New federal funds to help California hospitals cover the costs of treating illegal immigrants have many in the state’s medical industry puzzling over how to ask patients about citizenship without making them afraid to seek care.
Earlier this month, federal health officials announced plans to spend $1 billion nationwide over the next four years on emergency care for undocumented patients. California will get more than any other state—$71 million in fiscal 2005—in the first federal effort to cover costs for patients who are not U.S. citizens.
To receive the money, hospitals must ask patients a series of questions designed to determine whether they are in the country illegally. Among other things, patients would be asked if they have a foreign birth certificate or driver’s license, a border-crossing card from Mexico or a U.S. Social Security number.
The questions stop short of directly asking patients if they are U.S. citizens, due in part to protests from California hospital executives and advocates for patients and immigrants who feared such blunt queries would make the ill and injured afraid to seek care.
“When there was talk of asking the citizenship question directly, our concern was that patients would not come in, and if they had a communicable disease that would be a major public health problem for everybody,” said Duane Dauner, president of the California Healthcare Association, a hospital trade group.
Because both the funding and the questionnaire that accompanies it are new, no one is sure whether the indirect questions about citizenship will stop people from going to hospitals.
“The devil is in how this is implemented” said Francisco Estrada, director of public policy for the Mexican American Legal Defense and Education Fund. “It is possible some hospitals will ask flat-out about immigration status, and it is possible that some patients will fear deportation if they go to the emergency room.”
Scripps Health, a nonprofit chain of five hospitals in San Diego County, also will take the money and ask the questions necessary to get it, said Chris Van Gorder, president and chief executive officer of the system.
“It’s a huge step for the federal government to start paying some of the bill for illegal immigrants,” said Gorder, who has one hospital seven miles from the Mexican border that lost $14 million last year because it treated a high number of uninsured and undocumented patients.
At Scripps, one in four uninsured patients is an illegal immigrant. Van Gorder said the new federal funds will cover about 15 percent of the total cost of the undocumented patients’ care.
“Like many others, we have some reservations about the questions,” Gorder said. “But we think we can ask them with sensitivity.”