"Too many of our citizens go without health care," President Bush said during a January 2003 speech in Scranton, Pa. "We've got a lot of people who go to emergency rooms for primary care...." The President's solution: more community health care centers—paid for by the taxpayer.
Memo to Bush: the ER crisis is not due to a shortage of supply. It's due to a longage of demand—notably from immigrants, especially illegal immigrants.
Between 1992 and 2001 visits to U.S. hospital emergency rooms increased by 20%. Uninsured immigrants and their children were certainly the fastest growing component. (There's no official data on immigrant ER usage specifically.) We know this from looking at exactly who lacks health insurance.
We are constantly told that there are "X million Americans without health insurance." (The current estimate: 41.2 million [Source: Current Population Survey, March 2002.])
But next time you hear this, ask this question: how many of them are immigrants—and their native-born children? Answer: 12.2 million – or about 30 percent of all uninsured persons.
They account for more than half—59 percent – of the growth in the uninsured population during the 1992-2001 period [Steven Camarota, "Without Coverage: Immigration's Impact on the Size and Growth of the Population Lacking Health Insurance, Center for Immigration Studies].
Here are the uninsured rates for various immigrant groups (Table 1):
The rapid escalation of ER usage by uninsured immigrants has brought financial disaster to many hospitals. Southwestern border hospitals lost hundreds of millions before the recent federal bailout. In LA County the cost of caring for illegals has diverted money from other services, forcing clinics, trauma centers—and emergency rooms—to close.
Federal law requires hospitals to treat anyone who shows up in their emergency rooms. Apparently it does not prohibit hospitals from closing insolvent emergency rooms. Or passing un-reimbursed ER costs on to insured natives or their employers, many of whom can hardly pay their existing insurance premiums.
Let's assume the average ER visit costs between $500 and $1,000 per person. (That seems reasonable given that back in 1999 Medicare's average ER tab was $396 per person.) If each of the 12.2 million uninsured persons who live in immigrant families goes to an ER once, the annual ER subsidy would be between $6.1 and $12.2 billion.
Many visit ERs several times a year.
Of course, some uninsured immigrants notoriously proceed to run up multi-million dollar bills in long-term care—which doesn't show up as an ER expense.
Any policy aimed at alleviating the ER emergency must confront the role played by uninsured immigrants.
A modest proposal: cut off ER demand at the border. Simply enforce the laws against illegal immigration – and cut off legal immigration with a moratorium.
Edwin S. Rubenstein (email him) is President of ESR Research Economic Consultants in Indianapolis.