(Illustration by The Epoch Times, Getty Images, Jeffrey Beall/CC, Shutterstock)
Hospital systems struggle – and Medicare/Medicaid deficits mount – as uninsured illegal immigrants use emergency wards as their free health-care destination
By Autumn Spredemann | The EPOCH TIMES
Tens of thousands of illegal immigrants are flooding into U.S. hospitals for treatment and leaving billions in uncompensated health care costs in their wake.
The House Committee on Homeland Security recently released a report illustrating that from the estimated $451 billion in annual costs stemming from the U.S. border crisis, a significant portion is going to health care for illegal immigrants.
With the majority of the illegal immigrant population lacking any kind of medical insurance, hospitals and government welfare programs such as Medicaid are feeling the weight of these unanticipated costs.
Apprehensions of illegal immigrants at the U.S. border have jumped 48 percent since the record in fiscal year 2021 and nearly tripled since fiscal year 2019, according to Customs and Border Protection data.
Last year broke a new record high for illegal border crossings, surpassing more than 3.2 million apprehensions.
And with that sea of humanity comes the need for health care and, in most cases, the inability to pay for it.
In January, CEO of Denver Health Donna Lynne told reporters that 8,000 illegal immigrants made roughly 20,000 visits to the city’s health system in 2023.
The total bill for uncompensated care costs last year to the system totaled $140 million, said Dane Roper, public information officer for Denver Health. More than $10 million of it was attributed to “care for new immigrants,” he told The Epoch Times.
In January, CEO of Denver Health Donna Lynne told reporters that 8,000 illegal immigrants made roughly 20,000 visits to the city’s health system in 2023.
The total bill for uncompensated care costs last year to the system totaled $140 million, said Dane Roper, public information officer for Denver Health. More than $10 million of it was attributed to “care for new immigrants,” he told The Epoch Times.
Though the amount of debt assigned to illegal immigrants is a fraction of the total, uncompensated care costs in the Denver Health system have risen dramatically over the past few years.
The total uncompensated costs in 2020 came to $60 million, Mr. Roper said. In 2022, the number doubled, hitting $120 million.
He also said their city hospitals are treating issues such as “respiratory illnesses, GI [gastro-intenstinal] illnesses, dental disease, and some common chronic illnesses such as asthma and diabetes.”
“The perspective we’ve been trying to emphasize all along is that providing healthcare services for an influx of new immigrants who are unable to pay for their care is adding additional strain to an already significant uncompensated care burden,” Mr. Roper said.
He added this is why a local, state, and federal response to the needs of the new illegal immigrant population is “so important.”
Colorado is far from the only state struggling with a trail of unpaid hospital bills.
EMS medics with the Houston Fire Department transport a Mexican woman the hospital in Houston on Aug. 12, 2020. (John Moore/Getty Images)
Dr. Robert Trenschel, CEO of the Yuma Regional Medical Center situated on the Arizona–Mexico border, said on average, illegal immigrants cost up to three times more in human resources to resolve their cases and provide a safe discharge.
“Some [illegal] migrants come with minor ailments, but many of them come in with significant disease,” Dr. Trenschel said during a congressional hearing last year.
“We’ve had migrant patients on dialysis, cardiac catheterization, and in need of heart surgery. Many are very sick.”
He said many illegal immigrants who enter the country and need medical assistance end up staying in the ICU ward for 60 days or more.
A large portion of the patients are pregnant women who’ve had little to no prenatal treatment. This has resulted in an increase in babies being born that require neonatal care for 30 days or longer.
Dr. Trenschel told The Epoch Times last year that illegal immigrants were overrunning healthcare services in his town, leaving the hospital with $26 million in unpaid medical bills in just 12 months.
ER Duty to Care
The Emergency Medical Treatment and Labor Act of 1986 requires that public hospitals participating in Medicare “must medically screen all persons seeking emergency care … regardless of payment method or insurance status.”
