Delivering Dual Benefits

Sandra Andrade lay in her hospital bed, overcome with anxiety about her newborn son.

All through her pregnancy, she had worried. The placenta was blocking her birth canal and growing into other organs. She knew she needed a Cesarean: If she went into labor, she might bleed to death.

Now her boy was in intensive care at Women’s and Children’s Hospital at Los Angeles County USC Medical Center. With his future — and her own recovery — on her mind, Andrade, 36, was relieved to be spared at least one worry: Who would pay for their care.

She’d been without private insurance since the premiums became too costly. But a friend assured her that, even as an illegal immigrant from Colombia, she would qualify for Medi-Cal, the state and federal health insurance program for the poor.

Andrade, a clothing exporter, is one of more than 100,000 undocumented women each year who bear children in California with expenses paid by Medi-Cal, according to state reports. They now account for about one in five births.

Regardless of their parents’ status, the children are American citizens by law.

Many illegal immigrants who might otherwise shy away from government services view care associated with childbirth as something they can safely seek, a protected right.

“I wasn’t afraid at all,” said Andrade, who came to the United States with her daughters on a tourist visa and stayed here with her boyfriend after it expired. “I’d always heard that pregnant women are treated well here.”

California long has been one of the more generous states in offering such benefits, covering everything from pregnancy tests to postpartum checkups for impoverished illegal immigrants.

‘Birthright’ citizenship

Such births and associated expenses account for more than $400 million of the nearly $1 billion that the program spends each year on healthcare for illegal immigrants in California, documents and reports show. Only about a dozen other states extend similar benefits to illegal immigrants, according to health and immigrant rights groups.

Although it has not so far figured prominently in the national discussion of immigration reform, a debate is simmering about the costs — and the rights — of illegal immigrants’ American-born children.

Some advocates for immigration control want to abolish automatic or “birthright” citizenship for babies born to undocumented women in the United States. They consider it just the first in an unacceptably long line of public benefits flowing to children who were born here only because their mothers broke the law.

“I think most Americans think that — while they certainly don’t want to do anything to harm children — you cannot have a policy that says anybody in the world come here and have a baby and we have a new American,” said Ira Mehlman, a spokesman for the Federation of American Immigration Reform, an immigration control group based in Washington, D.C.

{snip}

Births and prenatal care are the biggest single outlay by Medi-Cal for illegal immigrants’ healthcare, with the rest going for various other emergency treatments, limited breast and cervical cancer treatment, abortions and some nursing home care, according to the state.

In Los Angeles County’s public and private hospitals, undocumented women accounted for 41,240 Medi-Cal births in 2004, roughly half the deliveries covered by the public program.

In the four county-run hospitals alone, undocumented women and their newborns will receive more than $20 million in delivery, recovery, nursery and neonatal ICU services this year, according to a county estimate.

{snip}

“My husband pays taxes. They take a bunch out of his paycheck,” Ludys Ortiz, 36, said as she nursed her newborn son Christian at Women and Children’s Hospital, down the hall from Andrade.

Her husband works for $12 an hour washing cars at a body shop.

Ortiz, who entered the U.S. illegally in 2004 from Honduras, worked as a caretaker for children and the elderly, then as a house cleaner.

The pregnancy was unexpected.

“I am embarrassed because I’m not from here, I didn’t pay anything and they delivered my baby without my having to pay anything,” she said.

“But I’m more grateful than ashamed, because there’s no sin in asking for help, only in stealing.

“We all have some rights in life. No matter what, we’re human beings,” she added. “The only thing that divides us is a few pieces of paper.”

Ortiz, who was caught by immigration authorities in Texas shortly after her arrival, is not planning to stay in the U.S., however. She said she desperately misses her daughter in Central America and will tell the judge she wants to go home, taking her son with her. Her family’s mission in the U.S. was accomplished: earning enough money to build a tile-roofed house in the Choluteca province of Honduras.

{snip}