Mark Kaufman

A bill pushed by President George W. Bush—intended to block human service providers from giving benefits to undocumented immigrants—has come home to roost in Multnomah County. It's causing the county's health spending to skyrocket—and blocking US citizens from getting benefits.

Jennifer York, 24, moved to Oregon from California about a month ago. She has three children, the youngest of whom was stung by a bee recently. He's allergic to bees, so York called an ambulance, which took her son to the emergency room. She paid the bill out of her own pocket, even though she didn't want to take him to the emergency room in the first place. But she had no choice—her children weren't insured because of changes introduced into federal law by the Deficit Reduction Act of 2005.

For her children to qualify for Medicaid under the Oregon Health Plan, York needs to offer proof of their citizenship, such as a birth certificate or a passport. Unfortunately, her children were born in different states. She had to go through the trouble of obtaining certified birth certificates for two of her children from California, which can take 12 weeks or longer to process before her children can even apply for coverage.

Any medical problem the children suffer in the meantime is paid 100 percent out of pocket.

The act, which was signed into law in February 2006 and went into effect this year, added a new citizenship documentation requirement designed to prevent illegal immigrants from obtaining coverage. Recipients of Medicaid must now provide a US birth certificate, naturalization certificate, or passport to be eligible for benefits.

However, the new requirements are causing some eligible people to lose their coverage. US citizens not born in Oregon, for example, need to go through the process of requesting the necessary documents from other offices in other jurisdictions—a process that is often expensive and time consuming for the uninsured, who are predominantly working poor, says Vanetta Abdellatif, director of the county's Integrated Clinical Services.

On June 21, the Multnomah County Board of Commissioners approved a request for an extra $4.6 million from the county's contingency fund to deal with (among other expenses) revenue shortfalls in primary health care clinics. Primary health care clinics usually handle low- or zero-income patients who can't go anywhere else because they receive Medicaid/Medicare through the Oregon Health Plan or have no insurance.

According to Abdellatif, 35.5 percent of the visits at county clinics were from uninsured patients this year—up from 28.3 percent in 2006. (Portlanders make up the majority of those numbers.) A change of 7.2 percent may seem slight, but each percentage point costs the county an extra $325,000—meaning that the county has absorbed about $2.3 million in extra costs. The county adjusted both this year's budget and next year's to reflect the changes.

"When we built the budget, we knew some of the stuff was happening," Abdellatif says. "But we didn't anticipate a shortfall."

However, Oregon Health Policy and Research Deputy Administrator Tina Edlund warned against attributing the increase in uninsured solely to Bush's bill. "All we have is anecdotal evidence of that," she says.

But the Oregon Department of Human Services has already completed a study of the policy's first six months in operation. Between September of 2006 and February of this year, more than 1,000 people had their benefits denied or shut off because they weren't able to meet the documentation requirements.

Of those, the vast majority were citizens (91 percent spoke English as their primary language)—and 64 percent were children.