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Immigrant Care Costs Fuel Debate : Finances: Fuzzy data on the undocumented makes it hard to gauge the extent of the public subsidy, experts say.

CODE BLUE. The Crisis in Los Angeles County Health Care . One in a series


Matilde Monzon, expecting her first child, has no driving desire to become a symbol for anything. Her principal wish is for a healthy baby.

Nonetheless, the 31-year-old former garment worker embodies many of the contradictions and complexities swirling around the incendiary debate over the costs of illegal immigration.

Monzon has been receiving prenatal care and hopes to give birth to her first child at County-USC Medical Center, the sprawling Eastside facility that is the nation's busiest public hospital complex. Medi-Cal, the government-funded insurance plan for the poor, is picking up the tab.

"Without this care, I don't know what I'd do now," Monzon said on a recent day as she sat in the waiting area of Women's and Children's Hospital, part of the vast County-USC complex.

Monzon suffers from epilepsy, but she said she never sought out medical care, public or private, until eight years after she crossed the U.S.-Mexico border and became pregnant--challenging the popular notion that such benefits draw immigrants, who subsequently burden the system.

Although debated for years, the extent of the public subsidy of illegal immigrant health care costs remains a matter of much dispute and questionable numbers. "It's a very difficult population to measure," noted Theresa A. Parker, chief deputy director of the California Department of Finance.

With Los Angeles County teetering on the brink of insolvency, the emotion-charged issue has received renewed scrutiny: House Speaker Newt Gingrich (R-Ga.) is seeking bolstered federal reimbursements for emergency services, Gov. Pete Wilson is ratcheting up demands for U.S. assistance and two Los Angeles County supervisors have publicly called for slashing county subsidies of non-emergency aid for illegal immigrants.

"We should be providing just what Newt Gingrich said we are going to get money for--emergency care," said Supervisor Deane Dana, who, along with fellow conservative Republican Mike Antonovich, has called for an end to non-emergency care for illegal immigrants.

Both San Diego and Orange counties have made illegal immigrants ineligible for subsidized primary care, which may include everything from checkups to dental visits to elective surgery and treatment for progressive, ultimately life-threatening ailments.

Opponents say such a drastic county policy shift would be both inhumane and fiscally unsound, scaring off even legal immigrants from seeking crucial preventive services and forcing more patients into emergency rooms--where care is inevitably more costly. Board Chairman Gloria Molina calls such assistance a "moral responsibility," particularly since illegal immigrants pay sales tax and, if employed, income taxes, just as everyone else.


To be sure, providing care to illegal immigrants is a huge expense in a county with the nation's largest undocumented population--one that tends to be, like Monzon, poor and uninsured.

U.S. law requires that hospitals provide emergency services to all patients, regardless of immigration status. But Washington generally only reimburses providers for the costs of illegal immigrants who qualify under Medicaid (Medi-Cal in California). State taxpayers pick up half of Medi-Cal costs, while counties and, to a lesser degree, private providers, are often left with the huge medical bills for poor illegal immigrants ineligible for Medi-Cal.

For legal and other reasons, most undocumented patients simply aren't asked about their immigration or citizenship status. (That may soon change, following a court ruling last year upholding California officials' right to quiz all Medi-Cal applicants about their status.)

The most authoritative official estimate of illegal immigrants' use of health care services dates back to 1992, when a Los Angeles County study reported that a quarter of all patients treated in county facilities were unlawful residents. Their care, the study calculated, cost the county $159.5 million in the previous year--almost one-third of unreimbursed county health expenditures.

A separate official estimate, calculated during 1990-91, found that nearly two of every three babies delivered at county hospitals were born to undocumented mothers. During last year's heated Proposition 187 debate, this finding became a kind of rallying cry for proponents. The measure sought to slash publicly funded health and other benefits for illegal immigrants.

But despite the wide use of the county estimates, some experts say the numbers are probably inflated. In particular, critics say that county officials, unschooled in the intricacies of immigration law, mistakenly count many legal residents as illegal immigrants.

"I think the extent of county care for the undocumented is definitely overstated," said Yolanda Vera, staff attorney with the National Health Law Program, a nonprofit group that seeks to increase poor people's access to health care.

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