http://www.ama-assn.org/amednews/2007/0 ... sa0101.htm

The illegal effect: Who pays for treatments?
While politicians are deadlocked on the issues of immigration and uninsured Americans, hospitals and doctors are caught between helping everyone and staying in business.

By Doug Trapp, AMNews staff. Jan. 1/8, 2007.

Every week or so, another person sends the same scathing e-mail to April Foran, who answers electronic communications for Parkland Health and Hospital System in Dallas. "Does our public health care system treat illegals better than American citizens? Yes it does!" it reads.

A then-pregnant military wife -- upset with Parkland's charity care for illegal immigrants -- wrote it in the fall, said Foran, director of corporate communications.

Some people read the e-mail and write to thank Parkland for providing health care to people who need it most. But others write to tell Ron Anderson, MD, Parkland's president and CEO, that he should force undocumented pregnant women out of the hospital to have their "anchor babies" in the street.

Welcome to the debate over U.S. immigration policy, health care style. Parkland exemplifies how some hospitals and physicians get caught in the middle. The hospital system is struggling to balance federal law, public opinion, a crushing and costly load of uninsured patients, and its responsibility to patients.

The hospital legally can't and doesn't discriminate between illegal immigrants and citizens, says Dr. Anderson, head of Parkland since 1982. Doctors have an oath to care for people, he said. Only the federal government can enforce immigration law.

The legal and ethical obligation to treat illegal immigrants puts extra pressure on a system already providing vast amounts of care to patients who can't pay.

Parkland, in majority-Hispanic Dallas County, and its 10 health centers accumulated $409 million in uncompensated care charges in fiscal year 2005. The system had $1.04 billion in revenues, including $329 million in local property taxes, during the same period.