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01-31-2007, 08:47 PM
Illegal immigrants straining health care


Sunday, January 28, 2007

Star-Ledger Staff

For years, the cost of providing health care to illegal immigrants has been one of the hottest flash points in the raging national debate over immigration, even though no one knew what that cost actually was.

Congressional researchers tried and failed to determine how much hospitals are paying to treat the estimated 11 million people living in the U.S. illegally. Economists threw up their hands.

And because they don't ask patients about their immigration status, even hospital officials themselves have been unsure how large the problem is.

Over the last two years, however, as the federal government began reimbursing hospitals for a portion of the costs, some New Jersey health care officials have begun tallying up the costs of caring for the state's estimated 400,000 illegal immigrants.

The New Jersey Hospital Association now estimates the state's 81 hospitals will spend between $275 million and $300 million treating uninsured illegal immigrants this year.

That's less than 2 percent of the $14 billion hospitals spend to treat patients. But for many hospitals already struggling financially, officials say it's another factor pushing them deeper into the red. And it hits some facilities harder than others -- particularly those in urban areas.

"We've been watching this issue for four or five years now and it's a sleeping giant," said hospital association spokesman Ron Czajkowski. "It is really starting to have a big impact now."

At St. Clare's Hospital in Dover, officials are launching programs specifically to cut the costs of treating uninsured patients like Esperanza Hernandez, 64, who arrived from Mexico six months ago and has no health insurance and no immigration papers.

After a dizzy spell three weeks ago, Hernandez did what many of her fellow illegal immigrants do when they are sick: She headed to the emergency room.

Frustrated by a long wait, she left before seeing a doctor. Four days later, she went instead to a mobile health clinic run by St. Clare's, where a nurse checked her blood pressure and prescribed an electrocardiogram.


Hernandez's visit to the clinic -- which is funded by grants and donations and costs far less per visit than the hospital emergency room -- was one small victory in the hospitals' efforts to keep costs down.

"Our mission tells us we don't turn anybody away who seeks out our care," said St. Clare's Health System spokesman Ben Martin. "We're trying, hopefully, to keep them from coming to the emergency department."

Such efforts put hospitals smack in the center of a politically charged debate over the costs of illegal immigration.

Immigration opponents say caring for unauthorized immigrants is a massive financial drain that threatens to bankrupt hospitals from California to North Carolina.

Immigrant advocates, and some economists, call such claims overblown. They cite numerous studies showing the typical illegal immigrant runs up far smaller health care bills than the average U.S. citizen.

Czajkowski, along with officials from nearly a dozen New Jersey hospitals interviewed for this article, describe the reality as somewhere in the middle.

It is a growing burden, they say, but one that is often impossible to quantify and to separate from the larger problem of the state's 1.1 million uninsured residents. Under federal law, hospitals must treat patients for emergencies regardless of their ability to pay or their immigration status. In many cases, New Jersey law requires that hospitals also provide inpatient services.

In 2003, Congress ordered the United States General Accounting Office to determine how much U.S. hospitals were spending to treat illegal immigrants.

After examining the issue in New Jersey and nine other states with high numbers of illegal immigrants, the GAO issued a report in May 2004 saying it was impossible to determine, largely because hospitals do not generally ask patients about their immigration status.


Jack Martin, special projects director for the Federation for American Immigration Reform, a group calling for lower immigration levels, says the sheer numbers of illegal immigrants make the problem a "devastating" one for a growing number of hospitals nationwide.

The fact that illegal immigrants tend to be younger and healthier, Martin added, "doesn't mean it's any less of a burden that should not be on the taxpayer, because of the fact that they should not be in the country."

In New Jersey, only a few hospitals have tried to break down the costs.

St. Clare's Health System, whose 541 beds include the hospital in Dover and another in Denville, spent $2 million last year treating illegal immigrants. Officials there call it a growing burden, but still a small fraction of the system's $319 million budget.

And a 2004 review conducted as part of the GAO report by officials at the financially troubled Jersey City Medical Center found illegal immigrants accounted for 25 percent of the $60 million the hospital spent to treat uninsured patients.

Many hospitals don't tally up the expense. To them, undocumented immigrants are simply part of the larger problem posed by the growing numbers of people who lack health insurance, but must be treated anyway.

"Show me a poor guy who has no insurance whose family lived three generations in Paterson, and a guy who just came in from somewhere and, to me, it's the same problem," said Joseph Orlando, CEO of Barnert Hospital in Paterson. "Politically, it may be more complicated, but where the rubber meets the road, where I am, it doesn't make any difference."


But when it comes to paying the bills, health care officials say there is one key difference: While the state charity care fund reimburses hospitals for about half the cost of caring for uninsured U.S. citizens, illegal immigrants are not eligible for that money.

That means unless illegal immigrants pay their own bills, the hospital usually winds up footing the entire cost.

In 2004 Congress set out to change that. The Medicare prescription drug act passed that year allocated $250 million to reimburse health care providers for treatment of undocumented aliens. Most of that money went to states along the U.S.-Mexico border. New Jersey is eligible to receive just $5.2 million a year.

"It's a spit in the bucket," said Czajkowski.

That leaves hospitals looking for other ways to keep the costs down.

At St. Clare's, the effort spawned the community outreach mobile health van, a tractor-trailer-size vehicle with a small waiting room and two exam rooms. The van spends three days a week parked along a side street in Dover, treating patients described by volunteer translator Miguel Pagan as "99 percent" undocumented immigrants.

"A lot of them are afraid of the system," said Theresa Zito-Maixner, an advance practice nurse who treats patients in the van. "I have to tell them it's okay to see a doctor, they're not going to get deported. There's a lot of them who haven't seen a doctor in years."

By treating patients in the van instead of the emergency room, the hospital has saved $607,000 over the past five years, said Martin, the St. Clare's spokesman.

The approach is similar to the one being considered by legislators hoping to bring universal health insurance to New Jersey. The plan would set up a separate network of clinics for an estimated 447,000 undocumented immigrants and homeless people.

"If you say everyone is going to have health insurance, which is the plan, the only ones left will be undocumented," said David Knowlton, president and chief executive of the policy group New Jersey Health Care Quality Institute.

"You have to begin with the premise that you can't not treat them," he said. "You can't not do it because of federal law. And you can't not do it morally."