State Sen. Victor Torres represents Osceola County in central Florida, which has a predominantly Hispanic population. At Sunday services at his local church, immigrants often tell him they are afraid to seek medical care.
“They say, ‘My mother is sick, my child is sick, but I don’t have insurance,'” the Democrat said in an interview. “And I tell them, ‘I can’t turn you away.’ Go to the hospital. Don’t wait until the last moment when it’s too late.”
under the federation Emergency medical care and labor law (EMTALA), a Medicare-participating hospital with an emergency department — Approximately 98% A percentage of U.S. hospitals must provide emergency care to all patients, regardless of their ability to pay.
But Florida and Texas recently required hospitals to ask patients about their immigration status. Supporters say the new policy sheds light on the cost of care for undocumented immigrants, but critics say it is aimed at discouraging immigrants from seeking care. .
Florida Republican Governor Ron DeSantis in May 2023 signed cleaning immigration law It includes a provision that would require hospitals that accept Medicaid (including state funding) to collect data on patients’ immigration status. Texas Republican Governor Greg Abbott followed suit in August. presidential order The law requires public hospitals in Texas to collect data on the costs they incur in providing emergency and inpatient care to people without permanent legal status.
“Texans should not have to bear the burden of financially supporting the health care of illegal immigrants.” abbot said when issuing orders.
Data from Texas is not yet available. However, in Florida, March report The state Department of Health Care Administration suggests that patients without legal status account for a relatively small share of total health care costs.
According to the agency’s research, immigrants without legal status accounted for 0.82% of hospital visits and 0.83% of emergency room visits in the second half of 2023. Florida hospitals spent a total of $69 billion in 2022, so based on these rates, they spent about $566 million caring for immigrants without legal status.
agency recognized It was unclear how much of that $566 million included so-called uncompensated care, meaning care not paid for by insurance or patients. They also found no correlation between a hospital’s level of unpaid care and its proportion of undocumented patients, and no clear relationship between a hospital’s profitability and its proportion of patients who were undocumented immigrants. .
In fact, the agency found that high spending on uncompensated care was more related to a county’s rural location than to its high immigrant population without legal status.
Drishti Pillai, associate director of the Racial Equity and Health Policy Program at KFF, a health policy research institute, said, “Studies show that immigrants use fewer health care services than their U.S.-born counterparts and are more likely to “The overwhelming evidence is that they are not taking advantage of the high benefits.” . Pillai recently co-authored KFF. Problem overview Regarding the potential impact of the Florida and Texas actions.
KFF is an immigrant reduce spending They are more concerned about health care than U.S.-born residents, and some studies show that they ultimately medical subsidies You can receive the benefits of other U.S. residents through the payment of insurance premiums and taxes.
Both states require hospitals to notify patients that they will receive treatment no matter how they answer immigration-related questions. In Florida, hospitals must also tell patients that their responses will not be reported to immigration authorities. Still, data from Florida suggests patients are staying away for fear of being questioned about their immigration status.
Mr. DeSantis boasts that the policy has reduced Medicaid spending.
“We knew we weren’t going to get help from the federal government, so we had to do all of this at the state level,” DeSantis told Fox News. In an interview in June. “We started asking patients about their immigration status every time they came into the hospital. As a result, Florida’s Medicaid spending plummeted by 50 percent.”
A recent analysis of federal and state data supports that claim. In 2022, the year before Florida’s law was enacted, state and federal Medicaid spending on emergency services for immigrants without legal status totaled $148.4 million. According to one study, from July 1, 2023, when the law took effect, to May 3, 2024, the total amount decreased to $67 million. political analysis Data from the Florida Department of Health Services and the U.S. Department of Health and Human Services. Medicaid, which provides health insurance to low-income people, is jointly funded by the federal government and states.
