WASHINGTON -- Early on a recent morning, men huddle in the Home Depot parking lot, ground zero for day laborers on the hunt for work. Cars pull into the lot, and the men swarm.
Among them is Marcos, at 65, wiry and bronzed with a silvery smile. He's been in the country illegally for 20 years, working construction and landscaping, doing whatever he can get, whenever he can get it. When he's sick, he just rests, because -- like most undocumented workers -- he doesn't have insurance.
"I don't know if I have high blood pressure," he said, laughing ruefully, "Because I don't check. Doctors, you know, are expensive."
For decades, the United States has struggled to deal with the health care needs of its undocumented immigrants -- now an estimated 11 million -- mainly through emergency room care and community health centers. But in the coming years, that struggle will evolve. As with the rest of America, the population of people living here illegally is aging and beginning to develop the same health problems that plague senior citizens generally and are a lot more expensive to treat: chronic diseases, cognitive disorders and physical injuries.
Many undocumented adults lack health insurance, and even though they're guaranteed emergency care for acute problems such as heart attacks, senior citizens without documentation don't have access to care for chronic issues such as kidney disease and high blood pressure. What's more, experts predict that many will -- like Marcos -- forgo primary preventive care even when it is available, likely making their chronic health problems worse -- and more expensive to treat.
"They're hosed. If you're an undocumented immigrant, you're paying into Social Security and Medicare, but can't claim it," said Steven Wallace, associate director of the UCLA Center for Health Policy Research.
When uninsured people go without preventive health care and end up in the hospital, someone has to pay. Since most of these patients are low-income, much of their bill ends up as bad debt, which then pushes up rates for those who have insurance, or are billed to public programs like Emergency Medicaid, which is paid for out of general taxes.
This contributes to a game of shifting costs. Hospitals that don't cover their costs go bankrupt and close, so indigent care costs that end up as unpaid bills are covered by other payers, such as insurance companies. When insurers pay more, they raise insurance premiums, passing on the costs to consumers, Wallace said.
"It'll place a strain on the entire health care system, from primary care to hospitals," Wallace said.
Approximately 10 percent of the undocumented population is over 55 now, according to the Migration Policy Institute, but researchers agree that the percentage and the raw numbers almost certainly will rise.