The numbers are difficult to gauge as the policy position of the Centers for Medicare & Medicaid Services (CMS) is that it “will not require hospital staff to ask patients directly about their citizenship or immigration status.”
In southern California, again close to the border with Mexico, some hospitals are struggling with an influx of illegal immigrants.
American patients are enduring longer wait times for doctor appointments due to a nursing shortage in the state, two health care professionals told The Epoch Times in January.
A health care worker at a hospital in Southern California, who asked not to be named for fear of losing her job, told The Epoch Times that “the entire health care system is just being bombarded” by a steady stream of illegal immigrants.
“Our healthcare system is so overwhelmed, and then add on top of that tuberculosis, COVID-19, and other diseases from all over the world,” she said.
A Salvadorian man is aided by medical workers after cutting his leg while trying to jump on a truck in Matias Romero, Mexico, on Nov. 2, 2018. (Spencer Platt/Getty Images)
A newly-enacted law in California provides free healthcare for all illegal immigrants residing in the state. The law could cost taxpayers between $3 billion and $6 billion per year, according to recent estimates by state and federal lawmakers.
In New York, where the illegal immigration crisis has manifested most notably beyond the southern border, city and state officials have long been accommodating of illegal immigrants’ healthcare costs.
Since June 2014, when then-mayor Bill de Blasio set up The Task Force on Immigrant Health Care Access, New York City has worked to expand avenues for illegal immigrants to get free health care.
“New York City has a moral duty to ensure that all its residents have meaningful access to needed health care, regardless of their immigration status or ability to pay,” Mr. de Blasio stated in a 2015 report.
The report notes that in 2013, nearly 64 percent of illegal immigrants were uninsured. Since then, tens of thousands of illegal immigrants have settled in the city.
“The uninsured rate for undocumented immigrants is more than three times that of other noncitizens in New York City (20 percent) and more than six times greater than the uninsured rate for the rest of the city (10 percent),” the report states.
The report states that because healthcare providers don’t ask patients about documentation status, the task force lacks “data specific to undocumented patients.”
Some health care providers say a big part of the issue is that without a clear path to insurance or payment for non-emergency services, illegal immigrants are going to the hospital due to a lack of options.
“It’s insane, and it has been for years at this point,” Dana, a Texas emergency room nurse who asked to have her full name omitted, told The Epoch Times.
Working for a major hospital system in the greater Houston area, Dana has seen “a zillion” migrants pass through under her watch with “no end in sight.” She said many who are illegal immigrants arrive with treatable illnesses that require simple antibiotics. “Not a lot of GPs [general practitioners] will see you if you can’t pay and don’t have insurance.”
She said the “undocumented crowd” tends to arrive with a lot of the same conditions. Many find their way to Houston not long after crossing the southern border. Some of the common health issues Dana encounters include dehydration, unhealed fractures, respiratory illnesses, stomach ailments, and pregnancy-related concerns.
“This isn’t a new problem, it’s just worse now,” Dana said.
Emergency room nurses and EMTs tend to patients in hallways at the Houston Methodist The Woodlands Hospital in Houston on Aug. 18, 2021. (Brandon Bell/Getty Images)
Medicaid Factor
One of the main government healthcare resources illegal immigrants use is Medicaid.
All those who don’t qualify for regular Medicaid are eligible for Emergency Medicaid, regardless of immigration status. By doing this, the program helps pay for the cost of uncompensated care bills at qualifying hospitals.
However, some loopholes allow access to the regular Medicaid benefits. “Qualified noncitizens” who haven’t been granted legal status within five years still qualify if they’re listed as a refugee, an asylum seeker, or a Cuban or Haitian national.
Yet the lion’s share of Medicaid usage by illegal immigrants still comes through state-level benefits and emergency medical treatment.
A Congressional report highlighted data from the CMS, which showed total Medicaid costs for “emergency services for undocumented aliens” in fiscal year 2021 surpassed $7 billion, and totaled more than $5 billion in fiscal 2022.
