Cost of uncompensated care for undocumented immigrants difficult to calculate, experts say

Sep 22 2008

Pinpointing the exact cost of providing hospital care to undocumented immigrants in the U.S. is challenging for several reasons, according to government officials and health care experts, the Arkansas Democrat-Gazette reports.

The cost "remains elusive," according to a 2004 Government Accountability Office report, because most hospitals do not record patients' immigration status. According to the report, the Social Security numbers included in patients' records can be fake or stolen. In addition, many patients, including U.S. citizens and undocumented immigrants, are treated in emergency departments and leave before giving their legitimate Social Security numbers. Also, some U.S. residents refuse to disclose their Social Security numbers, according to the report.

The report found that the median share of uncompensated inpatient days by patients who did not have a Social Security number was between 4% and 5%. However, the report noted that the results are not "necessarily representative of the entire population" because only 198 hospitals, or 39% of those surveyed, provided adequate information to be included, according to the Democrat-Gazette.

According to Leighton Ku, a professor of health policy at George Washington University, despite the popular opinion that large amounts of money are being spent on uncompensated care for undocumented immigrants, several studies have found that the amount is far lower than many projections. A RAND study found that about 1.3%, or about $1.1 billion, of public funds spent on U.S. health care in 2000 was for undocumented immigrants. The study also found that the total spending -- including public, private and personal money -- on undocumented immigrants, who make up 3.2% of the U.S. population, was estimated at $6.5 billion, or 1.5% of total national medical costs.

According to the study, undocumented immigrants use fewer health services because of a lack of insurance, overall better general health, language barriers and the fear of being deported if they use government providers. In addition, Ku said that women typically spend more on health care than men but that most undocumented immigrants are men.

Some Reimbursement Available

According to the Democrat-Gazette, although hospitals are not compensated for all of the care they provide under the Emergency Medical Treatment and Labor Act -- which requires that everyone has access to emergency medical care regardless of their ability to pay -- they do receive some reimbursement for uncompensated care. Hospitals are compensated under the Section 1011 program, which was created in 2003 to compensate hospitals for emergency room care for undocumented immigrants. In 2006 and 2007, hospitals received $406 million in federal reimbursements out of a possible $692 million under the program (Manthey, Arkansas Democrat-Gazette, 9/21).

Federal Aid for Undocumented Immigrant Emergency Care Set To Expire

A federal program that reimburses states for providing emergency care to undocumented immigrants is set to expire at the end of September, the Arizona Republic reports. Federal law requires that hospitals treat emergency department patients regardless of immigration status. The program, which was established to temporarily address the costs of providing care to undocumented immigrants until Congress passed comprehensive immigration reform, provides about $250 million annually to states such as Arizona, California and Texas that "have been hardest hit by immigrant care costs," according to the Republic.

Arizona hospitals have called on Congress to continue the program, and the Border Health Care Relief Act, sponsored by Rep. Gabrielle Giffords (D-Texas), would extend the funding to hospitals in states along the U.S. border. Sen. Jon Kyl (R-Ariz.), sponsor of the legislation that created the program, said, "I don't think it is a very rosy prospect because we are just about out of the legislative session. The only bit of good news here is there is still a little bit of money left over." According to the Arizona Hospital and Healthcare Association, there will be about $77 million available to hospitals in the state once the program expires (Alltucker, Arizona Republic, 9/21).