shock which began with aggressive concentrate destocking and then sharp mine supply downgrades last year, has now advanced to an increasing bind on metal production, as reflected in this week's China smelter supply rationing signal. With continued positive momentum in China's copper demand, a healthy refined import trend should generate a substantial ex-China refined deficit this year. With LME stocks having halved from Q4 peak, China’s imminent seasonal demand inflection should accelerate a path into extreme tightness by H2. Structural supply underinvestment, best reflected in peak mine supply we expect next year, implies that demand destruction will need to be the persistent solver on scarcity, an effect requiring substantially higher pricing than current, in our view. In this context, we maintain our view that the copper price will surge into next year (GSe 2025 $15,000/t average), expecting copper to rise to $10,000/t by year-end and then $12,000/t by end of Q1-25’

Another reason why Goldman is doubling down on its bullish copper outlook: gold.

The sharp rally in gold price since the beginning of March has ended the period of consolidation that had been present since late December. Whilst the initial catalyst for the break higher came from a (gold) supportive turn in US data and real rates, the move has been significantly amplified by short term systematic buying, which suggests less sticky upside. In this context, we expect gold to consolidate for now, with our economists near term view on rates and the dollar suggesting limited near-term catalysts for further upside momentum. Yet, a substantive retracement lower will also likely be limited by resilience in physical buying channels. Nonetheless, in the midterm we continue to hold a constructive view on gold underpinned by persistent strength in EM demand as well as eventual Fed easing, which should crucially reactivate the largely for now dormant ETF buying channel. In this context, we increase our average gold price forecast for 2024 from $2,090/toz to $2,180/toz, targeting a move to $2,300/toz by year-end.

Much more in the full Goldman note available to pro subs.

Tyler Durden Fri, 03/15/2024 - 14:25

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The millions of people not looking for work in the UK may be prioritising education, health and freedom

Economic inactivity is not always the worst option.

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17 hours ago

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March 15, 2024

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Taking time out. pathdoc/Shutterstock

Around one in five British people of working age (16-64) are now outside the labour market. Neither in work nor looking for work, they are officially labelled as “economically inactive”.

Some of those 9.2 million people are in education, with many students not active in the labour market because they are studying full-time. Others are older workers who have chosen to take early retirement.

But that still leaves a large number who are not part of the labour market because they are unable to work. And one key driver of economic inactivity in recent years has been illness.

This increase in economic inactivity – which has grown since before the pandemic – is not just harming the economy, but also indicative of a deeper health crisis.

For those suffering ill health, there are real constraints on access to work. People with health-limiting conditions cannot just slot into jobs that are available. They need help to address the illnesses they have, and to re-engage with work through organisations offering supportive and healthy work environments.

And for other groups, such as stay-at-home parents, businesses need to offer flexible work arrangements and subsidised childcare to support the transition from economic inactivity into work.

The government has a role to play too. Most obviously, it could increase investment in the NHS. Rising levels of poor health are linked to years of under-investment in the health sector and economic inactivity will not be tackled without more funding.

Carrots and sticks

For the time being though, the UK government appears to prefer an approach which mixes carrots and sticks. In the March 2024 budget, for example, the chancellor cut national insurance by 2p as a way of “making work pay”.

But it is unclear whether small tax changes like this will have any effect on attracting the economically inactive back into work.

Jeremy Hunt also extended free childcare. But again, questions remain over whether this is sufficient to remove barriers to work for those with parental responsibilities. The high cost and lack of availability of childcare remain key weaknesses in the UK economy.

The benefit system meanwhile has been designed to push people into work. Benefits in the UK remain relatively ungenerous and hard to access compared with other rich countries. But labour shortages won’t be solved by simply forcing the economically inactive into work, because not all of them are ready or able to comply.

It is also worth noting that work itself may be a cause of bad health. The notion of “bad work” – work that does not pay enough and is unrewarding in other ways – can lead to economic inactivity.

There is also evidence that as work has become more intensive over recent decades, for some people, work itself has become a health risk.

The pandemic showed us how certain groups of workers (including so-called “essential workers”) suffered more ill health due to their greater exposure to COVID. But there are broader trends towards lower quality work that predate the pandemic, and these trends suggest improving job quality is an important step towards tackling the underlying causes of economic inactivity.

Freedom

Another big section of the economically active population who cannot be ignored are those who have retired early and deliberately left the labour market behind. These are people who want and value – and crucially, can afford – a life without work.

Here, the effects of the pandemic can be seen again. During those years of lockdowns, furlough and remote working, many of us reassessed our relationship with our jobs. Changed attitudes towards work among some (mostly older) workers can explain why they are no longer in the labour market and why they may be unresponsive to job offers of any kind.

