A bill meant to provide an eventual path to citizenship for the 11 million illegal immigrants currently residing in the U.S. is now making its way through Congress. If its current draft passes through the House, most illegal immigrants will receive full citizen status in 10 years.
Until attaining citizenship, they will be considered Registered Provisional Immigrants (RPIs) and won’t qualify for public health benefits like Medicare and Medicaid. My colleague Xavier wrote a great piece on Monday explaining why they shouldn’t have to wait a decade before receiving these health benefits.
Although he makes a compelling argument, I couldn’t disagree more.
With the healthcare industry changing so rapidly due to the Affordable Care Act, coding changes, and the rise of health IT, physicians need a breather. That’s why 10 years seems like a perfect buffer period for U.S. physicians to brace for yet another significant change.
ACA Patient Influx
It’s been well publicized that 32 million new patients will enter the healthcare system in 2014 because of the ACA. But according to a new study of more than 5,000 physicians called the PPI, 48% of physicians don’t feel equipped to handle any of these new patients. So where are 11 million additional RPI patients supposed to go?
The answer isn’t clear. Maybe physicians could push patients through their practice faster so they can increase their patient bases, but then the quality of patient care might suffer.
Although the rapid development of health IT promises to help physicians treat patients faster with higher quality outcomes, many physicians still need time to find and implement the right solutions. This is evident when you consider that 50% of practices were looking to replace their EHR in 2012.
In 10 years, physicians will have had enough time to equip themselves with the best health IT solutions. Therefore, quality of care for all citizens will not have to suffer from an influx of patients.
Declining Reimbursements
Illegal immigrants tend to work low-paying jobs that lack health benefits. If the bill passes, their work status isn’t likely to change immediately. It will take many years before they are able to attain salaried jobs, which offer health insurance.
On a related note, if granted access to public health benefits prior to the 10-year waiting period for full-citizenship, many RPIs will end up on Medicaid, which means lower reimbursement rates for physicians. On average, physicians treating Medicaid patients receive only 56% of the payment they’d receive if the same patients were covered under private insurance.
Couple this with sequestration cuts that have slashed Medicare reimbursements by 2%, and physicians will face even greater financial difficulties. With a 10-year buffer period, RPIs will have time to land more stable, well-paying jobs that offer insurance coverage.
Physician Shortage
Due to both the ACA patient influx and the upcoming retirement of many baby-boomer physicians, the U.S. is due to face a shortage of 45,000 primary care physicians by the year 2020. This figure was calculated without considering the 11 million immigrants set to enter the healthcare system before then if health benefits are extended to RPIs.
As my colleague pointed out, the bill includes provisions that will make it easier for foreign doctors to enter the country. But it’s highly doubtful 45,000 foreign physicians, plus however many are needed to cover 11 million new patients, will immediately enter the country to make up for the shortage.
This again proves the need to keep a 10-year buffer period in which foreign doctors will gain easier access to the U.S. without an additional patient population entering the health system to offset the physician increase. Thus, when these immigrants do gain full access to public health benefits, the country’s physician workforce will have a better chance to properly treat them.
There is no doubt these prospective Americans will eventually need access to health benefits if granted citizenship. Such protections are one of the perks of being a citizen, after all. But in its current form, which withholds these benefits from RPIs until they achieve full-citizenship status, Senate Bill 744 allows for the smoothest transition.
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