Minnesotans For Sustainability©
Sustainable Society: A society that balances the environment, other life forms, and human interactions over an indefinite time period.
Medical Emergency: Who Pays the Price for Uncompensated Emergency Medical Care Along the Southwest Border?
U.S./Mexico Border Coalition*
Report on Uncompensated Emergency Health Care
On September 26, 2002, Senator Jon Kyl of Arizona announced the release of the Coalition's report entitled "Medical Emergency: Who Pays the Price for Uncompensated Emergency Medical Care Along the Southwest Border?" The report, which was prepared by MGT of America for the Coalition, was funded through an HHS appropriation secured by Senator Kyl.
The study reports that, in 2000, border hospitals spent more than $200 million to provide emergency health care to undocumented immigrants - $79 million in California; $74 million in Texas; $31 million in Arizona; and $6 million in New Mexico. Emergency transportation providers spent more than $13 million in 2000.
The Coalition's report makes several policy recommendations (see Executive Summary). The bottom line is Congress should reimburse local governments and ambulance services for providing emergency medical care to undocumented immigrants.
Southwest border counties —the 24 counties adjoining the Mexican border— are facing a medical emergency. A score of federal and state policies, such as declining federal Medicaid reimbursements and rising professional liability insurance costs, are contributing to an imminent health care crisis. The disproportionate burden placed on southwest border counties for providing emergency healthcare services to undocumented immigrants is compounding an already alarming state of affairs.
In 2000, the Immigration and Naturalization Service (INS) apprehended over 1.5 million undocumented immigrants—a fraction of the individuals that either entered the United States without detection or over-stayed their entry visas. They come for various reasons, but many end up needing emergency medical care they cannot afford.
Uncompensated care is the unreimbursed or uncollectible costs incurred by any medical provider for providing healthcare services. The federal government defines a medical emergency as a condition with a sudden onset that could expect to result in a person’s serious bodily harm or death if not immediately treated. Every state and county along the southwest border has approached the issue of uncompensated emergency health care services differently. However, as the number of undocumented immigrants in the country has escalated, state and local governments have increasingly stepped up to the plate to cover the cost of uncompensated care.
A poll conducted in November 2000 by Fingerhut Granados Opinion Research established that Americans believe, by a margin of almost six to one, that the federal government rather than local government should pay for emergency medical services provided to undocumented immigrants. While the majority of Americans feel the federal government should pay for this care, to date, researchers have had little success defining the size of the problem. In fiscal year 2001, Senator Jon Kyl of Arizona secured funds for the U.S./Mexico Border Counties Coalition (USMBCC) to:
The USMBCC hired MGT of America, Inc. (MGT) in the fall of 2001 to conduct the analysis.
Estimating the Cost of Uncompensated Care
According to the American Hospital Association annual survey, southwest border county hospitals reported uncompensated care totaling nearly $832 million in 2000. Using an advanced statistical modeling approach, MGT determined that almost $190 million or about 25 percent of the uncompensated costs these hospitals incurred resulted from emergency medical treatment provided to undocumented immigrants.
To develop our cost estimate, we compared reported levels of uncompensated hospital care and socio-economic factors such as poverty rates, median age, and net domestic migration in non-border counties to border counties. We found a statistically significant difference between the amount of uncompensated care delivered in border counties versus non-border counties. We attribute this difference to undocumented immigrants who seek emergency medical care in southwest border counties.
Using a separate methodology, MGT estimated that emergency medical services (EMS) providers incurred another $13 million in uncompensated costs in 2000. Here we used the County Business Patterns data set and the average percent of uncompensated care reported on our survey of border EMS providers to estimate the cost.
Together the costs of emergency hospital and transportation services exceeded $200 million. Yet, this figure does not represent the total costs borne by southwest border counties and local medical providers. In Figure 1 the boxes in gray represent the costs we were not able to estimate. Costs incurred for preventive, acute, extended or rehabilitative healthcare, and non-emergency medical transportation are not included in our estimate since these services fall outside the federal definition of an “emergency” and were therefore beyond the scope of our analysis. Furthermore, services delivered by a physician in a hospital’s emergency department that are not paid by or through the hospital are billed separately and cannot be captured by examining uncompensated hospital costs. As such, costs incurred by physicians attending an undocumented immigrant in a medical emergency also are not included in our cost estimate.
Some members of Congress are addressing the issue of uncompensated emergency medical services and have filed legislation to address the lack of adequate federal reimbursement for emergency medical treatment provided to undocumented immigrants. In light of our study’s findings, we propose the following recommendations:
The need for federal action is clear. The growing medical emergency on the southwest border has far reaching implications, not only for the southwest border, but for the nation as a whole.
MFS note: Also see on the MFS
Website, "Illegal Aliens and American Medicine".
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