Wednesday, August 16, 2006

Healthcare professionals weigh in on cost of undocumented

A few weeks ago the health care policy journal "Health Affairs" released a study looking at the use of hospital emergency rooms as primary care facilities by undocumented immigrants and Hispanics in general. Contrary to popular opinion that states that immigrants "crowd our emergency rooms" running up costs for all American tax payers, the study found that undocumented immigrants, and Hispanics on a whole, used emergency services at a considerably lower rate than any other demographic group. It was native-born recipients of government funded healthcare programs such as Medicare and Medicaid who were chief cause of rising emergency department costs according to the study.

Weighing in on the debate, the Hospital Association of Southern California recently released a statement on the effects of the undocumented on healthcare costs. The Association, which represents 170 different hospitals in a state that contains the largest number of foreign born residents in the country, asserted that blaming immigrants for increased healthcare cost takes focus away from the true root causes of the current healthcare crisis.

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From James Lott, Executive Vice President of the Hospital Association of Southern California comes this statement:

(Reprinted with permission.)


Too many illegal immigrants are overwhelming the healthcare system and driving up health insurance costs. That's the latest sound bite in the war of words over immigration reform. In a recent poll, a majority of the respondents thought that illegal immigrants were responsible for 50 percent or more of the uninsured treated in Southern California hospitals. But is that really the case?

While it is true that providing treatment to undocumented immigrants creates a drain on hospital resources, the question is: How much of the problem can reasonably be attributed to the undocumented? And if we solved the problem of illegal immigration tomorrow -- which we won't -- would healthcare costs return to "reasonable" levels?

Illegal immigrants are responsible for roughly 20 percent of the $2 billion in unreimbursed care that Southern California hospitals deliver each year. Even if you consider that factor, you have to conclude that it's the larger problem of just simply having so many uninsured patients that is a key driver of rising hospital costs.

In order to receive federal Medicare and Medicaid payments, a hospital must agree to treat and stabilize everybody who shows up to a hospital ER regardless of their ability to pay or their immigration status. That means undocumented immigrants who show up at the emergency room will receive treatment regardless of their immigration status or whether they're insured. But so will legal immigrants, naturalized citizens and native-born Americans.

It is a matter of law that these people receive treatment. Indeed, we may have an ethical responsibility to do so as well. The problem is that most hospitals in California end up being paid for only about 5 percent of the medical care given to uninsured patients. And that leads to the question: So, who's going to pick up the tab?

In the absence of strong political leadership on the question of insuring the uninsured, the answer, inevitably, is that hospitals and those patients with insurance, as well as those uninsured who do pay, will end up paying for those who seek care without insurance -- regardless of whether they are here legally or not.

Mr. Lott, in another article, took a look at a recent study of the spate of hospital closings in California. Between 1995 and 2000, 23 hospitals were forced to close their doors. Common wisdom would dictate that the increase in undocumented immigration played some role in these closings. A popular argument in the "blame the immigrants for healthcare problems" camp has always been that because of rising costs incurred due to undocumented immigrants, hospitals all over the country have been forced to close. The study commissioned by California Attorney General Bill Lockyer found that the situation is far more complex than that and villains numerous.


...The researchers concluded "…that financial hardship was the common reason cited by all the [23] hospitals that closed [between 1995-2000], a claim which is supported by an examination of their financial performance. In each case, we found declining reimbursements, income per bed and utilization present prior to closure."

The researchers went on to say they "…learned that urban, Southern California hospitals, located in close proximity to other hospitals, were the ones that most frequently closed."

It's as simple as that and the villains are easy to identify:

  • Health plans and their predatory payment practices

  • Government and its inadequate Medicare and Medi-Cal payments

  • Unfunded mandates (e.g. seismic safety, nurse staffing, etc.)

  • Labor shortages and out-of-control labor costs

  • Spiraling construction costs

  • Uninsured and underinsured Californians

  • Unbridled demand for services

  • Non-general acute care hospital competitors (e.g. specialty hospitals)

Since this report was published in 2001, another 17 hospitals closed in Southern California, 11 of which were located in Los Angeles County....


Obviously, like all other problems blamed on increased immigration from school overcrowding to high taxes, the problems of our healthcare system are complex and have multiple causations, not the least of which is the government's inability to supply the leadership necessary to ensure a system that can provide adequate healthcare for all its citizens. The number of uninsured in the United States has surpassed the 45 million mark and is expected to reach 56 million by 2013. Moreover, 15.6 million Americans are "underinsured."

Given the fact that California ranks number 1 in the nation in immigrant population by a large margin, we can assume that the situation there represents the most extreme case scenario in the country. According to 2000 census, 8.9 million people - 26.2 % of the population were foreign born while the national average is 11.1 percent. Of the foreign born, 60.8% are not US citizens.

When the largest organizations of healthcare professionals in California maintain that to blame immigration for the failing healthcare system only takes attention from the real problems ... Somehow you would think people might listen.

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