Politics & Policy

Er in The Red

Congress is poised to increase medical coverage for non-citizens.

Amid the current Medicare/prescription-drug turbulence, a provision has been overlooked in the Republican Senate bill that would expand health-insurance coverage to uninsured women and children who are not even citizens.

Senator Bob Graham (D., Fla.) has proposed that the State Children’s Health Insurance Program (SCHIP) be expanded by 30 percent to cover a non-citizen woman’s prenatal and postnatal care — and her child’s health care as well. SCHIP was created in 1997 as part of the Balanced Budget Act of 1997, under Title XXI of the Social Security Act, in order to cover uninsured children. With Graham tacking this proposal onto the Senate bill, one has to ask: If this is a Medicare bill for old people, then why are pregnant women and children being covered in the same bill?

During the Finance Committee markup on June 12, Sen. Nickles (R., Okla.) asked this same question. Nickles contended that SCHIP should be dealt with separately and not in conjunction with Medicare and prescription drugs. Nickles did not object to providing SCHIP, but pointed out that it is an entirely different subject and therefore warrants an entirely different debate — especially since SCHIP will cost $2.5 billion over ten years.

Furthermore, Nickles pointed out that the increase in SCHIP is going to subsidize non-citizens at a higher level than Medicaid subsidizes citizens. Medicaid recipients who are in the lowest-income threshold starting in 2005 will now be out-funded by non-citizens who make more money than they do.

But according to the 1996 Welfare Reform Act, immigrants are prohibited from receiving government entitlements for their first five years in the U.S. In fact, immigrants must have a sponsor who will vouch that they will not be a ward of the federal government for the prescribed number of years. Putting SCHIP in a Medicare bill makes no sense, Nickles argued — but judging by the 1996 welfare reforms, it’s also illegal.

The 1986 Emergency Medical Treatment and Active Labor Act (EMTALA), subsequently amended to become more stringent, forces practically every hospital in the U.S. to treat illegal aliens who lack medical insurance or other means of paying the hospital for its services. But, like any other entity, hospitals do not have an endless supply of cash to spend on their patient. The more hospitals must pay for illegals, the less they will have available to spend on legal, law-abiding citizens.

Realistically, then, EMTALA was a tradeoff that favored non-citizens at the expense of citizens. A brief look at hospitals in one border state, Arizona, highlights the problems: The Southeast Arizona Medical Center in Douglas, Ariz., had to close its OBGYN clinic. Now Douglas citizens must drive 75 miles to the city of Sierra Vista just to have children delivered, according to Public Information Officer Cindy Hayosteck. “The EMTALA mandate wasn’t the only reason, but [was] a major reason the OBGYN clinic had to close,” said Hayosteck. Copper Queen Hospital in Bisbee, Ariz., had to shut its nursing home because “overall, it was costing more per patient than the hospital was receiving,” according to May Kolbe, director of administrative services. “You can’t subsidize everything; something has to go.”

Ironically, at a time when expanding entitlements to senior citizens is politically savvy for politicians, legislation favoring non-citizens who cannot vote is actually taking precedence over senior citizens, as Copper Queen shows.

Tuscon Medical Center in Tuscon, Ariz., closed Level 1 of the trauma center because it was becoming too costly to treat illegals injured on their journey into the U.S. “We lose on average [of] $5 million a year on trauma services,” said Communications Director Julia Strange. Texas hospitals are also hit hard because — at 25 percent — Texas has the highest uninsured rate in the country. The uncompensated care required by EMTALA is a “big burden all over the state,” says Texas Hospital Association (THA) Vice President of Communications Ann Ward. THA has served Texas hospitals and health systems for over 70 years. According to the U.S.-Mexico Border Counties Coalition, EMTALA costs border states such as California, Arizona, Texas, and New Mexico approximately $200 million a year, and costs the entire country $1.4 billion.

Colorado, not even a border state, is also adversely affected by EMTALA. In 2001, the Colorado Health and Hospital Association reported 87,101 visits to Memorial Hospital’s emergency room in Colorado Springs. Such an alarming number shows clearly that patients are overusing emergency facilities as a result of the free medical service imposed by EMTALA.

According to the Colorado Springs Business Journal, hospitals in Colorado Springs and Penrose/St.Francis agree that “emergency rooms have become a catch-all for everything that ails people, from a minor cold to a need to detoxify from a night of too much liquor.” In fact, the American Hospital Association reports that 70 percent of pediatric emergency visits in the U.S. are not necessary. Dr. John Lundy of Mimbres Memorial Hospital in Deming, N.M., summarized this problem quite well for the Deming Headlight: “If on a particular day we get people from Mexico who need taking care of, we take care of them. But it’s time to let the citizens know their tax dollars are getting stymied a little bit.”

Senator Jon Kyl (R., Ariz.) championed the provision in the Medicare bill that would reimburse $1 billion over five years to eligible hospitals. “One of my top priorities in the Senate has been to provide reimbursement to local health-care providers for the costs of federally mandated emergency care of illegal immigrants,” Kyl said in a June 12 press release.

Kyl’s position is understandable. If Congress legislates that hospitals must accept uninsured immigrants, then, as a corollary, Congress obviously must provide the funds to execute such legislation.

The problem lies both with the provisional increase of SCHIP, and with the reimbursement of hospitals being incongruously and furtively inserted into a senior citizens’ bill. Nickles insists that separate debates and hearings take place to determine a cost-benefit analysis on both SCHIP and EMTALA — given that both programs will cost $3.5 billion. This issue may not even be brought up in the overall debate, but could easily be lost in the verbal dexterity of the Senate floor.

Jason Mattera is a journalism intern this summer in Washington, D.C.



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