Monday, December 11, 2006

The post-Katrina baby boom in New Orleans

Katrina's baby boom

The latest demographic shock in New Orleans, reports the New York Times, is a boom in babies born to "Latino immigrant workers, both legal and illegal, who flocked to the city to toil on its reconstruction." The baby boom has had a profound impact on the population, the health care system, and the sustainability of existing immigration law in greater New Orleans.

Historically, the racial composition of New Orleans was divided strictly between blacks and whites. The exigencies of post-Katrina reconstruction have brought an influx of Hispanic residents. This population accounts for many of the new births in Orleans and Jefferson Parishes.

This forum has already lamented the shabby shape of greater New Orleans' health care system after Katrina. A baby boom under these circumstances necessarily strains the metropolitan area's depleted health care resources. The system strains even further given the financial constraints on illegal immigrants and the typically low or nonexistent levels of prenatal care received by mothers in this class:
The boomlet of Latino babies in New Orleans poses particular challenges. Nonemergency Medicaid is not available to illegal immigrants or even to legal immigrants who have been in the country less than five years. Virtually none of the immigrant mothers-to-be have private insurance. They are mostly poor. Many fear being deported.
New Orleans is rapidly assuming a new cultural identity that has a strong Hispanic component. Classic street foods such as beignets and chicory coffee are yielding in favor of tamales. The changing culture of New Orleans poses special problems for the law. Restrictions on Medicaid, coupled with the general lack of health care resources, funnels pregnant women toward emergency rooms. This variation on an unfortunate theme within the American health care system -- treating emergency rooms, which should be caregivers of last resort, as the primary or even exclusive source of health care for vulnerable populations -- exacts an exceptionally steep toll from New Orleans' most recent wave of newcomers.

Workers of Mexican and Central American origin are vital to the reconstruction of New Orleans. Excluding these immigrants from Medicaid is backfiring. If anything, the existing legal framework for health care approach exacerbates the health care burden that Orleans and Jefferson Parishes must shoulder. The immigrant babies of New Orleans are American citizens. More important, they are human beings. Whatever the failings of the legal and health care systems before Katrina, those systems have a renewed opportunity -- and, indeed, a significant obligation -- to serve the most vulnerable populations of greater New Orleans.


Anonymous Anonymous said...

Great point. I never fail to be astonished at how ostensibly Christian organizations join forces with politicians committed to making health care for the poor as circuitous, badly funded, and scarce as possible.

12/11/2006 3:36 PM  
Anonymous sneedlemd said...

When I first read this in the NY Times it made my blood boil. This could and should have been foreseen over a year ago. Sudden explosion of new construction ==> need for cheap manual labor ==> influx of illegal immigrants ==> who have no insurance, and at least some of whom will bring their families ==> ERs overwhelmed with charity care, followed by new babies. Truly elementary, my dear Watson. The question is, what are we doing about it? Oh, that's right: stretching the safety net a little more. You can debate about health care for illegal immigrants all you want, but until an alternative exists, they will continue to get their care in the local ERs, and the local ERs just have to absorb the costs.
Yet another strain on an already collapsing health care system, with no systemic remedy in sight.
I have said it before: the government's utter lack of consideration to something as fundamental as health care after Katrina gives me no confidence in its ability to respond to future disasters with any (more) competence.

12/11/2006 3:51 PM  
Blogger Eric Chad said...

As a fiscal conservative with libertarian roots, I'm really at a loss for what to do here. I guess ideally I would hope that private organizations like non-profits could take care of this sort of health care for the poor, but obviously that's not happening.

It seems like, unless some sort of action is taken to rectify the situation, taxpayers are going to be footing the bill regardless, either subsidizing health care for illegal immigrants directly or doing so less directly by paying for emergency room care that these individuals cannot provide on their own. I suppose with that background I would prefer some sort of bailout program, perhaps through medicaid, that would provide the mothers of this boomlet with specialized care from an OB/GYN rather than an emergency room physician who lacks particular expereince in prenatal and neonatal care. While specialized, it seems that the abundance of knowledge already possessed by OB/GYNs could actually provide less costly treatment, should such treatment be subsidized by medicaid or a similar program.

