Bill Requiring Hospitals To Report Undocumented Persons Defeated

IMMIGRANTS & PUBLIC BENEFITS

Health Care

Bill requiring hospitals to report undocumented persons defeated
Immigrants' Rights Update, Vol. 18, No. 4, June 18, 2004

Rep. Dana Rohrabacher’s bill threatening access to emergency health care for undocumented non–U.S. citizens was defeated by a vote of 331 to 88 in the U.S. House of Representatives on May 18. The bill was heard on the floor of the House because the House leadership agreed to bypass the normal committee process, under a deal with Rep. Rohrabacher (R-CA) in exchange for his vote in favor of last year’s Medicare Prescription Drug, Improvement and Modernization Act (S. 1). Rohrabacher’s reluctance to vote for the Medicare bill stemmed from his objection to its section 1011, which provides $1 billion over two years to reimburse hospitals, doctors, and emergency transportation providers for uncompensated emergency services to undocumented persons.

The Undocumented Alien Emergency Medical Assistance Amendments of 2004, HR 3722, would have denied hospitals and other health care providers reimbursement for uncompensated emergency care to undocumented noncitizens under section 1011 unless they reported those noncitizens to the Dept. of Homeland Security (DHS). Providers would have been required to collect information, including a sworn statement about the noncitizen’s employer and a biometric identifier (e.g., a fingerprint), and transmit the information to the DHS in digital form. As a practical matter, this requirement would have obliged providers to verify the immigration status of all uninsured patients presenting health care emergencies.

The Rohrabacher bill also would have narrowed the scope of emergency health services available to undocumented persons. Under current law, the Emergency Medical Treatment and Active Labor Act (EMTALA) requires medical personnel to screen and stabilize all persons who seek treatment at an emergency room, and strictly limits the conditions under which a patient may be transferred prior to being stabilized. The Rohrabacher bill would have lowered the threshold set by the EMTALA by permitting hospitals to remove any undocumented patient, including a woman in labor, to his or her country of origin when (1) no “significant likelihood” existed that the patient’s condition (or if the patient were a woman in labor, her child’s condition) would materially deteriorate as a result of the patient being transported or (2) the care the patient needed (a) “involve[d] organ transplantation or other extraordinary medical treatment (or other treatment the estimated cost of which exceed[ed] $50,000)” and (b) “[was] for treatment of a condition that existed before the [patient] entered the United States or [was] not required as a direct and immediate result of an accident in the United States.”

The bill also would have undermined existing public charge law, which provides that health services other than long-term institutionalization are excluded from public charge determinations, by making a noncitizen’s inability to pay medical expenses a ground for his or her removal from the U.S. In addition, employers of undocumented workers whose medical expenses were reimbursed by the federal government under section 1011 would have been required to repay the government for those costs.

Proposals such as HR 3722 jeopardize the health of immigrants and the general public by undermining the relationship of trust between health care providers and their patients, and deterring immigrants and their family members from seeking needed health services, including testing and treatment for communicable diseases. Health care providers, including the American Hospital Association and the National Association of Public Hospitals, opposed the bill vigorously. A summary of the bill is available online at www.nilc.org/immspbs/cdev/Rohrabacher_5-04.pdf.