Who pays for long-term care for illegals?

Practice of helping some go back home stirs debate
By TODD ACKERMAN, HOUSTON CHRONICLE
Updated 12:36 a.m., Sunday, October 30, 2011

With an infant son, a common-law wife who's a U.S. citizen and a job at a Galveston bait shop, Francisco Martinez was working toward the American dream.

Then Martinez fell off the shop's roof and landed unceremoniously at the intersection of one of America's most vexing ethical, political and financial conundrums: the care of severely sick or injured illegal immigrants.

"It's a tragic, intractable problem," said Antonio Zavaleta, a professor of anthropology at the University of Texas at Brownsville who specializes in health care and immigrant populations. "There's no clear solution."

Provide the long-term care and those institutions will rack up expenses that either bankrupt them or get passed on to U.S. citizens through higher charges. Don't provide the care and many of those patients won't survive, an ethical blight for a nation that prides itself on being humanitarian.

The UT Medical Branch at Galveston's solution, after saving Martinez's life, was to try to persuade the Mexican national, now paralyzed from the chest down, to return to his homeland for the special, long-term care he needs. Martinez's response, despite UTMB's offer to pay for the trip, was to tell hospital officials, "if you don't want me here, just throw me outside."

UTMB's plan was an example of medical repatriation, once little known, recently the subject of national newspaper articles, law journal reviews and medical association reports. No one tracks the exact number of illegal immigrant patients who've been transferred back to their native countries, but it's thought to occur nationally hundreds of times a year.

The Harris County Hospital District has repatriated seven such patients since 2010, but officials say all were voluntary. The controversy comes when a transfer occurs without the consent of the patient, typically because the patient no longer has family back home or fears the quality of or access to care there.

Houston's major private nonprofit hospital systems - Methodist, St. Luke's and Memorial Hermann - either had no comment or didn't respond to inquiries about whether they'd arranged the transfer of any illegal immigrant patients back to their home country.

Opposing views

What is clear is that the practice stirs passionate responses on both sides of the immigration debate.

Geoffrey Hoffman, director of the University of Houston Immigration Clinic, describes it as "patient dumping" or "private deportation" and calls it "despicable." Noting deportation is the "exclusive province" of the federal government, not hospitals, he says forcing patients to "accept" repatriation back to a country where there may be no hope of follow-up care can "only reflect badly on our great nation."

By contrast, Mark Krikorian of the Center for Immigration Studies in Washington argues that there are "real-world limits" to the level of health care U.S. institutions should provide non-citizens. He says that it's one thing to provide the life-saving emergency care federal law requires, quite another to provide lifelong, bankruptcy-causing or premium-raising care "to people here illegally in the first place."

Beneath the rhetoric, there's no denying the cost of such care. In 2010, for instance, the Harris County Hospital District spent nearly $170 million on the care of illegal immigrants. That was up from $100 million in 2007.

From 2005 to 2008, states were able to recoup some of those costs thanks to federal funding - Texas got about $45 million a year - aimed at compensating states for the emergency care of illegal immigrants the law requires hospitals provide. The program, pushed by Texas and other states that bear the brunt of such care, was not renewed after 2008.

Still, the real problem isn't hospitals, which transfer most all patients, both U.S. citizens and illegal immigrants, once urgent care is no longer needed and the bed is needed for other patients. It's long-term care facilities, unable to afford to accept patients, like Martinez, who don't have insurance. It remains for hospitals, obligated by federal regulation to arrange post-hospital care for those who need it, to find alternatives and to provide care indefinitely if they can't.

Long-term options

Alternatives south of the border aren't terribly attractive. There are few long-term care facilities, and access to public hospitals is limited for people who left the country to live in the United States, according to some experts. "In Mexico, you go home to die," Zavaleta said.

So are there any good alternatives? The Catholic charity Casa Juan Diego provides long-term care for up to 80 illegal immigrant in Houston. In addition, a California company, MexCare, arranges transfers of consenting patients in any U.S. state to private Mexican facilities with which it works - the discharging U.S. hospital pays the bill, but it's typically a third of what it would cost it to keep the patient.

David Lopez, president of the Harris County Hospital District, argues that illegal immigrants should be able to buy health insurance, much as they're able to buy car insurance in some states. But he acknowledges that there's no single solution.

"It's going to take a multiplicity of solutions," says Lopez. "One thing is certain - the status quo is not the answer."