Sign on railings supporting NHS staff during pandemic.
COVID made many people reassess their priorities. Alex Yeung/Shutterstock

And maybe it is from this viewpoint that we should ultimately be looking at economic inactivity – that it is actually a sign of progress. That it represents a move towards freedom from the drudgery of work and the ability of some people to live as they wish.

There are utopian visions of the future, for example, which suggest that individual and collective freedom could be dramatically increased by paying people a universal basic income.

In the meantime, for plenty of working age people, economic inactivity is a direct result of ill health and sickness. So it may be that the levels of economic inactivity right now merely show how far we are from being a society which actually supports its citizens’ wellbeing.

David Spencer has received funding from the ESRC.

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Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

By Autumn Spredemann of The Epoch Times

Tens of thousands of illegal…

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March 15, 2024

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Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

By Autumn Spredemann of The Epoch Times

Tens of thousands of illegal immigrants are flooding into U.S. hospitals for treatment and leaving billions in uncompensated health care costs in their wake.

The House Committee on Homeland Security recently released a report illustrating that from the estimated $451 billion in annual costs stemming from the U.S. border crisis, a significant portion is going to health care for illegal immigrants.

With the majority of the illegal immigrant population lacking any kind of medical insurance, hospitals and government welfare programs such as Medicaid are feeling the weight of these unanticipated costs.

Apprehensions of illegal immigrants at the U.S. border have jumped 48 percent since the record in fiscal year 2021 and nearly tripled since fiscal year 2019, according to Customs and Border Protection data.

Last year broke a new record high for illegal border crossings, surpassing more than 3.2 million apprehensions.

And with that sea of humanity comes the need for health care and, in most cases, the inability to pay for it.

In January, CEO of Denver Health Donna Lynne told reporters that 8,000 illegal immigrants made roughly 20,000 visits to the city’s health system in 2023.

The total bill for uncompensated care costs last year to the system totaled $140 million, said Dane Roper, public information officer for Denver Health. More than $10 million of it was attributed to “care for new immigrants,” he told The Epoch Times.

Though the amount of debt assigned to illegal immigrants is a fraction of the total, uncompensated care costs in the Denver Health system have risen dramatically over the past few years.

The total uncompensated costs in 2020 came to $60 million, Mr. Roper said. In 2022, the number doubled, hitting $120 million.

He also said their city hospitals are treating issues such as “respiratory illnesses, GI [gastro-intenstinal] illnesses, dental disease, and some common chronic illnesses such as asthma and diabetes.”

“The perspective we’ve been trying to emphasize all along is that providing healthcare services for an influx of new immigrants who are unable to pay for their care is adding additional strain to an already significant uncompensated care burden,” Mr. Roper said.

He added this is why a local, state, and federal response to the needs of the new illegal immigrant population is “so important.”

Colorado is far from the only state struggling with a trail of unpaid hospital bills.

EMS medics with the Houston Fire Department transport a Mexican woman the hospital in Houston on Aug. 12, 2020. (John Moore/Getty Images)

Dr. Robert Trenschel, CEO of the Yuma Regional Medical Center situated on the Arizona–Mexico border, said on average, illegal immigrants cost up to three times more in human resources to resolve their cases and provide a safe discharge.

“Some [illegal] migrants come with minor ailments, but many of them come in with significant disease,” Dr. Trenschel said during a congressional hearing last year.

“We’ve had migrant patients on dialysis, cardiac catheterization, and in need of heart surgery. Many are very sick.”

He said many illegal immigrants who enter the country and need medical assistance end up staying in the ICU ward for 60 days or more.

A large portion of the patients are pregnant women who’ve had little to no prenatal treatment. This has resulted in an increase in babies being born that require neonatal care for 30 days or longer.

Dr. Trenschel told The Epoch Times last year that illegal immigrants were overrunning healthcare services in his town, leaving the hospital with $26 million in unpaid medical bills in just 12 months.

ER Duty to Care

The Emergency Medical Treatment and Labor Act of 1986 requires that public hospitals participating in Medicare “must medically screen all persons seeking emergency care … regardless of payment method or insurance status.”

The numbers are difficult to gauge as the policy position of the Centers for Medicare & Medicaid Services (CMS) is that it “will not require hospital staff to ask patients directly about their citizenship or immigration status.”

In southern California, again close to the border with Mexico, some hospitals are struggling with an influx of illegal immigrants.

American patients are enduring longer wait times for doctor appointments due to a nursing shortage in the state, two health care professionals told The Epoch Times in January.

