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Posted on Wed, Mar. 01, 2006

Medical providers struggle with payments from Hispanic immigrants

Associated Press

RALEIGH, N.C. - About a third of the 1.3 million North Carolinians who have no health insurance are illegal immigrants, and keeping them healthy is forcing hospitals to pass the costs on to insured patients, a trade group says.

The growth of the illegal immigrant population is pushing up uncompensated-care costs at hospitals statewide, though it's hard to estimate by how much, said Don Dalton, spokesman for the North Carolina Hospital Association. Uninsured North Carolina residents wracked up medical bills of more than $1.4 billion last year, the association estimates.

While hospitals do not try to separately account for illegal-immigrant care, the federal Medicaid program does.

Spending on such care in North Carolina doubled from $25.8 million in 2000 to $52.8 million in 2005, according to the state Division of Medical Assistance. Care for illegal immigrants absorbs just a small portion of North Carolinas total Medicaid spending.

In fiscal year 2005, the cost of care for illegal immigrants was less than one half of 1 percent of the Medicaid programs total budget of $8.2 billion.

At Rifenburg Construction in Durham, few of the company's Hispanic workers buy health insurance because it's too expensive for them, said human resources manager Jerry Leon. Coverage costs $400 per month for a single employee and $1,300 per month for a family, he said.

"Most are here for the money, and to send money back to their country," Leon said. "They don't really want to invest in a health plan."

Leon offers his uninsured employees an extra $1 per hour in wages if they buy health insurance. So far, just a few of the company's 35 Spanish speakers have bought coverage. If they get sick, they often turn to community clinics, Leon said.

The clinics include Piedmont Health Services, a network of six federally supported health centers serving Orange, Chatham, Caswell and Alamance counties. Piedmont's chief executive officer, Brian Toomey, estimates that half its patients are Hispanics.

The health centers charge at least $20 per office visit. Only 4 percent of patients do not pay, Toomey said.

"These aren't freeloaders," Toomey said. "People pay for the service. They pay willingly, and they understand their obligation."

Hospitals find that uninsured Hispanics, like most other uninsured patients, often can't afford to pay their entire bill, Dalton said.

One hospital that has been hit hard with unpaid bills is Duplin General Hospital in Kenansville. The 101-bed nonprofit is the only hospital in the county with North Carolina's highest proportion of Hispanic residents - about 17.5 percent.

In 2003, the hospital lost $2 million due to treating uninsured patients - its first loss since at least 1996, executive director Doug Yarbrough said. In 2004, the loss was $2.3 million. The loss was expected to be less in 2005, partly because the hospital received an $800,000 infusion from a Medicaid program that helps hospitals pay for large numbers of indigent patients.

Yarbrough said he's been able to avoid trimming hospital staff or closing units, but if the losses continue, he might have no choice.

"We can go on like this for a few more years," Yarbrough said. "But at some point you run out of cash, and that's when the problems really start."