Both years represent a significant spike from the $3 billion in fiscal 2020.
An employee working with Medicaid who asked to be referred to only as Jennifer out of concern for her job, told The Epoch Times that at a state level, it’s easy for an illegal immigrant to access the program benefits.
Jennifer said that when exceptions are sent from states to CMS for approval, “denial is actually super rare. It’s usually always approved.”
She also said it comes as no surprise that many of the states with the highest amount of Medicaid spending are sanctuary states, which tend to have policies and laws that shield illegal immigrants from federal immigration authorities.
Moreover, Jennifer said there are ways for states to get around CMS guidelines. “It’s not easy, but it can and has been done.”
A Border Patrol agent counts illegal immigrants before transporting them for further processing in Campo, Calif., on March 7, 2024. (John Moore/Getty Images)
The first generation of illegal immigrants who arrive to the United States tend to be healthy enough to pass any pre-screenings, but Jennifer has observed that the subsequent generations tend to be sicker and require more access to care. If a family is illegally present, they tend to use Emergency Medicaid or nothing at all.
The Epoch Times asked Medicaid Services to provide the most recent data for the total uncompensated care that hospitals have reported. The agency didn’t respond.
Related Legislation
In Florida, a new 2023 law requires hospitals that accept Medicaid to collect and submit to the state information on patients’ immigration status (although the person can decline to answer).
Gov. Ron DeSantis said the legislation is “fighting back against reckless federal government policies and ensuring the Florida taxpayers are not footing the bill for illegal immigration.”
The Epoch Times requested the most recent report detailing the total uncompensated care costs attributed to illegal immigrants from the Florida Agency for Health Care Administration, but didn’t receive a response.
The Jackson Health System in Florida offers a discount on services to those without insurance, but they don’t make payment arrangements. A representative named Elsie told The Epoch Times,
“We do offer a 70 percent discount to a patient that does not have insurance; however, they must have no insurance at all. The 70 percent discount is offered off the total charge of the bill.”
When asked what happens if a patient refuses to give an ID or provide any personal information at the hospital, Elsie said another department gets involved.
“If they are refusing to give information and want to be seen [by a doctor], the escalation team goes ahead to review all that information to see the reason behind why they don’t want to provide information at the time of service.”
Other state legislators have also decried the amount of taxpayer money going to illegal immigrant healthcare.
In Illinois, the state’s “program of health benefits for undocumented immigrants is estimated to cost $990 million” for fiscal year 2024, said state Rep. Norine Hammond, a Republican, during a 2023 press conference.
A staff nurse from Bergen New Bridge Medical Center Hospital checks a patient in Paramus, N.J., on Oct. 26, 2023. (Kena Betancur/AFP via Getty Images)
She said it’s a $768 million, or 346 percent, increase over fiscal year 2023.
“Illinois taxpayers are already on the hook for more than $2 billion in costs to provide free healthcare benefits to illegal immigrants. When is enough enough?” state Rep. C.D. Davidsmeyer said in a November 2023 statement.
Mr. Davidsmeyer filed legislation in October 2023 to repeal the TRUST Act, ending Illinois’ status as a sanctuary state for illegal immigrants.
In Maryland, lawmakers are seeking to create private insurance options.
On March 8, the Maryland Senate passed the Access to Care Act, which would allow illegal immigrants to buy health insurance in the state.
Some members of Congress have also been spurred into action.
On Jan. 17, Rep. Richard Hudson (R-N.C.) and Rep. Brett Guthrie (R-Ky.) introduced the Protect Medicaid Act, which aims to “prevent federal taxpayer dollars from being used to administer or provide Medicaid benefits to illegal immigrants.”
“Liberal states, like California, have abused loopholes to provide Medicaid to illegal immigrants at the expense of hardworking taxpayers,” Mr. Hudson said. “Not only is this against the law, but it further incentivizes more illegal crossings at our border.” ##
With reporting by Brad Jones.