No Solution for Long-Term Medical Costs of Unauthorized Aliens?
October 30, 2011, 10:27 PM
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Todd Ackerman's article in the Houston Chronicle poses a difficult problem but, of course, doesn't even attempt to get at a real solution besides soaking American taxpayers while making them feel guilty about it.

It's entitled "Still no solution for illegal immigrants´ long-term care costs" (Todd Ackerman, Houston Chronicle, Oct. 30th, 2011) and here's how it begins:

"With an infant son, a common-law wife who's a U.S. citizen and a job at a Galveston bait shop, Francisco Martinez was working toward the American dream."

When you read an article beginning in this manner, you know you're in for something.

"Then Martinez fell off the shop's roof and landed unceremoniously at the intersection of one of America's most vexing ethical, political and financial conundrums: the care of severely sick or injured illegal immigrants.

"It's a tragic, intractable problem," said Antonio Zavaleta, a professor of anthropology at the University of Texas at Brownsville who specializes in health care and immigrant populations. "There's no clear solution."

So Zavaleta had to become an anthropology professor to be able to declare that "There's no clear solution"? Or maybe there is a clear solution, and he just doesn't like it.

"Provide the long-term care and those institutions will rack up expenses that either bankrupt them or get passed on to U.S. citizens through higher charges. Don't provide the care and many of those patients won't survive, an ethical blight for a nation that prides itself on being humanitarian."

How about just not let illegal aliens in to begin with?

"The UT Medical Branch at Galveston's solution, after saving Martinez's life, was to try to persuade the Mexican national, now paralyzed from the chest down, to return to his homeland for the special, long-term care he needs. Martinez's response, despite UTMB's offer to pay for the trip, was to tell hospital officials, "if you don't want me here, just throw me outside."

It's too bad that Martinez is paralyzed from the chest down, we can sympathize with him for that. But what about his employer? Shouldn't he be helping pay for this?

"UTMB's plan was an example of medical repatriation, once little known, recently the subject of national newspaper articles, law journal reviews and medical association reports. No one tracks the exact number of illegal immigrant patients who've been transferred back to their native countries, but it's thought to occur nationally hundreds of times a year.

The Harris County Hospital District has repatriated seven such patients since 2010, but officials say all were voluntary. The controversy comes when a transfer occurs without the consent of the patient, typically because the patient no longer has family back home or fears the quality of or access to care there.

...Geoffrey Hoffman, director of the University of Houston Immigration Clinic, describes it as "patient dumping" or "private deportation" and calls it "despicable." Noting deportation is the "exclusive province" of the federal government, not hospitals, he says forcing patients to "accept" repatriation back to a country where there may be no hope of follow-up care can "only reflect badly on our great nation."

Granted, it's a tough situation, but don't these situations put the hospitals in a difficult situation?

"By contrast, Mark Krikorian of the Center for Immigration Studies in Washington argues that there are "real-world limits" to the level of health care U.S. institutions should provide non-citizens. He says that it's one thing to provide the life-saving emergency care federal law requires, quite another to provide lifelong, bankruptcy-causing or premium-raising care "to people here illegally in the first place."

Good point about these patients being "here illegally in the first place".

"Beneath the rhetoric, there's no denying the cost of such care. In 2010, for instance, the Harris County Hospital District spent nearly $170 million on the care of illegal immigrants. That was up from $100 million in 2007.

From 2005 to 2008, states were able to recoup some of those costs thanks to federal funding - Texas got about $45 million a year - aimed at compensating states for the emergency care of illegal immigrants the law requires hospitals provide. The program, pushed by Texas and other states that bear the brunt of such care, was not renewed after 2008.

Still, the real problem isn't hospitals, which transfer most all patients, both U.S. citizens and illegal immigrants, once urgent care is no longer needed and the bed is needed for other patients. It's long-term care facilities, unable to afford to accept patients, like Martinez, who don't have insurance. It remains for hospitals, obligated by federal regulation to arrange post-hospital care for those who need it, to find alternatives and to provide care indefinitely if they can't.

...So are there any good alternatives? The Catholic charity Casa Juan Diego provides long-term care for up to 80 illegal immigrant in Houston. In addition, a California company, MexCare, arranges transfers of consenting patients in any U.S. state to private Mexican facilities with which it works - the discharging U.S. hospital pays the bill, but it's typically a third of what it would cost it to keep the patient.

David Lopez, president of the Harris County Hospital District, argues that illegal immigrants should be able to buy health insurance, much as they're able to buy car insurance in some states. But he acknowledges that there's no single solution. "It's going to take a multiplicity of solutions," says Lopez. "One thing is certain - the status quo is not the answer."

Agreed, "the status quo is not the answer". So here's my solution:

  1. Get control of our border and improve interior enforcement.
  2. Start deporting more.
  3. And for tough situations like the one in the article, charge the employer, a solution never mentioned in the article.

After all, it was Francisco Martinez' employer who was willing to hire him illegally. So now that Martinez is paralyzed due to a work accident, how about the employer footing the bill?
You can write to Todd Ackerman, the reporter who wrote the article at todd.ackerman@chron.com .