Illegal aliens’ health-care tab is elusive
Posted on Sunday, September 21, 2008
While illegal aliens add to uncompensated-care expenses at hospitals in Arkansas and across the United States, determining the size of that bill is difficult, according to government and health-care officials and other experts.
The U. S. Government Accountability Office has examined the price of uncompensated care — for which hospitals receive no payment — and concluded that an accurate assessment of the effect of illegal aliens’ contribution “remains elusive.”
Most hospitals nationwide don’t record patients’ immigration status, the agency said in a 2004 report, its most recent on the subject.
Several of Arkansas’ largest hospitals and health systems — including Baptist Health, St. Vincent Health System, Arkansas Children’s Hospital, Northwest Health System, Washington Regional Medical Center in Fayetteville, St. Joseph’s Mercy Health Center and the University of Arkansas for Medical Sciences — also say they don’t know much illegal aliens add to uncompensated-care expenses.
“This is not something we track, and we also do not believe the overwhelming majority of charity-care patients are illegal immigrants,” Baptist Health spokesman Mark Lowman said.
Lowman said the system treats all patients regardless of their ability to pay, including illegal aliens.
Hilary DeMillo, a Children’s Hospital spokesman, said that if “a child doesn’t qualify for any coverage, then that account is treated as all other self-pay accounts without any distinction.”
About 11 million to 12 million illegal aliens now reside in the country, according to estimates by Pew Hispanic Center, a nonpartisan research group in Washington. Nationwide, the number grew by more than 1. 5 million annually in 1999 and 2000. The count grew by more than 500, 000 annually from 2000-05, although some experts believe the numbers have fallen in the past 12 months.
Immigration has not proved to be a major topic during the U. S. presidential campaign this year. Sens. Barack Obama and John Mc-Cain support “secure borders” and a system for illegal immigrants to pay a fine for being illegal, learn English and have the opportunity to become citizens, their Web sites say.
Leighton Ku, a professor of health policy at George Washington University in Washington, said there is a “fairly widespread belief” that there are “vast amounts of money being spent on uncompensated care” for illegal aliens.
“In general,” he said, studies on the subject show that the amounts “are considerably less than many people believe.”
Ku cited a study by Rand Corp., a Santa Monica, Calif.-based independent nonprofit institution for an indication of the levels of care received by illegal aliens. Rand estimated that about 1. 3 percent of public funds spent on medical costs nationwide in 2000, or about $ 1. 1 billion, was for illegal aliens. Total medical costs for illegal aliens, including public, private and personal costs, was estimated at $ 6. 5 billion, “or 1. 5 percent of total national medical costs — half as large as their 3. 2 percent population share,” the report said.
An Arkansas Democrat-Gazette story in July reported that uncompensated care at Arkansas hospitals rose from $ 121. 2 million in 1990 to $ 341. 9 million in 2006, according to the American Hospital Association, but that’s mostly a reflection of overall costs at hospitals rising.
One group that wants to place limits on immigration, the Washington-based Center for Immigration Studies, says the uncompensated costs from illegal aliens likely is small in Arkansas because they’re a small share of the total uninsured.
“You just don’t have that many illegals,” said the center’s Steven A. Camarota, who added that some hospitals in areas with a large immigrant population could still struggle with the problem.
Arkansas has 30, 000 to 50, 000 illegal aliens, said a 2006 report by Jeffrey S. Passel of the Pew Hispanic Center, a widely quoted expert on census data and related issues. Passel’s report analyzed data from the U. S. government’s March 2005 Current Population Survey.
Camarota’s own estimates show the number in Arkansas is about 43, 000. The Urban Institute last year said Arkansas had about 52, 000 illegal aliens, and the western edge of the state has the highest proportion of them compared to the overall population.
Illegal aliens represent about 5 percent of the uninsured population in the state, Camarota estimated. About 61 percent of Arkansas’ illegal aliens are uninsured, according to Camarota’s estimates.
U. S. Census numbers for 2005-2007 showed 485, 000 Arkansans uninsured.
In its 2004 report, the Government Accountability Office said it was unable to measure illegal aliens’ costs in hospitals by looking at records of patients with no Social Security numbers. Illegal aliens can obtain fake or stolen Social Security numbers, and emergency room patients often are treated and gone before their numbers are collected, the report said. And some U. S. citizens refuse to give their numbers. For hospitals responding to a GAO request for data, the median amount of uncompensated inpatient days from patients who didn’t have a Social Security number was 4 percent to 5 percent. But those results aren’t necessarily representative of the entire population. Just 39 percent of hospitals surveyed, or 198 hospitals, provided enough information to be included.
