Immigrant Health Reimbursement Legislation

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

On February 2003, the Local Emergency Health Services Reimbursement Act of 2003 was introduced in the U.S. Congress. The legislation would amend the Balanced Budget Act of 1997 to authorize the government to reimburse state and local hospitals for the uncompensated care they provide to undocumented immigrants.

Purpose of health policy or idea

Overview

On February 13, 2003, the "Local Emergency Health Services Reimbursement Act of 2003" was introduced in the U.S. Congress.  Introduced in both the House and the Senate by a bi-partisan group of senators and representatives, the legislation would amend the Balanced Budget Act of 1997 to authorize the federal government to reimburse state and local hospitals for the uncompensated care they provide to undocumented immigrants.  The bill would allocate $1.45 billion annually in healthcare reimbursements.  California would get the biggest reimbursement because it has more undocumented immigrants than any other state.

Situation

Across the country healthcare providers are struggling to get enough revenue to cover their costs.  Areas with high numbers of immigrants - legal and illegal - feel an extra burden because a 1986 federal law requires hospitals to provide emergency care to all patients - regardless of their ability to pay.  Undocumented, or illegal, immigrants are not eligible for public programs that would compensate the hospitals for the emergency care they provide. 

Immigrant Health in General

According to a nationwide study published in November of 2002 by the Center for Immigration Studies, California bears a disproportionate burden and/or responsibility in caring for immigrants' health.  California has the greatest number (9,118,000) and percentage of immigrants (26.4 %) compared to all other states. 

Furthermore, one-third of immigrants do not have health insurance (2.5 times the rate for natives) and immigrants who arrived in the U.S. after 1989 and their U.S.-born children account for 95 percent (7.5 million) of the 7.8 million increase in uninsured since 1989.  Immigrants with no health insurance are less likely to seek preventative care, and are more likely to turn up for expensive emergency care with acute illness or injuries.

Immigration rates are likely to increase, so the costs of uncompensated care for many counties will continue to grow.  The high levels of uncompensated care can threaten the viability of emergency healthcare facilities.  Communities will suffer if emergency facilities close.  In addition, some reports show that counties with high rates of uncompensated care are unable to provide "charity care' for local residents.

Legislation (S 412 and HR 819)

The legislation that was proposed this February (Senate Bill 412 and House of Representatives Bill 819) does not address immigrant health issues broadly, instead it is specific to illegal immigrants. 

Legislators argue that because the federal government is responsible for controlling illegal immigration, it should also be responsible for helping communities shoulder the financial burden of illegal immigration.  There is precedence for this:  the State Criminal Alien Assistance Program (SCAAP) is a federal program that reimburses local communities for the costs associated with incarcerating illegal immigrants.

This legislation is an expansion of a bill proposed last fall that would provide federal funds to border states was proposed.   According to the original bill, 24 counties on the Southwest border incur $200 million annually in uncompensated costs for illegal immigrants.  This session the new bill was expanded to include all states, not just states along the border, with a disproportionate share of immigrants.  The expanded bill is expected to have more political support and thus a greater chance of being passed.

California Senators Dianne Feinstein and Barbara Boxer (both Democrats) support this legislation.  Senator Feinstein reports that last year "California spent an estimated $980 million on emergency medical services for undocumented immigrants."

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch

Political and economic background

Legislation that has the federal government reimburse states for costs associated with illegal immigration has been proposed before, but according to reports the efforts surrounding this latest proposal for reimbursement on healthcare costs are better organized, funded and politically supported than in the past.

The intention of the legislation is to help fill in some of the gaps in the United States' healthcare system.  Specifically, the gap that exists in funding because illegal immigrants who are injured in the US are guaranteed emergency healthcare - care for which hospitals and counties are uncompensated.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The idea of the federal government helping communities shoulder the health expenses of large immigrant populations can be traced to the federal government's financial assistance for incarceration of illegal immigrants (State Criminal Alien Assistance Program, or SCAAP). 

Passed in 1986 SCAAP didn't start reimbursing states until 1994.  According to some accounts, it took much effort from California's then-Governor Pete Wilson to get the money.

