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Big Strings on ER Aid

September 07, 2004

Congress finally agreed last year to help states cover the costs of providing emergency medical care to illegal immigrants. The federal government, after all, is responsible for an immigration policy that has allowed an estimated 2.2 million undocumented workers into California alone. Most of them work at low-paying jobs that don't offer medical insurance. When they get sick or injured, they turn to crowded and financially strained hospital emergency rooms, which by federal law, if not common decency, can't turn them away. It seemed only fair that Washington help pick up the tab.

Well, so much for fairness. The long- anticipated aid becomes available Oct. 1, but with strings attached that make it all but impossible to tap.

Under rules proposed by the U.S. Department of Health and Human Services, hospitals seeking reimbursement would be required to do what the Border Patrol has so far failed to accomplish: document the undocumented.

Hospital employees would have to ask patients, among other questions: Are you a U.S. citizen? A lawful permanent resident? An alien with a valid current employment authorization card? A foreign citizen with a student, tourist or business visa? An Aquarius or a Scorpio?

Already harried ER workers would have to sign forms certifying that the immigration information was accurate and make photocopies of passports, visas, border crossing cards or other documents for patients' files.

Federal bureaucrats defend the rules as merely a matter of making sure the money goes to the right place. That's a reasonable concern. But how likely is it that someone who is sick or bleeding and fearful of being deported would answer honestly if asked whether he or she is in this country legally? How many undocumented workers would simply produce fake IDs? And for that matter, how many people who are citizens -- you, for instance -- would have a passport handy if hauled into an ER in the back of an ambulance?

Hospitals don't typically ask about citizenship status; it's tough to document, and the mere act of asking tends to scare away people who are here illegally. Some folks may see this as a welcome outcome. But from a doctor's standpoint, it's not a good idea to discourage someone with, say, contagious tuberculosis from getting treatment.

The government should scrap these bureaucratic and unworkable rules, and use surveys or statistical sampling to divvy up the money. That was Congress' original aim when it allocated $1 billion over four years, with the biggest chunk -- $72 million a year -- intended for California. Los Angeles County alone estimates that it spends $350 million a year treating undocumented immigrants. The worry isn't that the money is going to the wrong place. It's that it isn't nearly enough.

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