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What is the cost of health care for illegal immigrants
By Jean Cole
Staff reporter


— One night on the job, Ricardo injured himself and was rushed to Athens-Limestone Hospital. The doctor on call that night thought Ricardo, not his real name, needed a specialist to perform surgery, so he was sent to University of Alabama Hospital at Birmingham. After surgery, Ricardo returned to Athens-Limestone Hospital and later went home.
The local hospital got stuck with a $110,000 bill. Ricardo, an illegal immigrant, was uninsured.

“With the current system, we are at risk of this happening,” said Randy Comer, compliance officer and reimbursement specialist for Athens Limestone Hospital. “(We) continuously hope that this does not occur again because, while the federal government provides an Illegal Alien Emergency Fund of $500,000 to the whole sate of Alabama, it’s used up in a flash and not available, and we are unable to recoup the cost of this individual’s much-needed health care. I would suggest that this is occurring throughout the country and is a situation that taxes the finances of most non-profit hospitals and facilities.”

That is an understatement, according to a 2004 study by the Center for Immigration Studies, a non-profit, non-partisan research organization in Washington, D.C.

In 2002, the United States spent $4.7 billion to cover Medicaid and treatment for uninsured illegal immigrants, according to the study.
And those numbers are growing.

The estimated cost of unreimbursed medical care in California alone was about $1.4 billion in 2004, according to the Federation for American Immigration Reform, or FAIR. In Texas, the estimated cost was about $.85 billion, and in Arizona the comparable estimate was $.4 billion per year.

Unreimbursed medical care has caused 84 hospitals to close their doors in California, according to Dr. Madeleine Cosman in a 2005 article in the Journal of American Physicians and Surgeons.

Athens-Limestone Hospital has seen nothing like the losses at hospitals in border states, but it has incurred some loss.

Local, nonprofit hospitals like Athens-Limestone treat everybody regardless race, color, sex, national origin, age or disability, said Gina Hanserd, director of marketing, public relations, volunteers and physician recruiting. That includes legal status.

In the past 12 months, the hospital treated 206 non-citizens — which includes illegal immigrants and immigrants who are not citizens but here legally — at a cost of $717,763. So far, the hospital has been reimbursed $94,290, or 13 percent, of the total.

Overall, though, non-citizens represent only about 3 percent of the $7.5 million total that the hospital writes off for people who are unable to pay their bills, Comer said.

The loss has not caused the hospital to ask for any additional tax money from the city or county, he added.

How the local hospital fairs compared to other community hospitals in the state is unknown. The state Alabama State Hospitals Association does not have access to that data from hospitals statewide, according to spokeswoman Rosemary Blackmon.

As lawmakers continue to talk about how to deal with the estimated 11 to 12 million illegal immigrants nationwide, local governments and community hospitals will continue to bear the costs.

One proposal is to give some illegals guest-worker passes and eventually let them apply for citizenship. Opponents call this amnesty.
Making illegals legal may be the solution for community hospitals, Comer said.

“If given amnesty and determined legal citizens, they would be eligible for government provided healthcare resources, which would probably have a positive effect on community hospitals,” said Comer.
Legal immigrant and Hispanic community leader Jose Guerrero believes those who come to America should try to go through the citizenship process.

“The laws are the laws,” said Guerrero, a teacher at Clements High School who owns Hispanic Media. “I encourage immigrants to get legalized.”

Guerrero hosts a radio program where he speaks with immigration lawyers and other experts who can help illegal pursue legal status. The program is spoken in a mix of Spanish and English.

“The first thing I say to them is learn English,” he said. “I tell them you’ve got to assimilate and be a good citizen. Try to legalize.”
He said he understands some of the uproar caused by the release of a Spanish language version of the National Anthem by a British music producer in April.

“I tell them, you can be proud of being Mexican. You can be proud of the Mexican soccer team. But you are here, and this is the greatest country in the world.”

As for medical care, Guerrero said many immigrants resort to home remedies for treatment or they “keep on suffering.”
He refers them to the hospital, the Limestone County Health Department or to a pediatrician, he said.

He praised the local businesses for their understanding.

“A lot of medical facilities here are good about letting them make payments,” he said. Still, he would like to see some of the plants that hire immigrants to tell them about the medical benefits they are paying through payroll deductions.

“They may be limited benefits, but the employer should provide an orientation,” he said. “A lot of people don’t know that they have it.”

Emergency services
Walk into an area hospital emergency room in the evening or on the weekend and you will typically find some Hispanics waiting to be seen by a doctor, sometimes they are illegal aliens.

Most costs for illegal immigrants come from two areas — emergency services and mother/baby services.

Like many uninsured or underinsured people, illegal immigrants often use the emergency room instead of a doctor’s office for medical care, which means they often don’t received and preventive care.

“Because emergencies are unplanned, and the emergency room is often times the gateway to healthcare for the uninsured or underinsured in this community, non-citizens often find the emergency department their only option,” Hanserd said.

According to FAIR, use of hospitals and clinics by illegal aliens (29 percent) is more than twice the rate of the overall U.S. population (11 percent).

The cost of the medical care of these uninsured immigrants is passed on to the taxpayer, and strains the financial stability of the health care community.

Forty-three percent of non-citizens in the United States under 65 have no health insurance, according to FAIR. That means there are 9.4 million uninsured immigrants, a majority of whom are in the country illegally, constituting 15 percent of the total uninsured in the nation in the mid-1990s, according to FAIR.

At Athens-Limestone Hospital, sometimes the uninsured patient needs to be admitted to the hospital, which increases the cost.
More than 50 percent of patients — citizens and non-citizens — hospitalized at Athens-Limestone Hospital are admitted through the emergency department, Comer said.

“There is always the risk of catastrophic health conditions occurring with non-citizens. For instance, there is one case in particular where a patient presented to the emergency department and was hospitalized, then transferred to the University of Alabama in Birmingham for surgery and returned to Athens Limestone Hospital. The treatment, which occurred from March through May, cost Athens Limestone Hospital $110,000 in costs it could not recoup.”

Babies

Babies are another cost.
Much of the cost of illegal immigrants comes from their American born children. If an illegal immigrant bears a child while in the United States, the child is granted U.S. citizenship at birth. They are sometime called anchor babies because they allow the parents a tie to the United States.
“Since children in the USA are citizens, they are awarded Medicaid per normal Medicaid processing,” said Alice Glanton, registered nurse for mother/baby services for Athens Limestone Hospital. “Immigrants who are pregnant can apply for Medicaid, which is federally funded, before their estimated delivery date.”

In July 2004, Medicaid made emergency services available to hospitals in Alabama for delivery to non-citizens. The availability of Medicaid has actually helped community hospitals in the state, but it is still a cost to taxpayers.

“Although Medicaid does not cover prenatal or postnatal care, it seems to encourage individuals to seek prenatal care so that they may access the available delivery funding and this ha been tremendously helpful to the hospital,” Glanton said. “Often times it negates mothers presenting to the emergency department in labor with absolutely no prenatal care, which is extremely risky for both mother and baby and the hospital as well.”