Posted on September 24, 2004

Worried Sick Over Plan

Robert Polner, Newsday (New York), Sept. 19

She spends 3 1/2 hours a day at a public health clinic getting dialysis for a kidney illness that has landed her in the emergency room on more than a few occasions. Left untreated, she says, her lifelong illness could kill her.

She’s 30 and one of the city’s tens of thousands of undocumented residents whose emergency treatment could be affected by a planned change in federal policy. A native of rural, impoverished Ecuador, she has resided in Corona for the past four years with her family. Given her immigration status, she spoke on the condition that only her first name — Norma — be used.

Now a legally technical debate in Washington over Medicare guidelines has gotten her attention because she says it would hinder her ability to get emergency care. The relatively little-known issue is a federal plan that would require uninsured patients like her to reveal their immigration status when receiving critical care.

“It’s very bad,” Norma said in Spanish, “especially for me, as sick as I am. It would be fatal for me — and not only for me.”

The Bush administration initiative is undergoing an unscheduled review at the Centers for Medicare & Medicaid Services after criticism from more than 100 immigrant advocacy groups and health care providers. The Bloomberg administration has called the policy unacceptable, and has promised to defy it. It was slated to begin Sept. 1 before being pulled back for further consideration.

Under the plan, emergency rooms nationally would be required to ask uninsured patients for their immigration status in order for the hospitals to get a share of $1 billion in added reimbursement available for crisis care services over the next four years.

Mary Kahn, a spokeswoman for the federal agency, part of the Department of Health and Human Services, said a final policy would be issued “very shortly.” She said some changes are in the offing but she didn’t know their scope or nature.

The debate dates back a year, when Congress approved the compensation for emergency treatment of the uninsured as part of its overhaul of the Medicare prescription drug program.

After that, the measure got tangled up in the often polarized debate over U.S. immigration policy when the Bush administration stipulated that emergency rooms could collect the money only if they asked the immigration status of the uninsured. At stake for New York City hospitals is $30 million, federal officials say.

An aide to U.S. Rep. John Kyle (R-Ariz.), sponsor of the $1 billion funding amendment, said fears among undocumented immigrants and hospitals are overblown: There is no requirement that the information be shared with law enforcement.

Kyle aide Scot Montrey said he doubts any hospital would withhold treatment from an undocumented immigrant and hospitals that are uncomfortable with the federal questionnaire can opt out of the funding. “You don’t have to ask questions until three minutes before a patient is discharged, not while someone’s bleeding to death in the waiting room of the ER,” he said.

New York City has much to lose in the debate. One of every four city residents — 2 million people — is without health insurance. What’s more, noncitizens are more than twice as likely to be uninsured, according to the 2002 Census.

“This would pose a significant public health threat for entire communities because it may keep undocumented immigrants from seeking care for communicable diseases,” the city’s Health and Hospitals Corporation said in a statement released to Newsday last week.

The hospital system stands “vehemently opposed” to implementation of the policy in its latest form, it added.

Local immigrant advocates say the policy debate alone has deterred the undocumented from going to hospitals. “It’s creating a significant buzz in the ethnic media and their communities,” said Adam Gurvitch of the New York Immigration Coalition, which is fighting the plan.

The fear of deportation keeps many noncitizens in the shadows. Norma said at least four times during an interview with Newsday that her full name must not appear.

Although her dialysis treatments would not be threatened directly by the new policy, she has been forced to make regular trips to a hospital and clinic when she has needed critical care. For her to have to identify herself each time she goes to an emergency room would pose a problem, she said.

“In a few words, I depend on those machines to live. If the government makes that change, people like me would no longer bear going to the hospital, out of worry and fear that the doctors would force me back to my country.”

Staff writer Luis Perez contributed to this story.