Who Should Pay for Illegal Immigrants' Health Care?

| Thu Sep. 2, 2010 6:00 AM EDT

Advocates for tighter immigration restrictions frequently rail against illegal immigrants for availing themselves of social services like education and publicly supported health care, arguing that they are overburdening taxpayers and utilizing scarce resources. They've succeeded in maintaining a ban on government health coverage for illegal immigrants, for instance, and have tried to implement more draconian measures on the state level.

But such measures haven't solved the political and ethical dilemmas of providing health care for illegal immigrants, which this New York Times story brings into focus. The Times piece explains how a public charity hospital in Georgia closed its outpatient dialysis clinic, only to displace some 60 uninsured illegal immigrants who need the treatment to survive. The charity hospital brokered a deal to cover about half the patients but only after a handful had died after being repatriated to Mexico. The Times explains:

Thirty-eight end-stage renal patients, most of them illegal immigrants, would receive the dialysis they need to stay alive at no cost under a rough agreement brokered Tuesday among local dialysis providers and Atlanta’s safety-net hospital, Grady Memorial... Grady, which receives direct appropriations from Fulton and DeKalb Counties, ultimately agreed on Tuesday to help pay for continuing dialysis for most of the immigrants. Others would be distributed among local dialysis providers as charity cases...

Five of the 13 patients who left for Mexico with assistance from Grady or the Mexican government have died, according to Matt Gove, a Grady senior vice president. Most died while still receiving dialysis, although not always as regularly as recommended... One patient, Fidelia Perez Garcia, 32, apparently succumbed in April to complications from renal failure after running out of Grady-sponsored treatments in Mexico.

However you slice it, there isn't an easy answer. Even if Grady hospital pulled all support for such dialysis patients, they would still end up in emergency rooms where they would be required by law to receive treatment. And if they couldn't pay, taxpayers would still end up footing part of the bill, as hospitals pass on such costs to state governments.

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One potentially cost-saving--and life-saving--solution could be to find ways to expand private health care coverage to illegal immigrants. The new federal health law could have helped in this regard by opening up its newly created health insurance exchange to all US residents, regardless of immigration status.

Unfortunately, the polarizing politics of immigration ended up overwhelming the health care debate as well. Only private companies offer plans in the exchange, but the fact that the government has a role in setting up the marketplace was enough to ignite the conservative anti-immigration opposition: late in the game, a provision prohibiting illegal immigrants from buying private health plans on the exchange was inserted into the Senate bill. Essentially, there was a missed opportunity for more illegal immigrants to get health care coverage on their own. And immigrant patients, along with US taxpayers, could end up having to pay the price.