I don't mean to be cold-hearted, thinking of these Latino mothers and their infants as dollar signs, but the money has to come from somewhere, and I see a federal government that will be particularly reluctant to use taxes to fund a program like this.

12/11/2006 4:55 PM  
Anonymous Anonymous said...

This only delineates the need for better control of the border and workplace enforcement. Our government's tolerance of this outrageous abuse of our health care system in which the needs of the citizen are undermined by foreigners who take for granted free health care. That citizens are deprived while our hospitals go under is looked upon by illegal alien advocates as a curiousity to be noted in the margins of a list of things to do. Forty percent of all Americans are without health care insurance and this country can not, no should not, accept the burden of caring for Latin America's needs. Serving the social and health care of foreigner is not only impractical and unfair, but serves to provoke continued illegal immigration.

The application of the 14th Amendment for birthright citizenship of progeny of illegal aliens, as forced upon us by an addled Court's misinterpretation of the framer's intent. There are few among us today who fail to understand that the 14th Amendment was strictly intended to apply to slaves by conferring citizenship, but there are those who have their own agendas who pretend otherwise in an effort to extend it broadly to all. The intent of the framer of the 14th was clearly documented, although conveniently ignored by romantic revisionists, including past Courts.

Mr. Chen likes to cite common and ancient law as the source of 14th Amendment rights, but fails to note that almost none of the Western nations, the sources from which common law was derived, respect that point of view today. We seem to be the odd man out mired in the distant past. Let us hope that reason prevails as the 14th is tested one last time by the Court.

12/11/2006 9:16 PM  
Anonymous sneedlemd said...

eric--the nonprofits are already absorbing as much as they can. You are absolutely right, this is a matter of $$$ and where it will come from. (Well, it will come from you and me regardless, but how will it be applied?) I entirely agree that a Medicaid extension would be the most efficacious but the ideologicals such as anonymous #2 will block that until hell freezes over, so we're stuck with the ED's absorbing the care and costs. WRT to anyonymous #2, these immigrants aren't thinking about health care or how to "game" the system. They're thinking about one thing: jobs (well, and money). If you knew anything about their experiences, you'd know they risk everything for the job. Housing, health care, even transportation is a secondary consideration after the opportunity to make lots of money. In any case, do you seriously propose we deny them health care? Especially since hospitals are already under legal restrictions prohibiting them from turning anyone away? How to discourage illegal immigration is a different debate that has very little bearing on the current reality on the ground on the Gulf Coast.

12/12/2006 9:58 AM  
Blogger Eric Chad said...

I'm not an economist and wouldn't know where to begin approaching the math of the situation, but I'd be willing wager that while the illegal immigrants are "gaming the healthcare system", a substantial amount of the money lost by taxpayers is recouped by the same illegal immigrants providing labor while being paid under the table at wages well below the minimum wage, thus making products and the process of reconstruction less expensive.

I'm not entirely tolerant of the argument that we need to be sure illegal immigrants are provided the minimum wage, as I think the fact that they'll work for substantially less is part of the reason the current system "works." Even while making less than the American minimum wage, these immigrants are making more than they would back home and the US is getting really cheap labor.

I'm also not tolerant of the argument that these illegal immigrants are stealing the jobs of American citizens by undercutting the minimum wage. More laborers requires more managers. These managerial jobs are generally higher paid than the labor jobs and will more often go to those workers who are American citizens. Once again, I'm not an economist, I don't even play one on T.V., but I've read convincing arguments that, from an economic standpoint, that things like illegal immigration and outsourcing can act as a net gain.

12/12/2006 12:41 PM  
Anonymous Anonymous said...

Actually, I do advocate denying them health care, except for extreme emergencies, and when the patient is stabilized he should be deported back to Mexico. Anything above that level of care should be borne by the Mexican government. If the Bush administration wasn't plagued by testicular cancer, they'd press a demand upon the Mexican government for compensation.

As it is, health care is rationed to U.S. citizens. Millions of American middle class Americans can't afford health care but are stuck with huge bankrupting medical bills in time of emergencies, their plight aggrevated by providers who bill at extraordinary rates to make up for non-payers. This is contrary to the intent of our Constitution's preamble which states that one of government's purpose is to promote the common welfare. Foreigners were never intended to be covered by this, only the citizen and his progeny. Read it.

12/28/2006 3:30 PM  

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