It’s Tricky to Treat Many Immigrants, Hospitals Say

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Immigration poses challenges for the health care system, which often can’t get compensated for cost of care. A 2003 Florida Hospital Association survey of 39 hospitals found the medical centers gave away $40.2 million in charity care for illegal immigrants. That didn’t take into account the noncitizens who are here legally but who are uninsured and underemployed and are likely to land in emergency rooms.

The United States has about 36 million immigrants, a third of whom are estimated to be here illegally, according to the U.S. Census Bureau. How to pay for their medical care is part of a broader debate on immigration policy and on what to do about the country’s out-of-control health care costs.

In many ways, the immigrants’ stories are no different than those of uninsured citizens, who have medical doors shut on them and debt collectors chasing for impossible-to-pay medical bills when they get care. But the challenges of being a noncitizen and uninsured—and the challenges of caring for them—are even greater than they are for uninsured Americans.

Consider:

o Medicaid will pay for emergency treatment for noncitizens, but the payments stop when the condition is no longer considered an emergency—even if the patient requires prolonged hospital care. Hospitals are not permitted to bill patients for the difference. At Lee Memorial Health System, it costs about $1,700 a day to stay in the hospital. Hospital officials say they end up writing off the extended stay.

o Noncitizens are not eligible for regular Medicaid or subsidized health insurance plans for children.

o Uninsured people of all stripes end up in emergency rooms for care, but immigrants do so at higher rates, according to the Florida Hospital Association. The emergency room is the costliest way to deliver medical care, and it’s also the place forbidden by federal law from turning anyone away. At Lee Memorial, the average ER visit cost is $325.

o Hospital social workers must turn into sleuths trying to track the identities of immigrant patients who come into the trauma center unconscious—a challenge if they’re illegal, lacking identification and their friends and family are fearful of speaking with anyone in a perceived position of authority.

o These same social workers sometimes struggle to find follow-up care for patients, who may need home health, rehabilitation or family members to care for them after discharge from the hospital. Frequently, they come across workers who share housing with other workers, but not spouses or relatives who could offer such care.

o Immigrants are flooding delivery rooms to give birth to children, who are automatically U.S. citizens. In 2005 and 2006 alone, Lee County saw a total of about 2,100 babies born to illegal-immigrant mothers, state birth records show.

These children, in turn, often qualify for Medicaid or other subsidized health plans. The Center for Immigration Studies report found in Florida 18 percent of immigrant-headed households had at least one family member who qualified for Medicaid as opposed to 11 percent of native households.

The issue, suggested Steven Camarota, author of the Center for Immigration Studies report, is American immigration policy opens the door to undereducated, low-wage workers who will need American support ranging from Medicaid to food assistance. Forty-seven percent of immigrants are uninsured or on Medicaid compared with 26 percent for native born.

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