‘YOUNGER, HEALTHIER’ Lack of insurance and better health are some reasons that illegal aliens use disproportionately fewer services, the Rand report said. “Part of it is that immigrants — particularly recent immigrants and the undocumented — tend to be a little younger, tend to be a little healthier,” Ku said. “If you were going to come and work in the fields or go work in a meatpacking plant for 10 hours a day, you’re probably a relatively healthy person, at least when you started out.” Most immigrants these days are men, Ku said, adding that women spend more on health care.
Language barriers and the fear of being deported if they go to a government provider also could be factors in illegal aliens receiving less care, Ku said.
The federal Emergency Medical Treatment & Labor Act, called EMTALA, requires that everyone has access to emergency services regardless of ability to pay. Hospitals that receive Medicare reimbursement and offer emergency services must give screenings for emergency conditions and stabilize the patients, including determining if a pregnant woman is in labor, regardless of ability to pay.
The act doesn’t distinguish between U. S. citizens and illegal aliens, but that doesn’t mean anyone could come to the United States and receive any kind of care for free, said Mary Kahn, a spokesman for the U. S. Centers for Medicare & Medicaid Services.
The law is only designed to stabilize patients facing emergency situations.
“An illegal immigrant is not eligible for the ongoing, broad range of health-care benefits available through Medicare or Medicaid,” Kahn said.
While hospitals aren’t compensated for all of the care required by the emergency medical act, some government reimbursement is available.
For the combined federal fiscal years 2006 and 2007, Arkansas hospitals, ambulance companies and other providers were reimbursed $ 668, 000 by the federal government through the Section 1011 program created in 2003 for uncompensated emergency room care for illegal aliens. Providers in the state could have received a maximum of $ 1. 9 million for such care, according to theMedicare & Medicaid Services center.
Nationwide, about $ 406 million in taxpayer money went to reimbursement to health-care providers for such care for those two years, out of a maximum of $ 692 million available under the program.
Under the program’s guidelines, hospitals do not ask a patient for immigration status but instead try to determine eligible cases in ways such as asking for a person’s country of birth and whether or not he is eligible for Medicaid.
The payments are only a portion of a hospital’s full cost of providing care, even emergency care, to illegal aliens, experts say. The funds available in each state and nationwide are limited, reimbursement often is less than what hospitals bill for, and hospitals don’t always bill for all the care they provide, Kahn said.
In general, illegal immigrants aren’t eligible for Medicaid. In Arkansas, Medicaid’s “unborn child” program did pay about $ 8. 4 million in fiscal 2007 for prenatal care for 3, 445 foreign women in Arkansas. Some of those are illegal aliens, but Medicaid doesn’t break down how many. Arkansas Department of Human Services spokesman Julie Munsell said the bulk of the immigrants are believed to be in the country legally. About 81 percent of the funding is from the federal government and the rest is from the state.
Arkansas Medicaid also has a “disproportionate share” program that reimburses for emergencycare services at a few hospitals that have a high proportion of poor patients. That would include some illegal aliens, but reimbursement is not broken out by citizenship or residency status, Munsell said. State funding of services for illegal aliens has been a divisive issue. Arkansas Senate Bill 206, filed in 2005, would have prohibited state services from being extended to illegal aliens unless the services were mandated by the U. S. government. Then-Gov. Mike Huckabee called the bill “inflammatory... race-baiting and demagoguery.” Jim Holt, the bill’s sponsor and a former Republican state senator from Springdale, said at the time that the issue was about a “commitment to a country.” “ The issue is not about color or racism, ” he said.
CALIFORNIA IMPACT In recent years, some hospital associations in states with large immigrant populations have estimated the effect of illegal aliens on members’ uncompensated care expenses. (The Arkansas Hospital Association hasn’t studied the issue, spokesman Paul Cunningham said. ) About 25 percent of the nation’s illegal immigrants live in California, The New York Times reported this year. The paper said the California Hospital Association has estimated that illegal immigrants receive about 10 percent of the $ 9. 7 billion in uncompensated care in that state.
Florida’s hospital association said in a 2003 report, its most recent on the subject, that caring for uninsured people who aren’t citizens cost 39 hospitals or health systems in the state about $ 40. 2 million in 2002.
Because hospitals were only asked to report significant cases, the $ 40. 2 million underestimates the total cost, said Rich Rasmussen, an association vice president.
“What we wanted to focus in on in this report is that there are a number of patients who are uninsured that our hospitals are asked to provide care for. We wanted policymakers to understand that it’s not just their local residents. There are a large number of people being treated that may not be U. S. citizens.”
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