States might get help with immigrant care

Border counties in Southwest states are overwhelmed with the costs of emergency care for illegal immigrants.

By Markian Hawryluk, amednews staff. Oct. 21, 2002.

Washington -- Treatment of illegal immigrants cost hospitals in 24 counties bordering Mexico more than $190 million in 2000, according to a recent study. Now congressional lawmakers from those states want the federal government to foot the bill.

The study, conducted by the United States-Mexico Border Counties Coalition, found that about 25% of the $832 million in uncompensated costs incurred by the 77 hospitals in Southwest border counties in 2000 resulted from emergency care provided to undocumented immigrants. Emergency medical services providers incurred another $13 million in uncompensated care costs in 2000.

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The true cost of the care provided to these immigrants might be substantially higher. Services delivered by a physician in a hospital's emergency department that were not billed through the hospital were not captured by the study. Other hospitals and clinics in non-border counties were also not included in the analysis. Losses at hospitals in Maricopa County in Arizona, for example, have been estimated as high as $50 million.

The study's authors said the cost is overwhelming the border counties and, in conjunction with declining Medicaid revenues and rising liability costs, is leading to a crisis.

"The problem of uncompensated emergency services has far-reaching implications beyond loss of hospital revenues," the coalition said. "Health care costs and insurance premiums are rising due, in part, to burgeoning levels of uncompensated care."

Some of the counties with high rates of uncompensated care are having trouble funding charity care for legal residents. And in some instances, high levels of unpaid medical bills for undocumented immigrants have forced local hospitals and clinics to reduce staffing, increase patient charges and cut back on services.

A bill proposes $200 million a year in federal funds for uncompensated emergency care.

The study also suggested that the Immigration and Naturalization Service continues to bring injured and ill undocumented immigrants to hospital EDs without taking financial responsibility for their medical care.

"This study underscores the seriousness of the crisis Arizona and other border states are facing," said Sen. John Kyl (R, Ariz.). "Unless we act now to reimburse states and local health care providers for the costs of federally mandated care to illegal immigrants, more local hospitals will be forced to cut costs and possibly close their doors."

Kyl, joined by Sens. John McCain (R, Ariz.), Jeff Bingaman (D, N.M.) and Pete Domenici (R, N.M.), has introduced legislation that would reimburse states and health care organizations up to $200 million per year for emergency treatment costs.

A similar provision was included in the Medicare payment package proposed by Sens. Max Baucus (D, Mont.) and Charles Grassley (R, Iowa), but it would set aside only $48 million per year. At press time, the package, which also included a Medicare physician payment update fix, was stalled due to objections over its $43 billion price tag.

The bills would direct funds to the 17 states with the highest numbers of illegal immigrants, with more funds for the six states that top the list.

More than money

But Bruce Bethancourt, MD, a Phoenix internist, said the problems with treating illegal immigrants go beyond simply the money.

"I think it's the impact that it has on the whole system," he said.

Bills would give federal funds to 17 states with the most illegal immigrants.

Under the Emergency Medical Treatment and Active Labor Act, hospitals must admit any patient requiring emergency care and must have doctors on call to treat them. As a result, Dr. Bethancourt has had to cancel full days of appointments after spending the entire night in the ED treating immigrants requiring intensive care.

"There's the loss of revenue, but that is only the minor point," he said. "There may have been patients that really needed to see me that day."

Many Arizona physicians have pulled their hospital privileges to avoid the on-call responsibilities. That has left many hospitals without access to on-call specialists for all their patients.

"If the emergency room or trauma center goes broke because others aren't paying, what happens when I need the emergency room, my family needs it or my patients need it?" Dr. Bethancourt said. "It's a huge problem that's putting an undue burden not only on the emergency room, but on the physicians and the hospital itself."

He believes Congress should repeal the EMTALA law and provide funding to treat illegal immigrants who require emergency care.

Kyl has also been critical of the unfunded mandate that EMTALA has created.

"The spirit behind laws requiring emergency medical care to all comers is laudable and welcome," Kyl said. "But it comes at a price. And since this is a federal mandate imposed on states and localities, the federal government has a duty to pay for it."

The study recommended providing additional federal funding to reimburse hospitals, EMS providers and other health care practitioners for care provided to undocumented immigrants.

The coalition also suggested requiring hospitals to track the number of undocumented immigrants treated using the absence of a Social Security number as a proxy.