Florida Republican Congressman Rick Ross runs a farm And it employs hundreds of immigrant workers, who voted in favor of the bill. “I think this bill is primarily political and not punitive. It doesn’t prevent them from getting medical care. [creates] The realization that it is going to be more difficult. ”
Other supporters of the Florida law and Texas order say it makes sense for states to understand how much money they spend on care for illegal immigrants and cut back if possible. .
“Today, our health care system is overwhelmed by illegal aliens who come into this country, and the cost is for legal citizens, legal immigrants like you and me, to come here the right way. “The burden is being borne by people who have lost their lives,” said Chairman Abraham George. the Texas Republican, an immigrant from India, said in an interview.
“Fear Tactics”
Florida’s Torres noted that most immigrants and their families take on difficult jobs, contribute to the economy, and pay taxes without receiving benefits such as Social Security, Medicaid, or Medicare.
“This is a Republican intimidation tactic against immigrants who work every day without asking for any help,” Torres said. “They’re just desperately trying to protect themselves and their families.”
Illegal immigration has been a central issue in the presidential campaign, with former President Donald Trump and other Republicans often saying immigrants are draining the national treasury by using benefits. Generally speaking, immigrants without permanent legal status Unable to register Because you have federally funded health insurance under Medicaid, Medicare, or CHIP (Children’s Health Insurance Program), you cannot purchase a plan under the Affordable Care Act.
But hospitals can’t turn them away in an emergency. 6 states (California, Colorado, Illinois, New York, Oregon, and Washington), plus the District of Columbia uses state funds to provide insurance to some adults regardless of immigration status.
In Texas, even some Democrats are questioning how much hospitals and the state spend caring for immigrants without legal status who are uninsured and unable to pay out of pocket. I’m concerned.
“These people are our neighbors. They should never be denied treatment or demonized by extremists. But we can’t afford not to fund this.” Texas Democratic Party state Rep. Eddie Morales told Stateline.
Morales said it’s legitimate to investigate how much Texas spends on caring for immigrants without legal status, and that hospitals should help pay for uncompensated care. . But he blamed Republicans in Washington for stalling bipartisan legislation aimed at addressing border challenges.
long term costs
KFF’s Pillai said the efforts in Florida and Texas are helping people without legal status avoid treatment and, if their symptoms worsen and they end up having to go to the hospital, those states can help. He said this could result in increased medical costs.
“This can make routine situations more complicated, potentially make subsequent treatment more expensive, and can lead to increased medical costs if you end up in the emergency room.” Yes,” Pillai said.
In their brief, Pillai and colleagues also point out that immigrants without legal status play a large role in the workforce in Florida and Texas, particularly in sectors such as construction, agriculture and transportation.
That’s why Texas Farmers Union President Mike Oldham said he does not support President Abbott’s executive order. Oldham said the measures create a climate of fear that makes it impossible for migrant workers and their families who come to Texas to “even go out during the day.”
“We need migrant workers. If we want milk, cheese, eggs and all the vegetables, we need migrant workers,” Oldham said. “You can’t go get white people to do those jobs. They just won’t do it.”
Oldham said requiring hospitals to ask more questions on medical forms or hire interpreters to inquire about a patient’s immigration status would only create unnecessary burden on hospitals.
Hospitals in Texas and Florida too scary We discuss these policies because we don’t want to be in the spotlight, especially when it comes to serving people without legal status, said Deliana Garcia, chief program officer at the Immigrant Clinician Network. . We support immigrant populations and collaborate with clinicians.
Garcia said the health system can support a person when they are relatively healthy, or later provide more expensive treatment when their condition becomes more severe.
She also said, “You don’t want to be circulating in a place where someone who is unwell can make you sick.”
This story first appeared in state linepart of States Newsroom, a nonprofit news network supported by a coalition of grants and donors as a 501c(3) public charity. Stateline maintains editorial independence. If you have any questions, please contact Editor Scott S. Greenberger. [email protected]. follow the state line facebook and ×.
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