Illegal immigrants inundate hospitals
Sunday, January 09, 2005
By ANDREW D. SMITH
Staff Writer
New Jersey's escalating population of illegal immigrants is placing an
ever-growing burden on the state's hospitals, which expect to lose $200 million
this year on care to the underground community.
Doctors and administrators around the state are complaining that the cost of
treating illegal immigrants has forced them to delay the purchase of
life-saving technology or the addition of valuable staff.
And according to the New Jersey Hospital Association (NJHA) in West Windsor,
the burden will only increase unless state or federal agencies step in and pay
the bills.
"New Jersey hospitals generate about $15 billion in total annual revenue, so
people may assume that $200 million would have little impact on the industry,"
said Sean Hopkins, the senior vice president for health economics at the NJHA.
"However," Hopkins said, "even with all those revenues, the hospitals in this
state expect to generate a total net surplus of just $78 million, and some 40
percent of the hospitals in the state expect to lose money.
"When you look at those tight margins, the $200 million figure suddenly looks
much more important," Hopkins said. "For some hospitals, the money they spend
on uncompensated care for undocumented immigrants may force them to delay a big
service or economize on existing care."
The shadowy nature of illegal immigration has hindered efforts to tally the
number of illegal aliens or to calculate the exact costs they impose upon the
health-care system.
The federal government officially estimates 135,000 illegal immigrants live in
the state, but the Seton Hall University Institute on Work believes the number
may actually exceed 500,000. Estimates of the number of illegal aliens in the
country vary just as widely.
Given the uncertainty about how many immigrants live in the country illegally,
no one can say exactly how much they cost the nation's hospitals.
However, given that New Jersey's illegal aliens cost hospitals an estimated
$200 million, the many millions of illegal aliens across the nation surely cost
several billion dollars per year. The hospitals in just one city, Los Angeles,
report that they lose $350 million a year on illegal immigrants.
The federal government bears primary responsibility for enforcing the nation's
immigration laws, but it never agreed to foot the bill for those who escape its
grasp.
To compensate for the multibillion-dollar costs that illegal aliens impose upon
the nation's hospitals, for example, the federal government is planning to
spend just $200 million a year, nationwide, for the next four years.
Hospitals in New Jersey expect to receive about $5.7 million a year - about 3
percent of the costs they'll incur - during that period.
Hospitals can get additional reimbursement from the state government, which
pays some money for charity care given to state residents, regardless of
whether those residents live here legally.
In practice, however, charity care covers only a very small percentage of the
cost associated with illegal-immigrant health care.
To qualify for payments from the state, hospitals must convince their patients
to give extensive information about themselves and their finances. Many illegal
immigrants, for obvious reasons, decline to provide such information. Many
others provide false information.
To make matters worse, from the hospital viewpoint, charity care historically
pays out about a quarter for every dollar that hospitals spend on a qualified
patient. Payment levels are higher now, but hospitals still get less than 50
cents on the dollar.
In other words, hospitals spend big money on providing free care, not just to
illegal aliens but to all types of residents.
Among those who qualify for charity care, hospitals in New Jersey expect to
spend $813 million this year and get $381 million back from the state. In
addition, hospitals expect to lose another $1.2 billion treating those who do
not qualify for state aid and do not pay their bills.
Most of the money spent on illegal aliens falls into the second category - bad
debt. But hospitals do convince some immigrants to do the paperwork needed to
bring charity-care payments.
More government aid would, of course, help offset both types of losses.
However, officials in both Washington and Trenton refuse to speculate about the
possibility of expanding payments, while Hopkins and his colleagues in West
Windsor express little hope.
"I'm no insider. I have no idea what is happening in Trenton or Washington," he
said. "On the other hand I do know, just from reading the paper, that the state
government expects to face a pretty large deficit in the next budget year and
that the federal budget looks even worse. In other words, I'm not exactly
holding my breath."
Princeton HealthCare System, which runs the University Medical Center at
Princeton, provided a glimpse into how hospitals care for patients who live
here illegally.
Patients who visit either the Princeton HealthCare clinic or the hospital
emergency room must provide basic information, such as their name and address
and some proof of residence. That information helps Princeton HealthCare figure
out whether the patient qualifies either for Medicaid or for state charity
care.