A health care worker at a hospital in Southern California, who asked not to be named for fear of losing her job, told The Epoch Times that “the entire health care system is just being bombarded” by a steady stream of illegal immigrants.

“Our healthcare system is so overwhelmed, and then add on top of that tuberculosis, COVID-19, and other diseases from all over the world,” she said.

A Salvadorian man is aided by medical workers after cutting his leg while trying to jump on a truck in Matias Romero, Mexico, on Nov. 2, 2018. (Spencer Platt/Getty Images)

A newly-enacted law in California provides free healthcare for all illegal immigrants residing in the state. The law could cost taxpayers between $3 billion and $6 billion per year, according to recent estimates by state and federal lawmakers.

In New York, where the illegal immigration crisis has manifested most notably beyond the southern border, city and state officials have long been accommodating of illegal immigrants’ healthcare costs.

Since June 2014, when then-mayor Bill de Blasio set up The Task Force on Immigrant Health Care Access, New York City has worked to expand avenues for illegal immigrants to get free health care.

“New York City has a moral duty to ensure that all its residents have meaningful access to needed health care, regardless of their immigration status or ability to pay,” Mr. de Blasio stated in a 2015 report.

The report notes that in 2013, nearly 64 percent of illegal immigrants were uninsured. Since then, tens of thousands of illegal immigrants have settled in the city.

“The uninsured rate for undocumented immigrants is more than three times that of other noncitizens in New York City (20 percent) and more than six times greater than the uninsured rate for the rest of the city (10 percent),” the report states.

The report states that because healthcare providers don’t ask patients about documentation status, the task force lacks “data specific to undocumented patients.”

Some health care providers say a big part of the issue is that without a clear path to insurance or payment for non-emergency services, illegal immigrants are going to the hospital due to a lack of options.

“It’s insane, and it has been for years at this point,” Dana, a Texas emergency room nurse who asked to have her full name omitted, told The Epoch Times.

Working for a major hospital system in the greater Houston area, Dana has seen “a zillion” migrants pass through under her watch with “no end in sight.” She said many who are illegal immigrants arrive with treatable illnesses that require simple antibiotics. “Not a lot of GPs [general practitioners] will see you if you can’t pay and don’t have insurance.”

She said the “undocumented crowd” tends to arrive with a lot of the same conditions. Many find their way to Houston not long after crossing the southern border. Some of the common health issues Dana encounters include dehydration, unhealed fractures, respiratory illnesses, stomach ailments, and pregnancy-related concerns.

“This isn’t a new problem, it’s just worse now,” Dana said.

Emergency room nurses and EMTs tend to patients in hallways at the Houston Methodist The Woodlands Hospital in Houston on Aug. 18, 2021. (Brandon Bell/Getty Images)

Medicaid Factor

One of the main government healthcare resources illegal immigrants use is Medicaid.

All those who don’t qualify for regular Medicaid are eligible for Emergency Medicaid, regardless of immigration status. By doing this, the program helps pay for the cost of uncompensated care bills at qualifying hospitals.

However, some loopholes allow access to the regular Medicaid benefits. “Qualified noncitizens” who haven’t been granted legal status within five years still qualify if they’re listed as a refugee, an asylum seeker, or a Cuban or Haitian national.

Yet the lion’s share of Medicaid usage by illegal immigrants still comes through state-level benefits and emergency medical treatment.

A Congressional report highlighted data from the CMS, which showed total Medicaid costs for “emergency services for undocumented aliens” in fiscal year 2021 surpassed $7 billion, and totaled more than $5 billion in fiscal 2022.

Both years represent a significant spike from the $3 billion in fiscal 2020.

An employee working with Medicaid who asked to be referred to only as Jennifer out of concern for her job, told The Epoch Times that at a state level, it’s easy for an illegal immigrant to access the program benefits.

Jennifer said that when exceptions are sent from states to CMS for approval, “denial is actually super rare. It’s usually always approved.”

She also said it comes as no surprise that many of the states with the highest amount of Medicaid spending are sanctuary states, which tend to have policies and laws that shield illegal immigrants from federal immigration authorities.

Moreover, Jennifer said there are ways for states to get around CMS guidelines. “It’s not easy, but it can and has been done.”

The first generation of illegal immigrants who arrive to the United States tend to be healthy enough to pass any pre-screenings, but Jennifer has observed that the subsequent generations tend to be sicker and require more access to care. If a family is illegally present, they tend to use Emergency Medicaid or nothing at all.

The Epoch Times asked Medicaid Services to provide the most recent data for the total uncompensated care that hospitals have reported. The agency didn’t respond.

Continue reading over at The Epoch Times

Tyler Durden Fri, 03/15/2024 - 09:45

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