U.S. Government to Help Fund Hospital Care for Illegal Aliens

By Diane M. Grassi

On May 10, 2005 the Bush administration announced the specifics relating to new funding for hospitals and doctors who provide free emergency medical care to illegal aliens. The amount of reimbursement will total $1 billion dollars until September 2008 and is meant to stave the continual closings of hospitals most predominant in California and other border states.

The mainstream press did not comprehensively report on this legislation which is part of the Medicare Modernization Act of 2003, and establishes prescription drug coverage for Medicare recipients. The funding of medical care for illegals has nothing to do with the Medicare program but was an amendment to the bill which was signed into law on December 8, 2003 by President Bush.

There will be controversy following such funding, both from those who support it and from those who do not. Ultimately, the American taxpayers will bear the brunt of the payments, and while up to now such costs have gone unacknowledged by the federal government, individual states had the full responsibility of all costs for illegal aliens seeking medical care by way of the emergency room. On the positive side, the federal government must now recognize that this is indeed a federal government problem. Lack of enforcement of immigration law has landed the United States in this situation, which has caused the closure of 84 hospitals in California over the past several years, with nine more closing in 2004. Arizona has also been badly hit, predominantly by the Mexican population which does not necessarily even stay in the U.S., but merely comes across the U.S. border to access free medical care and then return to Mexico, sometimes in U.S. provided ambulances.

Steve Escoboza, spokesman for the Healthcare Association of San Diego and Imperial Counties agrees that “at least the federal government has recognized this burden, and it’s a significant movement in the right direction.” But Ann Pumpian, CEO of Sharp Healthcare claims “it isn’t coming close to covering the costs of services we provide. San Diego County alone has given illegals more than $100 million every year.” So the problem looms large as the entirety of California will only receive a total of $70 million with San Diego only expecting to get 15% or about $10 million per year of the total amount. According to Jan Emerson, a spokeswoman for the California Hospital Association, “California hospitals provide $500 million in emergency care for illegal immigrants, seven times the amount of the federal grant.” But Emerson did also say, “This is a highly symbolic first step. The federal government is finally acknowledging that it has a responsibility to pay for health care provided for illegal immigrants.”

With the largest allocation going to California in the amount of $70 million per fiscal year, Texas was next with $46 million followed by Arizona with $45 million; New York with $12 million; Illinois with $10 million; Florida at $8.7 million and New Mexico with $5 million. Senator Kay Bailey Hutchison, (R-TX) one of few in the Congress speaking out on immigration reform, said she “was pleased that the money was being made available,” even as she called for “new efforts to secure our borders.”

Under scrutiny is the question of hospitals’ requirement to ask patients for certain documents relating to payment. But according to the Centers for Medicare & Medicaid administrator, Mark McClellan, “a hospital should not directly ask a patient if he or she is an undocumented alien.” Hospitals may ask “indirect questions” such as if the person is eligible for Medicaid; whether the person reported a foreign place of birth; whether the person has a foreign passport, foreign driver’s license or foreign ID.

Hospitals may not directly ask patients if they are U.S. citizens or legal immigrants. In the event they are enrolled in Medicaid, the hospital will bill Medicaid. Hospitals are also required to make photocopies of documents indicating a patient’s immigration status, kept on hand for possible future review by federal auditors. Additionally, McClellan said the department “would not provide information about illegal immigrants to law enforcement officials for use in routine civil immigration proceedings.” In rare cases, however, the information could be used in criminal investigations. But Cecilia Munoz, a vice president for the National Council of La Raza, said that the new requirements “were an improvement over the original proposal but would still discourage some immigrants from seeking treatment.”

Prior to hospitals being awarded reimbursement under the new program, they must first exhaust the possibility of payment from other sources such as Medicaid and private insurance carriers. This will create another obstacle for hospital administrators as they must be very discreet and sensitive to the questions they ask of potential foreign nationals.

In question will be the vehicle used to reimburse hospitals and whether or not this addresses the underlying problem that U.S. taxpayers are ultimately paying for these costs in one way or another. Initially this program will free up some resources for individual state budgets, however the health care coverage of illegal aliens still remains an unresolved problem on the solvency of the U.S. health care infrastructure. Whether it is through taxation or higher insurance premiums and co-pays for the insured, the effort by the government thus far appears to be a gesture of good will, yet it remains to be seen whether or not the program will be successful for the various hospital institutions and will propel more outcry for border reinforcement.
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