Medicaid refuses to pay for illegal aliens.
Bruce Traub, the chief financial officer at Princeton HealthCare, figures that
even after accounting for government reimbursement, his organization gives away
about $4 million worth of care every year. Of that, he estimates Princeton
HealthCare spends somewhat less than $400,000 specifically on illegal aliens.
"The cost of charity care affects every other aspect of our operations," Traub
said. "It affects our staffing levels. It affects our maintenance expenditures.
It affects our technology investments. . . . To give you some perspective, we
spend a total of about $4 million each year on new technologies and maintaining
the facilities, so an extra $4 million, even an extra $400,000, would be a big
deal."
The area's other hospitals either declined to comment about illegal immigrants
or provided a brief statement about their commitment to care for all people,
regardless of their immigration status or their ability to pay.
A statement from Robert Wood Johnson University Hospital at Hamilton, for
example, reads: "We believe that everyone should have equal access to quality
health care regardless of their ability to pay. As a nonprofit organization we
finance charity care and other programs to help those that cannot afford
adequate medical care."
New Jersey's hospitals have little hope, beyond government payments, for the
number of illegal aliens who may need their care, even as that number grows by
the hour.
Recent data from U.S. Immigrations and Customs Enforcement indicate that more
than 8,200 illegal immigrants sneak into the United States every day. At that
rate, some 3 million illegal aliens, most of them Mexicans, will enter the
country this year, adding to an underground population that may already total
15 million.
Estimates, however, vary widely. Other analyses of government data conclude
that only 750,000 illegal immigrants arrive each year, while the 2000 Census
counted 8 million illegal immigrants.
The federal government employs just under 10,000 people to guard the nation's
2,000-mile border with Mexico. In all, federal agents have apprehended more
than 1 million illegal immigrants in the past year, but their efforts often go
to waste.
The government has little room to detain immigrants between their arrests and
their deportation hearings, so it must release the vast majority of the people
it arrests and hope they return for future hearings.
In a recent study by the Office of the Inspector General, fewer than 10 percent
of all aliens ordered deported from the country ever got the boot. The rest,
who were released before trials they never attended, eluded capture.
Even when the government does manage to deport people, many of them simply
return to this country, often in just a few days.
In California, which has far more illegal aliens than New Jersey, the state
medical association reports the cost of caring for illegal immigrants has
helped force 60 emergency rooms to close during the past decade.
Those closures, in turn, have led to crowding at many of the others. In big
cities from Sacramento to San Diego, patients with minor injuries often must
wait hours for care.
The situation will likely get worse in the next few years.
The rate of closures is on the rise, according to reports from the California
Medical Association, and considering that some 80 percent of the state's
emergency rooms report that they now lose money, largely because of the care
they give away to illegal immigrants, hundreds more emergency rooms may be at
risk.
In Arizona, along the Mexican border, dozens of hospitals have cut back on
services to cover the money they lose by providing free care to illegal
immigrants. Administrators from one facility, the Southeast Arizona Medical
Center, told local and national publications that the costs of caring for
aliens drove them out of business.
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At first glance, New Jersey's hospitals may seem capable of alleviating many of
their own problems with illegal aliens. Even accounting for the fact that
hospitals will not turn away a patient in need of medical care, a quick call to
some deporting authority would theoretically ensure that no hospital would have
to treat the same illegal alien twice.
As it turns out, hospitals not only have no legal obligation to report those
who violate the nation's immigration law, they also lack the right to make such
reports voluntarily.
Federal patient privacy laws forbid New Jersey hospitals from telling
authorities about patients who break federal immigration laws.
This suits hospital officials just fine.
Doctors concede their obligation to notify the authorities when they have
reason to suspect violent crimes, but they oppose any measure that would
reverse current law and require them to turn in illegal aliens.
"The law does require hospitals to notify authorities about every case of wound
or burn related to a weapon used in an act of aggression," said Ron Czajkowski,
a spokesman for the hospital association.
"But the hospitals in this state are quite firm in their opposition to any law
that would require them to report immigration violations.
"Violence is one thing, but immigration is not really a crime. It's a social
phenomenon that happens to be illegal. Besides, if people suspected that
health-care providers would report them, they would not seek medical care,
which would be bad for them and could create a public health menace."
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