Injection of Money.

The Bush administration has set aside $1 billion to pay hospitals and doctors for providing emergency care to illegal immigrants through 2008. The goal is to relieve the overwhelming financial burden on hospitals that are required to provide the care to all patients who need it, regardless of the patient's ability to pay. Hospitals will ask patients for documents to substantiate claims for payment, but cannot directly question the patient's citizenship. Instead, indirect questions related to Medicaid eligibility, place of birth, and foreign identification documents would establish a patient's status. There is debate in the healthcare community about whether or not the plan adequately addresses the illegal immigrant healthcare challenge. Still, some view it as a necessary step toward a broader solution that would ultimately include funding for all uninsured patients.

"This is the first time hospitals have been able to recoup some payment for undocumented immigrant care," says Carla Luggiero, senior associate director for Federal Relations at the American Hospital Association. "But the larger question is how we as a nation deal with uninsured patients as a whole. This is a step in the right direction."

While native-born Americans still dominate the United States' uninsured population, the percentage of uninsured immigrants is on the rise--and the trend appears to be accelerating, according to a study the Employee Benefit Research Institute (EBRI) published in June titled The Impact of Immigration on Health Insurance Coverage in the United States.

"Immigrants accounted for about one-third of the increase in the uninsured between 1994 and 1998, but between 1998 and 2003 they accounted for 86 percent of the increase," says Paul Fronstin, director of the EBRI Health Research and Education Program. "To the degree that immigration continues to increase, it is likely that the uninsured will also continue to increase."

The study did not distinguish between legal and illegal immigrants, but at least one quarter of all immigrants are estimated to be undocumented, with the largest group coming from Mexico. Sixty percent of the uninsured immigrants live in California, Texas, New York and Florida. Two-thirds of the $1 billion in funding distributed under the new plan will go to states with high populations of undocumented immigrants.

Dr. Kathryn Stewart, medical affairs director for Mt. Sinai Hospital in Chicago, is not satisfied with the scope of the law. She calls $1 billion a "drop in the bucket" that doesn't begin to cover the cost of providing care to undocumented immigrants who often remain in the hospital for months.

A BIG STEP: For the first time, hospitals can recoup some of their expenses for undocumented immigrant care.

"The law covers emergency stabilization and emergency room care, but most of what undocumented immigrants come to our emergency room for does not meet the criteria of an emergency," Stewart says.

"They are not coming for life-threatening conditions. They are coming for skin infections and frostbite. These things would not be covered under the law. Hospitals are shouldering enormous burdens and we need more help."

Others argue that it's the undocumented aliens that need the help. Albert Brown-Gort, associate director of the Institute for Latino Studies at the University of Notre Dame, says immigrant labor helps drive the profits of many U.S. companies, yet immigrants often don't receive healthcare benefits. The care of last resort--emergency care--is the most expensive.

"From a public health and a moral perspective, all immigrants need to be treated, but it's complicated to divide how much of immigrant labor is society's gain and how much is a private company's gain," he says. "If they weren't getting jobs they wouldn't come. But we are all paying for it.

"How we handle the immigration issue goes to the heart of what kind of society we are."

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By Jennifer LeClaire