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NEWS ANALYSIS : A Messy War Over Immigrant Health Care : Politics: The governor and his opponents state their positions with an eye toward political advantage. The result is more confusion in an already complicated issue.

November 08, 1993|DANIEL M. WEINTRAUB | TIMES STAFF WRITER

SACRAMENTO — Gov. Pete Wilson's views on health care for illegal immigrants have been widely misinterpreted, according to Administration officials, and he has been wrongly accused of seeking to deny emergency care to immigrants.

The governor wants the care to continue, they say. He just wants the federal government to pay for it.

But critics who have painted Wilson's views in harsh colors say that if Wilson has been misunderstood, it is his own fault. They believe the muddle is deliberate.

Wilson raised the issue of immigrant health care Aug. 9 as part of a broader statement against illegal immigration. Since then he has repeatedly complained that government services are an incentive drawing immigrants across the border into California, and he lumps health care among the benefits that he would end to reduce that lure.

But his aides can cite only one health service--prenatal care--that Wilson wants to eliminate. And that is a service the state provides without coercion by Congress.

The confusion over Wilson's position is a reflection of the fine line the governor is treading on immigration issues. He has deliberately staked out some of the toughest public positions in this area and polls show that the public supports the tone he has chosen.

But he also does not want to seem mean or coldhearted--as he was accused of being a year ago when the voters rejected his effort to slash welfare benefits for poor women and children.

These sometimes contradictory goals were apparent when Wilson kicked off his campaign against illegal immigration with an open letter to President Clinton.

In the letter, published as an advertisement in several national newspapers, Wilson proposed removing what he called "the rewards for illegal immigration" by repealing the federal mandates that make illegal immigrants eligible for "health, education and other benefits."

But in the same letter, the governor said he wants doctors to continue providing emergency care to illegal immigrants and delivering their babies--the two services that make up the lion's share of treatment that is given to people who are in this country illegally.

Ignoring this very large caveat, Wilson's political opponents focused on his call for repealing benefits.

Democratic state Treasurer Kathleen Brown, expected to try to challenge Wilson next year, called his proposals barbaric.

"Should a small, bleeding child be turned away from an emergency room because of who his or her parents are?" Brown asked in a widely publicized speech.

Wilson's answer, according to his aides, is "no." Four of his Cabinet secretaries wrote Brown a joint letter Oct. 13 contending that she had misrepresented the governor's position. Wilson's aides have been making the same point with reporters.

"We are not proposing the elimination of programs or services," said Dan Schnur, Wilson's chief spokesman. "We are proposing the elimination of mandates that require those services to be provided. Those are two different things."

But even Schnur's effort to clarify Wilson's position seems to fall short.

The health care mandate Wilson wants to repeal is not a law that requires the provision of services to illegal immigrants. It is more of an accounting mechanism for paying for those services.

Other state and federal statutes--known as "anti-dumping laws"--require doctors in hospital emergency rooms to treat anyone who comes through their door needing urgent care--without regard to their ability to pay or their citizenship status. Wilson has not proposed to repeal these laws.

Rather, Wilson wants to change the way the bill is paid.

If the patient cannot afford it and is a childless adult, the hospital sends the bill to the county program for indigents. If the patient is on welfare or is poor enough to qualify for the major public assistance program--Aid to Families With Dependent Children--he or she is enrolled in Medi-Cal, the state and federal health system for the poor.

Like U.S. citizens, low-income illegal immigrants are issued Medi-Cal cards, and the cost of their care is split 50-50 between the state and federal governments. Last year the state's share came to about $355 million.

For illegal immigrants, however, the state and federal program pays only for so-called restricted benefits--emergency care and the delivery of babies. Their eligibility expires after one month unless the emergency continues.

Wilson wants hospitals to continue to provide the care but send the entire bill directly to Washington, where, unless other laws are changed, it would go unpaid.

Roy Behr, director of policy for Treasurer Brown's undeclared campaign, said Wilson's original proposal would have resulted in the denial of emergency care to some immigrants.

"He's changed his mind and rephrased his proposal several times," Behr said. "It's not at all clear what his position is anymore."

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