CHICAGO — As he pushes his cart around the Southwest Side selling steamed ears of corn, sliced cucumbers and other street food, Omar Castillo embodies a potential life-and-death issue that has become a high-voltage third rail in the debate over health care reform. Peddling snacks — doused with lime and chili powder and priced at $1.50 each — is how Castillo, 19, is trying to pay for expensive medication he needs to stay healthy after receiving a kidney transplant last year.
Because he is in the U.S. illegally, he has no ready access to aid for such long-term medical expenses. To cover such needs for an estimated 6.8 million undocumented and uninsured immigrants in the country, some health care advocates have proposed broadening the health care proposals before Congress, but fierce opposition has kept the idea off the table.
As it is, Castillo received his transplant and a year of free medicine only as part of a hospital study at the University of Illinois at Chicago Medical Center, after a Latino activist campaign and a call from the governor’s office got him included. With the study over, his last free prescription is running out, and with it, his chances for a healthy life.
“We don’t know what we’ll do when the medicine is gone,” said Castillo, holding two nearly empty bottles of pills he takes to ward off an organ rejection.
Immigration activists say it is “immoral” for hospitals and doctors, as well as a nation, to deny health care to the seriously ill, no matter their legal status. But proponents of tougher immigration enforcement — and others fighting to contain runaway health care costs — fear that providing such services would only encourage more undocumented immigrants to cross the border.
Given spotty health care in countries such as China or México, “health insurance alone might be worth people coming here ... especially if you’ve got a family that’s got a lot of illness in it,” argued Roy Beck, director of Numbers USA, which has pushed for tighter restrictions on medical aid to non-citizens.
The issue has become so sensitive that House Speaker Nancy Pelosi, D-Calif., emphasized that undocumentedimmigrants would not be covered under the current proposals. The Congressional Hispanic Caucus, denying a report that it would push for coverage of the undocumented, issued a statement prescribing coverage only for “legal, law abiding” immigrants who pay their “fair share” for health care.
Under current federal laws, undocumentedimmigrants are only entitled to receive emergency health care, though some states offer assistance to cover uninsured children.
Some undocumented patients have resorted to using stolen Social Security numbers purchased in the black market to qualify for health programs — a form of medical identity theft increasingly on hospital radars.
Many more scramble to pay for their medicine and doctors visits in cash, which is a mounting challenge in an economy where even day-laborer work has dried up.
“A lot of people are living with things that are easily treatable (and) that those of us with good health insurance just don’t have to live with because we can go get the medication,” said Jennifer Tolbert, a policy analyst at the nonprofit Kaiser Family Foundation, which has studied health care disparities among immigrants.
To some extent, “if those individuals have communicable diseases ... there may be a risk (of) spreading that condition,” Tolbert said. Hospitals nationwide have grappled with how to deal with indigent patients without legal status. In Chicago and elsewhere, some private facilities have arranged to have undocumented patients flown back to their own country, a practice that resulted in a landmark lawsuit in Florida last year on behalf of a Guatemalan man who suffered severe brain injuries from a car accident.
Last month, a Florida jury found that the hospital was within its rights to have Luis Alberto Jiménez repatriated.
The situation has left Castillo pushing his cart through the streets of Gage Park, trying to raise enough money to refill prescriptions for mycophenolate mofetil and tacrolimus — immunosuppressants that ward off an organ rejection and, together, can cost at least $900.
“Helotes! Raspadas!” Castillo’s voice echoes, while a cousin repeatedly squeezes a bicycle horn to draw residents from their brick bungalows. Other street vendors compete nearby, keeping an eye out for city inspectors while boasting about their flavorful snacks.
After about six hours in the hot sun on a recent day, Castillo and his family took home $20, money that also goes toward food and other needs. After arriving illegally from México City in 2005, Castillo worked in construction for about six months before he began growing weak and having trouble breathing, family members said. A doctor later discovered that Castillo was born with a partially developed kidney.
Compared to others who are uninsured and facing chronic illness, Castillo has been lucky.
Last summer, the UIC medical center assumed the cost of his kidney transplant after a group of Latino activists rallied outside the hospital and persuaded former Gov. Rod Blagojevich to pressure UIC on Castillo’s behalf. Threatened months later with impeachment, Blagojevich cited Castillo’s case as one reason he should remain in office.
UIC hospital spokeswoman Jeanne Galatzer-Levy declined to comment on Castillo’s case, or those of other individuals, citing federal patient confidentiality laws. But an organ transplant can cost upwards of $150,000.
In Chicago, about a dozen patients in need of organ transplants lean on one another through an informal support group. They sat recently inside one patient’s home in the Pilsen neighborhood, comparing kidney dialysis regimens and worries over mounting hospital bills. Within the group, sharing medicine is common. In cases where pills are running out, so is rationing one pill a day instead of three.
Asked about returning to México or other homelands to receive more comprehensive care, the group broke into laughter.
“Over there, it’s a thousand times worse,” said Juan Zavala, a legal immigrant from México and a transplant recipient who started the informal network. “Here, you may get treated poorly by some nurse or doctor. There? They’ll give you a kick and tell you you’re out of luck.”
Sitting nearby, listening, was Liliana Cruz, 16. After she was diagnosed with kidney failure in the Mexican state of Michoacán, her family came to the U.S. illegally in 2005 to seek help in getting a transplant after doctors said they’d have to pay cash in their own country.
But in Chicago, an operation is still beyond reach, so far.
Cruz’s age qualifies her to receive a transplant paid for by the state’s All Kids health subsidy program, and she has a willing donor in an adult older sister. But the UIC Medical Center has declined the procedure because the sister’s part of the surgery would not be subsidized.
“I just want a normal life,” said Cruz, during a recent round of kidney dialysis paid for by the state. “Right now, this machine is my life.”