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Helping hospitals

Federal funding to pay for the care of uninsured illegal immigrants must not be allowed to end.

September 29, 2008

So many unfunded federal mandates regarding illegal immigration stick in the collective craw of border states -- whose schools, prisons and healthcare systems bear a disproportionate responsibility for the country's broken immigration policies -- that it's hard to single out just one. But near the top of the list is Congress' requirement that hospitals provide emergency treatment to illegal immigrants and its amnesia about paying for it, an act of neglect with special implications for Southern California.

No one should be denied care in a medical emergency, regardless of residency status or insurance. And it should be noted that citizens, not illegal immigrants, make up the bulk of poor patients whom hospitals could turn away if not for the federal Emergency Medical Treatment and Active Labor Act. But poor Americans who meet income guidelines are eligible for Medi-Cal, and hospitals are reimbursed for their care. Illegal immigrants are not, so hospitals that care for them fulfill their ethical and legal obligations at the expense of their financial health.

That's why there was such a sense of victory five years ago, when Congress finally agreed to help out hospitals as part of the Medicare Modernization Act of 2003. It wasn't much, but thanks to Sens. Jon Kyl (R-Ariz.) and Dianne Feinstein (D-Calif.), as well as senators from other border states, Congress appropriated $1.4 billion a year for Arizona, California, Florida, New Mexico, New York and Texas. Almost as important as the money was the acknowledgment that Washington's obligation extended beyond border patrols and workplace raids. On Tuesday, however, the program comes to an end, once more leaving hospitals in the lurch.

Caring for illegal immigrants is not the main reason nearly 50% of hospitals in California are operating in the red -- or why 11 in Southern California, mostly in the Los Angeles area, have closed since 2004 -- but it is a factor. Statewide, the total cost of uncompensated care is estimated to be a staggering $9.8 billion, according to the California Hospital Assn.; illegal immigrants account for about $1 billion of that. Los Angeles County spends between $340 million and $400 million on healthcare for illegal immigrants.

The funding from Congress was supposed to be a stopgap measure until the arrival of comprehensive immigration reform, which now is a distant dream. And even before the banking disaster hit, the program was lost among election-year distractions. This lapse should not morph into a permanent retreat. Both the law and human decency forbid denying care to sick and injured people, but that responsibility shouldn't fall solely on hospitals.

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