Thread: How much is spent for healthcare on IAs It’s hard to say

How much is spent for healthcare on illegal immigrants? It’s hard to say

By Tracy Buffington/Executive EditorSaturday, Sep 06, 2008 - 02:08:55 am CDT

Editor's note: Immigration 101 is a series of stories looking at immigration issues in the Fremont area. The series will cover a variety of topics and run occasionally throughout the next several weeks. Today we look at the cost of healthcare.

In emergency situations, hospitals across the nation must provide care.

Federal regulations prohibit hospitals such as Fremont Area Medical Center from withholding treatment from patients in an emergency condition - including childbirth - regardless of the patient’s financial status.

Across the nation, hospital emergency rooms have become the basic healthcare provider for those who do not have insurance and cannot afford visits to a family physician. Among those are immigrants to the United States - both legal and illegal.

How much do these emergency room visits cost Dodge County residents? And how much of that cost can be attributed to illegal immigrants?

There are no simple answers.

But FAMC officials, in a fact sheet provided to the Mayor’s Task Force on Immigration, tried to answer those questions.

Privacy regulations can make it difficult - if not impossible - to find the actual answer about illegal immigrants. While hospital personnel require identification during the registration process, they aren’t allowed to determine the legal status of patients.

Also, FAMC is required to gather racial information about its patients for various purposes, but the law prohibits the hospital from inquiring about resident status.

Over the past six years, as the Hispanic population in Dodge County grew by about 66 percent to 6.6 percent of the overall population, the percentage of Hispanic patients at FAMC remained relatively constant, officials said.

Hispanics, the ethnic group most often associated with illegal immigration, made up 6 percent of the emergency care patients, 14 percent of the obstetrical care patients and 5 percent of the inpatient care patients, the fact sheet said.

Another constant has been the percentage of Charity Care and bad debt expense - the two categories of unreimbursed care the hospital offers. Hispanics are responsible for about 10 percent of the Charity Care and bad debt expense, the fact sheet said.

During that same time, the hospital had seen its Charity Care expense increase from about $1 million in 2001 to $1.5 million in 2008 and its bad debt expense increase from $1 million to almost $4 million.

FAMC officials, in the fact sheet, attributed those increases to the growth in its service volumes, inflation and an increasing number of uninsured and underinsured patients.

Hospital officials said the Charity Care and bad debt expense attributable to all Hispanic patients is $300,000 to $500,000 per year. They cannot, however, break out how much of that might have benefited illegal immigrants because they are prohibited from asking a patient’s resident status.

That leaves about $4 million to $4.2 million in Charity Care and bad debt expense attributable to all other patients.

FAMC officials are not able to answer exactly the question: How much does healthcare for illegal immigrants cost the hospital? But they and task force members said it appears the use of the Charity Care and bad debt expense by Hispanic patients is proportional to their use of hospital services.

From the mayor's task force

In the interest of providing the general public with facts, the Immigration Task Force will be providing information from various sources in Fremont, Nebraska to supply information relevant to our city. The goal is to provide accurate and much needed information to help people in establishing their own opinions as they relate to immigration in our city. As the Hispanic population represents the bulk of Fremont’s immigrant population, our comments will tend to focus on this population as many of the questions we have before us are most accurately defined with that related data.

The first area we would like to address is health care. Before we begin a presentation of the data, there are three points which must be considered:

The first point is that hospitals have requirements which limit the information that they can and should report. Secondly, hospitals are required to care for all patients in an emergency condition (including childbirth) regardless of the patient’s financial status. Third, hospitals require identification during the registration process, but they are not allowed to determine if the patient is an undocumented alien.

FAMC has essentially two categories of unreimbursed care: Charity Care and Bad Debts. Bills are categorized as Charity Care only when FAMC can verify that a patient does not have the resources (such as assets or income) to make payment arrangements. FAMC is a not-for-profit organization and it views the provision of these charity services as part of its mission to serve the community. FAMC does pursue all other unpaid bills, and as with most other businesses, some portion of these accounts may be ultimately "written off" due to a patient’s inability to pay.

Look at the last 7 years, a time in which census data shows an increase of specifically the Hispanic population in Dodge County rising from 1,421 in 2000 to 2,363 in 2007, the amount of Charity Care at FAMC has remained at roughly 1% of Gross Charges. Data also shows that Charity Care at FAMC has increased from roughly $1 million in 2001 to $1.5 million in 2008. During that same period, Bad Debts have grown from 1.3% of gross charges in 2001 to 2.2% in 2008. The actual amount of Bad Debt Expense has grown from about $1 million in 2001 to almost $4 million in 2008. The reasons for these increases include growth in FAMC service volumes, inflation and an increasing number of uninsured and underinsured patients.

FAMC has no information that would show how much Charity Care and Bad Debt Expense is related to undocumented aliens as the law prohibits them from inquiring about resident status. FAMC is required to gather some information related to the racial composition of its patients for various purposes. For these reasons it is only possible for FAMC to provide a partial response to our data requests. For example, it is possible to approximate the percentage of patients who are White, Black, Hispanic, Asian Pacific, or Native American. It is also important to point out that undocumented aliens may be represented in any of those groups with the exception of Native American. Again, because our current issue under discussion in Fremont seems to relate largely to undocumented aliens from the Hispanic community we would offer the following:

Over the last 6 years, the percentage of Hispanic patients who have utilized FAMC has remained relatively constant in each of three service areas; 1) Emergency Care- 6%, 2) Obstetrical Care- 14% and 3) Inpatient Care- 5%.

Over the last 6 years, the percentage of Charity Care and Bad Debt expense related to Hispanic patients has remained relatively constant at about 10%. When considering the population of Fremont, the Hispanic population as a whole is approximately 10% so this stands to reason. It is important to keep in mind that the 10% figure represents all Hispanic patients;- whether they are documented or undocumented is impossible to know because the hospital is prohibited from inquiring about a patient’s resident status. The conclusion that this brings us to is that the approximate amount of Charity Care and Bad Debt Expense attributable to all Hispanic patients (whether documented or undocumented) has ranged between $300,000 and $500,000 per year, that leaves approximately $4.0 to $4.2 million dollars attributable to all other patients who utilized FAMC during that same time period.

To summarize, it appears that the use of Charity Care and Bad Debt Expense by Hispanic patients is proportional to their use of hospital services. Furthermore, we understand that from the overall increase in Charity Care and Bad Debt Expense over the past 6 years is in line with national trends.

We hope this information is useful to you and that these facts contribute to a constructive discussion and aid in making informed decisions related to Fremont’s Immigration issue.

http://tinyurl.com/5gbevk

All hosptials have to do is look at how many people they treat who do not have social security numbers. For minor children who do have ss numbers, look at the parents who don't. Those are most likely the illegal aliens.

This argument is old, they just don't want to let us know how bad the situation really is.