Government

AMA: More U.S. funds needed for immigrants' charity care

Hospitals and physicians are often left with the unpaid bills of people illegally entering the country who are brought in by federal agents for care.

By David Glendinning — Posted July 3, 2006

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Physicians and hospitals for years have been swallowing hundreds of millions of dollars annually in uncompensated care for illegal immigrants and other undocumented foreign nationals. Now doctors want the U.S. government to start footing more of the bill.

At the AMA Annual Meeting last month, the House of Delegates approved a resolution calling on policy-makers to take doctors and hospitals into account when crafting potential solutions to the immigration problem. For starters, physicians want the U.S. Office of Customs and Border Protection or another government agency to start paying for undocumented people that federal agents bring to local hospitals for care.

In many cases, detained illegal immigrants are placed in the hospital when they require immediate care and are taken back into custody once they have been treated, leaving the facility holding the unpaid bill, said Brian Johnston, MD, an emergency physician from California and an alternate delegate for the AMA's Organized Medical Staff Section.

The Centers for Medicare & Medicaid Services maintains a fund from which hospitals and physicians who provide care to undocumented people can receive reimbursement, but it is limited to $250 million per year for all states combined -- a figure that some physicians at the meeting said was insufficient.

"We believe that it is unconscionable for U.S. agencies to take injured illegal immigrants and dump them in American hospitals on 'humanitarian parole,' which is to say that they won't pay for the services," Dr. Johnston said.

Although the reference committee that reviewed testimony on the resolution suggested that the entire measure be referred to the Board of Trustees for further review, delegates overrode the recommendation. AMA Trustee Edward Langston, MD, said that the move showed how critical the situation has become for many physicians practicing in problem areas.

"This just creates more of a stress on an already overburdened system," he said. "We've seen that particularly in the emergency rooms."

Ethics and appearances

Physicians at the Annual Meeting balked at one part of the resolution that called on the Dept. of State to require anyone applying for a U.S. visa to have adequate health insurance before they can enter the country. The Board of Trustees will study this issue for a report back at a future meeting.

Several physicians, including some who work in border states, said that such a policy would come across as discriminatory against many foreigners. The State Dept. in some cases requires visas for foreign nationals even for short stays in the country, and such a mandate could serve as a barrier to tourism from certain nations while completely missing the population it is designed to target, they said.

Dr. Johnston countered that concerns about maintaining tourism should not result in visitors placing undue strain on the nation's health care system. Many countries around the world already require health insurance coverage for that very reason, he said.

But virtually no legal or illegal immigrant comes to the United States with health insurance in the first place, and physicians might not like the way the medical community comes across if they try to require this, said Sheldon Gross, MD, a pediatric neurologist and delegate from Texas.

"I really wonder if this is the right message that this house wants to send: that American doctors want to have you immigrate as long as you can pay our doctor bills," he said.

Some physicians arguing for further study of the entire immigration issue before any decisions were made suggested that other parts of the resolution could also have the appearance of conflicting with physicians' dedication to access to care for all people.

"I would strongly urge us not to step out in front if in fact this may be a significant violation in some circumstances of an ethical principle we already have," said John McMahon, MD, a member of the AMA Council on Ethical and Judicial Affairs.

But other delegates countered that the resolution only deals with compensation for health services given to illegal immigrants and other foreign nationals, not the question of whether doctors will agree to treat them in the first place. Several physicians said that access to care will depend largely on how many facilities can afford to stay open amid all the uncompensated care being given out every day.

"People absolutely have access; it's called the emergency room," said Melissa Garretson, MD, alternate delegate from the American Academy of Pediatrics. "What we'd like to have is payment for the services we provide."

Dr. Langston said that nothing in the new directive would impact in any way a physician's ethical duties.

"This is a policy issue," he said. "I don't see it as an ethical issue, because we're physicians and we'll treat whomever is brought in front of us."

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ADDITIONAL INFORMATION

State reimbursement

CMS provides $250 million each year to compensate physicians, hospitals and ambulance services for caring for undocumented immigrants. Any services required under the Emergency Medical Treatment and Labor Act are eligible for reimbursement. Here's how the federal funds will be allocated this fiscal year to the six states with the largest number of undocumented immigrants:

Funds allocated
Arizona $47,650,474
California $66,641,038
Florida $8,736,900
New Mexico $5,691,370
New York $12,168,096
Texas $46,990,888

Source: Centers for Medicare & Medicaid Services

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