Healthcare for residents of a foreign country

The following short article was in today’s paper.

Can this be correct? U.S. federal law requires U.S. hospitals to care for Mexican citizens living in Mexico, and to supply ambulance service to boot? How can this be? When did this law get passed and why is it still on the books?

I can’t say for certain what’s going on, since little information is given in that paragraph (and I don’t know exactly where the Rio Grande flows - is it solely a border between the US and Mexico, or is the city in question merely located near it and the line was included for “atmosphere” reasons?). However, my wild guess is that people who live in Mexico and are very sick manage to get ambulances to come pick them up - either by sneaking into Mexico, or taking advantage of ambulance services that will cross the border. Then they fill out false papers at the ER - many ERs, at least the one at the hospital I was at for my last job, had to provide emergency service for patients even if they had no insurance, but a bill will be sent and payment was expected - listing a fake US address. Then they skip out on their bills.

Is that what the article in question described?

Although short the article seems to be pretty clear. Federal law requires US hospitals to serve Mexican citizens living in Mexico, and to supply ambulance service to pick them up and deliver them to the hospital.

But if it’s a federal law does it mean that US hospitals have to serve all of Mexico? This would certainly seem to be absurd, but I have never heard of this before so I don’t really know. I would guess it just applies to border towns, but even still I can’t imagine how a law like this was ever passed, and I’m very curious as to how it came to be, and who initiated the legislation and why.

Oops I blew it. According to this article the ambulances are from Mexico, and they’re bringing patients into the US for treatment at Us hospitals. I should have Googled first and asked questions later.

Here’s the relevant quote about the US law:
“Under a 1986 federal law, U.S. hospitals must treat anyone who seeks emergency care, without regard to immigration status or ability to pay. The government gives hospitals extra funding to help poorer regions absorb the costs of unreimbursed care, but hospitals say it is not enough.”

And here’s the picture caption that covers the ambulance issue: “Ambulances from Mexico regularly deposit severely ill or injured patients at U.S. hospitals.”

So what’s happening is that the US requires hospitals to give emergency care to anyone who shows up. The caption shows that Mexican ambulance companies are hauling people to hospitals in the US. US hospitals are not doing this for free, but often are running into trouble billing - cf. this quote about what one hospital is doing: “Thomason Hospital responded by retaining a Mexican lawyer and requiring patients to sign “pagares,” or promissory notes, that carry weight under Mexican law. It also signed on with a firm that specializes in collecting past due accounts in Mexico.”

I think this is a good law, but it is being abused by those who aren’t paying. Then again, plenty of US citizens abuse the free care requirement too, as I saw at the last hospital I worked at - they waited until it became an emergency, then suddenly they have to be seen, and then the paperwork comes across the desks of the physicians in my old department, saying ‘all these patients didn’t pay and we can’t collect, should we write off these charges or not?’

Let me put it this way, if we didn’t have this law, some Japanese or French or even Mexican tourist in the US who gets hit by a car or has a heart attack might be denied treatment by the ER of some hospital, and that would just be ugly.

In Texas, where I’ve lived and worked, (former attorney general, now Senator) John Cornyn actually forbade public hospitals from providing care for illegal immigrants. Hospitals in San Antonio and Houston flouted this, citing public health risks if they didn’t provide treatment.

Open-treatment laws (which also cover pregnant women in labor in addition to emergency) do shaft those who provide the care. The federal government does provide some relief under the “Health Care and Other Facilities” program and the Hill-Burton program (see here for more info), but this doesn’t come close to completely reimbursing physicians and hospitals. It’s not unheard of for a facility to have to write off tens or hundreds of thousands of dollars as uncollectable. This is one of the factors that drives up the cost of health care for the rest of us.

That being said, however, there is incentive for this practice to continue. If Nuevo Laredo, Mexico experiences an outbreak of disease, it’s in Laredo, Texas’s interests to keep it from spreading, i.e. by providing treatment. The people of large Texas cities don’t want to get sick because the local hospital has to close its doors to foreigners. It’s that simple.


While the ERs aren’t allowed to turn the patients away, why, exactly, are the border guards allowing these people - in ambulances - into the country in the first place? I would assume there’s some proper and appropriate paperwork that would accompany instances of legitimate and expected patients when crossing the border and unexpected freeloaders could be turned away.

Note that the patients are expected to pay (and I assume at least some do), and some measures are being put in place at some hospitals to help ensure payment. Now what kind of bad publicity would the US get if someone was injured/desperately ill in a poor area of Mexico that couldn’t provide proper treatment? (And what worse - I assume - publicity and lawsuits would emerge if an American tourist in Mexico wasn’t allowed back in?) Imagine some border guard turning back an ambulance for someone who urgently needed to get to a trauma center, etc., just because they were crossing over from Mexico. It isn’t a totally closed border, people go back and forth to shop, work, even - I assume - drive over normally to see a doctor for a regular checkup and pay their bill.