Identify Foreign
Users of Publicly Funded Medical Treatment
PART 4 of a 5 Part
Full News Report
RECOMMENDATIONS -The escalating burden incurred by hospitals and other health facilities
for the uncompensated treatment of aliens is driven by both rampant illegal immigration
and an admission system for legal immigration that has become distorted from its original
intent. The health care system increasingly is confronted with foreigners legally resident
in the United States who either cannot or choose not to pay for their medical treatment
and foreigners illegally in the United States who have no other recourse for medical
treatment.
The first problem is largely the result of an immigration policy that has gone awry:
Despite an age-old policy designed to assure that immigrants will be self-supporting, we
are allowing large numbers of people to gain permanent residence despite the fact that
they are unlikely to be working in jobs with health care coverage or have personal
resources sufficient to pay for health services. The second problem- costs stemming from
illegal immigration- is a result of the unprecedented nine to eleven million aliens
illegally residing in the country who, for the most part, have no health insurance and
have few financial resources.
The common element of both of these foreign-born populations is that they are a financial
burden on the U.S. health care system and the American taxpayer. Neither the
sponsors of immigrants legally present in the country nor the employers of those illegally
in the country are held responsible for these expenses.
There is no single policy or program that will reverse the escalating problem of
uncompensated medical services provided to immigrants and illegal aliens other than
adopting a flat denial of treatment, which is too draconian to be considered. A better
solution would be the combination of short-term and long-term changes detailed below:
Identification of Foreign Users
of Publicly Funded Medical Treatment
The Department of Health and Human Services (HHS) should require that all foreigners who
seek publicly funded emergency medical treatment through Medicaid be fingerprinted on
equipment compatible with the US VISIT screening equipment and develop a program with the
Department of Homeland Security (DHS) to identify whether these foreigners are legally in
the United States and, if so, whether they have sponsors who have filed an affidavit of
support for them.
DHS should be required to provide information to HHS on sponsored immigrants, and HHS
should request reimbursement from the sponsor of unpaid medical expenses of the immigrant.
Immigration and Customs Enforcement personnel (including the Border Patrol), as a matter
of practice and policy, should determine the immigration status of all aliens it conducts
to medical facilities (or facilitates through a third party such as an ambulance service).
If the alien is in the United States illegally, ICE must arrange for their custody and
removal after treatment.
Adopting such a system would develop a reliable database on who is using emergency medical
services so that appropriate remedial measures could be designed in the public interest.
It would allow identification of those legally responsible for reimbursing health care
debts and allow the medical facilities to recoup expenses. It would provide information in
some instances as to the employer of the emergency medical care user in order to allow
follow-up legal efforts to obtain compensation.
Such a system also potentially could evolve into a means for non-emergency medical
facilities to address the problem of foreign patients who run up large medical bills that
they fail to pay. If Congress were to enact a law that specified that unpaid medical
obligations in the United States is a grounds for refusal of a new visa of any type or of
entry, abusers of the hospitality of U.S. health care providers would be denied the
opportunity to continue to abuse the system and pressure would increase on them to settle
their debt. Integral to the success of such a provision would be the identification of the
individuals by fingerprints furnished by the health care facility to the Department of
State and DHS.
For Legal Immigrants, Establish Guarantees of Medical Bills Payment Prior to Admission
The law provides that prospective immigrants are inadmissible if they are likely to become
a public charge. Similarly, those who subsequently become a public charge after gaining
permanent residence are deportable. (The public charge provisions do not apply to refugees
or asylees, but they do to other immigrants.)
Require sponsors of immigrants to post a medical surety bond to provide health
care insurance for the first five years after admission of the immigrant.
Require self-sponsoring immigrants, such as professionals or lottery winners, to similarly
post a medical surety bond that will provide health care insurance for the first five
years after admission for legal residence.
Deny approval of petitions for employer-sponsored immigrants and temporary foreign workers
unless the employer offers a health care plan in which the employer contributes at least
half of the costs.
The federal government should develop a medical visa program for admitting and
monitoring foreign visitors temporarily admitted for medical treatment. To
receive such a visa, the consent of the hospital where treatment will be received and a
cost estimate covering all aspects of the treatment should be required. Hospitals should
be required to report to the Department of Homeland Security (DHS) when the visitor
arrives for treatment and to inform the DHS when the visitor is discharged.
Enforce Laws Against Illegal Immigration
The major and expanding usage of emergency medical care facilities is largely a byproduct
of the enormous growth in the illegal alien population, which has entered and/or stayed in
violation of the legal immigration provisions. An estimated nine to eleven million aliens
are currently residing illegally in the United States, and further hundreds of thousands
of aliens may be in the country illegally for part of the year engaged in seasonal work.