The main proponents of this legislation have been legislators - on behalf of state and local hospitals - in states that have a large amount of uncompensated care (particularly border states).

Stakeholder positions

There are many different groups of people who would be affected by this legislation if it passes: 

• Legislators - There are senators and representatives from both the democratic and republican party in support of this legislation.  They are primarily representing states with large immigrant populations.  Both California Senators are in support of the legislation.  Specifically, the Senate bill was introduced by Senators Kyl (R-AZ), McCain (R-AZ), Domenici (R-NM), Feinstein (D-CA), Cornyn (R-TX), and Schumer (D-NY) and the House bill was introduced by Representatives (R-AZ), Flake (R-AZ), Shadegg (R-AZ), Hayworth (R-AZ), Renzi (R-AZ), Pastor (D-AZ), Grijalva (D-AZ) and Reyes (D-TX).  The bill is likely to be opposed by legislators who would rather see the money spent on alternative programs.
• Hospitals - State and county hospitals who care for illegal immigrants are strong supporters of this legislation because it would provide them with financial support.
• Counties - County areas that are heavily influenced by immigration are likely to be in support of this legislation because it gives money to the county to support their healthcare system.
• Immigrant Health Advocates - It is possible that immigrant health advocates would prefer to see the money spent on programs that cover undocumented and uninsured immigrants, and focus on primary and preventative care.
• INS Border Patrol -This legislation would take some of the pressure to cover medical care for undocumented immigrants off of the Border Patrol, as such, they might support it.  However, it is also possible that they would rather lobby to increase their own medical reimbursements.
• Hospital Based Physicians - Physicians who work hospitals departments such as emergency services and radiology are likely to be in support of this legislation because it helps them get reimbursed for the care they are providing that they are currently not reimbursed for.  Subsequently, the reimbursements would help their departments stay open.  
• Bush Administration - The White House is considered "unsympathetic" to this issue.  As evidence, journalists point out that President Bush didn't ask for any SCAAP funds in his 2003 budget proposal and, in fact, he proposed cutting out the reimbursements.

So far the media coverage of this proposed legislation shows that the issue is not extremely contentious.  While similar bills have failed to pass in earlier sessions, some believe that this bill has the broad support needed to pass.  The stumbling block that journalists suggest is opposition from the White House.  They believe the President may not support the legislation.  And, it is likely, that during this economic downturn and war, legislation that calls for extra federal spending will not get a lot of support.

Influences in policy making and legislation

Yes.  It is already a proposed bill in front of both the U.S. House and Senate.  On February 13, 2003 the Senate bill was referred to the Senate Committee where it was read twice and then sent to the Senate Committee on Finance.  The House bill was referred to the House Subcommittee on Health for "a period to be determined by the Chairman."

If the bills - which are identical - pass both the House and Senate the bill will go to the President for approval.

Adoption and implementation

All of the stakeholders described in 5.2 would be involved in the adoption process.   If the bill passes it is likely that the first hurdle will be getting the federal government to release the money.

Monitoring and evaluation

The legislation does not have a stated mechanism for review, but it is likely that the legislators and policy analysts from states who get reimbursements will analyse its impact on the state and local hospitals and the communities overall.  It is also likely that if there are any problems with the legislation, analysts and stakeholders will raise the issue publicly.

People have not suggested that this legislation - if passed - would have any undesirable effects.  What people might argue is that the money the legislation would allocate could be better spent in other ways.

Expected outcome

It seems likely that if this legislation passes it will help state and local hospitals meet their objective of staying financially viable as they provide care to undocumented immigrants. 

The legislation would reduce the uncompensated costs, thereby reducing the burden of providing care to undocumented immigrants and, possibly, improving the quality of care that is made available to undocumented immigrants and the communities as a whole.

References

Empfohlene Zitierweise für diesen Online-Artikel:

. "Immigrant Health Reimbursement Legislation". Health Policy Monitor, 01. Available at http://www.hpm.org/survey/us/d1/5