What To Do With Injured Illegal Aliens?

Hospitals Forced To Pay For Lack Of Public Safety Net

December 25, 2005
By J. Kevin Kinsella

Behind the health care system we all know - the busy emergency rooms and harried physicians and nurses - there exists the unofficial terrain of medicine.

This is where undocumented aliens are cared for - people who are in this country illegally and who become sick or are injured.

The public knows little about this secret health care system. Often, state or elected officials do not want to know about it.

Connecticut has always struggled with how to provide health care to immigrants. Those who come here via official channels are eligible for Medicare or Medicaid if they can't afford to purchase insurance through their workplace. Those who enter the country illegally, however, join the 250,000 uninsured in the state. Their choices regarding where they can receive health care are limited. The lucky few find free care with altruistic physicians and dentists. Most seek care at hospital emergency rooms, hospital clinics or community health centers.

The best estimates are that Connecticut has 40,000 illegal immigrants, most of whom live in urban centers. Every day, people from Bosnia, Albania, Sudan and other countries seek medical attention at the city's emergency rooms.

If they come for such life-threatening situations as major injuries or gunshot wounds, the federal government (via the state Department of Social Services) makes a one-time payment to the hospital. That payment is capped at a fixed number, which in the case of Hartford Hospital is $6,245, regardless of the actual cost of care. If they come for non-life-threatening events (an upper respiratory infection, say, or elective surgery), there is no payment at all.

If these patients need to be admitted to the hospital, the situation gets worse.

Two recent cases at Hartford Hospital are worth mentioning. The first was a woman from Taiwan who was admitted to the hospital with severe neurological injuries following a motor vehicle accident. After a course of treatment was completed, she remained in the hospital for six months because, without the ability to pay, no nursing home would accept her.

Hospitals, by contrast, cannot refuse to admit indigent patients and must continue to provide for them until suitable follow-up care can be found. Calls to the Immigration and Naturalization Service for assistance received no response. Finally, the hospital was able to place the patient in a facility in Taiwan, and then paid for air transport with a nurse.

The second case was a man from Guatemala who was admitted after being shot, with injuries that caused paralysis. His length of stay was more than six months. The man had no family, and no nursing home in Connecticut would accept him. Finally, Hartford Hospital arranged and paid for air transport to return the man to his native Central America, along with a medical resident as escort.

These two cases came to a total of more than $1 million, for which the reimbursement was $6,245. More important, these unnecessarily long hospital stays consumed bed days that could have been used by people in need of acute care. Stories such as these are not unusual - for most hospitals in the state, they are encountered on a daily basis.

The hospital has only has two ways to recoup these funds. One way is to raise the rates it charges commercial insurers on the theory that those who can afford to pay can subsidize those who can't. Generally, however, commercial insurers do not believe it is their responsibility to pay for this care. Or hospitals can ask the public to contribute.

Most people believe it's the state and/or federal government's responsibility to pay for these situations. Although it may be distasteful to some to use taxpayers' dollars for health care for undocumented aliens, it is even more distasteful to allow this problem to be borne entirely by the state's already overburdened hospitals.

In sections of the country - notably, the Southwest - this conveniently invisible problem has caused some hospitals to close. Leadership at the state and federal levels is needed to shine a light on this secret system.

J. Kevin Kinsella is vice president of Hartford Hospital.