The massive influx of illegal immigrants is not inevitable. Most illegal entrants or entry
overstayers violate our immigration laws in order to take jobs and improve their economic
opportunity. Congress recognized this when it adopted the system of employer sanctions
against hiring illegal aliens in 1986. That system was soon proven to have a major
loophole in that employers were not provided the means to verify the authenticity of
work-related documents that they were required to accept under the law. Congress acted in
1996 to begin to close that loophole by establishing pilot projects to permit employers to
verify Social Security numbers and the work eligibility of foreign-born employees.
The primary verification system, known as the Basic Pilot, is still operating as a
voluntary project, and it has been thoroughly evaluated by an outside contractor and found
to be operating largely as intended. The program was expanded by Congress in 2003 from a
program operating in a handful of states to becoming available nationally. When that
system is adopted as a mandatory requirement nationally, it will shut down legal
employment opportunities for illegal aliens using fraudulent identification, and it will
increase the efficacy of enforcement capabilities against employers who knowingly continue
to hire illegal aliens in order to exploit their vulnerability.
As soon as the DHS has addressed the problem areas in the Basic Pilot verification program
identified in the outside evaluation and has developed plans to make the system available
nationally, Congress should make participation in the verification program mandatory for
all employers whose workers are subject to social security withholding.
The Social Security Administration should restore the program abandoned in 2003 of
sending "no match" letters to all employers of employees whose SSNs are not
valid. These letters should be made available to the DHS any time that it reviews
the firm's I-9 records for its workers.
Immigration and Customs Enforcement (ICE) resources should be targeted on
employers who knowingly hire illegal aliens, with priority being given to
systematic exploitation of illegal aliens, such as in sweatshops. Periodic, random,
high-profile "sting" operations should be undertaken by ICE to disrupt the use
of day-laborer hiring sites by illegal alien workers and the employers who are breaking
the law by hiring them.
Reimburse States and Localities
for the Costs of Failures in Federal Immigration Policy
The federal government, in cooperation with local hospitals and state and local health
authorities, should report to Congress annually on the cost of uncompensated medical care
due to both legal and illegal immigration.
The federal government should establish a program to annually reimburse states,
communities, and hospitals for the uncompensated costs of medical care to illegal aliens
and non-immigrants, based on records of such treatment. A key requirement of that program
would be the fingerprinting requirement outlined above. Because immigration is a
federal responsibility, and in order to spread the burden equitably, Washington
should pick up the tab for providing health care for the people it has failed to prevent
from settling illegally
States and communities that work against federal efforts to combat illegal immigration,
e.g., by accepting foreign consular IDs issued to illegal residents as valid identity
cards, or allow illegal aliens to get driver's licenses, or adopt policies of
non-cooperation with immigration authorities, should be excluded from the reimbursement
program. These localities encourage illegal residence in their jurisdictions, perhaps with
a misguided view that illegal aliens benefit the community. To allow them to escape the
costs of those policies would be unfair to other communities.
Congress also should clarify existing federal emergency service laws regarding the
termination of a hospital's obligation for continuing care after the provision of
emergency treatment to stabilize the patient.
End the Taxpayer Subsidy to
Employers of Foreign Temporary Workers
Employers of temporary workers, especially unskilled agricultural workers on H-2A visas,
are not required to provide medical coverage for their workers. As a
result, those low-wage workers generally are forced to turn to emergency medical
facilities, public health programs, or charitable clinics. This is an unreimbursed burden
on the taxpayer and the medical facilities. President Bush's proposal to establish a new
guest worker plan and provide legal status to already employed illegal aliens does not
include any provision for lessening the burden on public medical facilities and the
American taxpayer from uncompensated medical services provided to these workers.
Similarly, legislation already in Congress to expand guest worker programs in agricultural
labor and/or provide legal status for those workers (H.R. 2899, H.R. 3142, S.1645, and
S.2010) neglect to provide any means for correcting the uncompensated burden.
No further guest worker programs should be adopted without the inclusion of provisions to
provide medical coverage for those workers and accompanying family members. The employer,
employee, and sending country all benefit from the opportunity to work in the United
States, and all three should be required to assume a liability should medical expenses,
whether of an emergency nature or not, arise. Current law governing temporary workers
should be amended to incorporate a similar requirement for all new visas.
Negotiate Medical Repatriation
Agreements With Sending Countries
When data collected by public hospitals on uncompensated costs reveal a pattern of abuse
by nationals of a specific country, the U.S. Department of State must negotiate a medical
repatriation agreement with that country. In the absence of such agreement, travelers from
that country should be required to obtain private international medical evacuation
insurance as a condition of admission. In addition, a port of entry surcharge fee on
citizens of that country may be levied in an amount necessary to defray the outlays by the
federal government for medical evacuation of indigent citizens of that country.
Federation for American Immigration Reform http://www.fairus.org
Part 5 -
$1 billion in
taxpayer money for Illegal Aliens Free Medical Care |
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