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Health Systems in Bind on Care for Illegal Immigrants : Finances: Federal law requires treatment but funds for state and county are scarce. Reform plan skirts the issue.

Health Systems in Bind on Care for Illegal Immigrants. FIRST OF TWO PARTS


An illegal immigrant from Mexico collapses in the Alhambra bakery where he works for minimum wage and no health benefits. Rushed to the nearest county hospital, he undergoes an emergency appendectomy. Cost to taxpayers: $1,990.

An impoverished Salvadoran, also in the United States illegally, receives gall bladder surgery and antibiotic treatment. Cost to taxpayers: $9,318.

And in Los Angeles County's crowded public hospitals, two out of three births are to illegal immigrants. Annual cost to taxpayers: $60 million.

For years, compassionate federal and state laws have required hospitals in California to treat virtually anyone who is poor and seriously ill, allowing hundreds of thousands of illegal immigrants to obtain free care.

A seemingly bottomless well of government health care dollars paid the bills. But the well has a bottom. Soaring medical costs have priced 37 million Americans out of health insurance. And shrinking public health budgets are forcing officials to do more with less, focusing unprecedented attention on the costs of treating illegal immigrants.

Nowhere is that scrutiny greater than in California, where more than half the nation's 2.4 million illegal immigrants reside. Projections by the state Health and Welfare Agency show that their health care will cost Medi-Cal about $880 million this fiscal year, nearly triple what the insurance program for the poor paid out four years ago.

And nowhere is the search for a solution more pressing than in Los Angeles County, where officials say illegal immigrants account for one-quarter of the patients in the overburdened public hospital and clinic system.

"We can't treat the whole world," complained a doctor at Los Angeles County-USC Medical Center, where budget deficits have forced staff and pay cuts.

Reliable statistics on the costs of illegal immigrant health care are hard to come by, as are solutions untainted by politics or even racism. Even tougher to ascertain are the potential costs of denying health care benefits to illegal immigrants, a money-saving measure proposed by Gov. Pete Wilson earlier this month. Public health officials warn that neglecting those health needs escalates the spread and cost of communicable disease in California, as demonstrated by the resurgence of tuberculosis.

There is little evidence that resident illegal immigrants use the public health care system cavalierly. Studies show that illegal immigrants, fearful of deportation, often are reluctant to use public health facilities until their conditions are life-threatening. Such delayed care, experts say, further escalates costs because it is usually least expensive to treat an illness early.

These costs are borne by taxpayers through government-sponsored health programs for the poor. This situation is unlikely to change because President Clinton's national health reform plan is expected to exclude illegal immigrants from coverage.

Elusive Data

Many of these programs are funded with a combination of federal, state and county tax dollars. Comprehensive data on health care costs for illegal immigrants does not exist because most hospitals and clinics have no means of determining how many of their patients are undocumented.

But California health officials were able to roughly gauge the impact on the state's largest health program--Medi-Cal--because of special codes used by hospitals to claim reimbursement for certain kinds of illegal immigrant care.

Since 1986, federal law has required states to use such programs to provide emergency and obstetrical treatment to illegal immigrants.

California's study--undertaken in hopes of obtaining more federal aid--concluded in January that illegal immigrant health costs accounted for the fastest-growing part of the Medi-Cal budget, rising from $299.4 million in fiscal 1989-1990 to a projected $880 million this fiscal year. Officials expect no reversal of this trend, in light of state projections that the number of illegal immigrants will increase by at least 100,000 a year.

"This situation is breaking California," said Jennifer Nelson of the state Health and Welfare Agency, which compiled the data used by Gov. Wilson earlier this year to plead for more federal aid.

Los Angeles and other hard-hit counties launched their own studies, hoping to get more money from the state.

More than half of the state's illegal immigrants live in Los Angeles County. Demographers estimate that the county has 700,000 illegal immigrants--a population that grows by 66,000 annually. Most of their care is provided by the county's six public hospitals and 45 health centers, the most extensive network of publicly financed health facilities in California.

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