One of the big arguments in favor of cracking down on illegal immigration is that illegal immigrants flood into emergency rooms and then don’t pay their bills. If this is in fact as big a problem as Lou Dobbs and his ilk make it out to be, how do they get away with it?
The last time I went to the ER was three years ago, and I had insurance to cover it. I recall them taking down my insurance information before administering any treatment (I wasn’t bleeding buckets or anything like that). When an illegal immigrant shows up at the ER and an administrator asks them about insurance what happens when they can’t produce any?
And if it were so easy to get health care at the ER without paying for it, how come more native born Americans haven’t latched on to this scheme? After all, there is no shortage of perfectly “legal” citizens who are also deadbeats and more than willing to game the system, especially when it comes to a necessity like healthcare.
You show up and fake that you can’t breathe. Then you “accidently” forget your wallet. The ER is done with triage so the most serious is those who can’t breathe or are not awake.
Or
You can say you’re his aunt and your “nephew” broke his arm. You don’t know his information but his father is at work (away from a phone of course) and you’re sure he’ll get the information to him.
Other hospitals don’t bother checking. Cook County Hospital says “Do you have insurance, just say “no,” I’m out of work.” They don’t check anything. At least they didn’t when I was there. Be prepared to wait though. If it isn’t a true emergency, you can wait more than a day or longer while the heart attacks, and the like (Cook County is a level one trauma center) take priority.
The key law you want to understand here is The Emergency Medical Treatment and Active Labor Act.
It can be summarized thusly “One would cover most of its purpose and effect by characterizing it as providing that no patient who presents with an emergency medical condition and who is unable to pay may be treated differently than patients who are covered by health insurance.”
More info here: http://www.emtala.com/faq.htm
There are plenty of people besides illegal immigrants getting emergency care and unable to pay. Here is one study showing 25% of such care is received by illegal immigrants: “According to the American Hospital Association annual survey, southwest border county hospitals reported uncompensated care totaling nearly $832 million in 2000.[1] Using an advanced statistical modeling approach, MGT determined that almost $190 million or about 25 percent of the uncompensated costs these hospitals incurred resulted from emergency medical treatment provided to undocumented immigrants.” The study is from counties along the Mexican border, an area with a lot of illegal immigration.
Is that a lot of money? Sure. But to imply that no US citizens are getting this type of care is far from the truth.
Well, honestly, a substantial % of working-class native-born persons receiving emergency-room care in the US do not wind up paying the resulting bills.
The hospital can bill you and send the account to collections, but if a guy making $9/hr with no savings and child support payments runs up a $20K ER bill, there’s a solid chance that they made more from his ambulance driver buying a Snickers in the snack machine than they’ll have made from the patient…
There are also programs that reimburse the hospital for patients who cannot pay (though the rates are lower than hospital rates, so they have to charge others in their bills). But plenty of American citizens show up in emergency rooms without the money to pay the bills, too.
How much illegal immigration? Say, 25% of the local population, maybe? Without that information, we can’t conclude anything about how much more likely illegal immigrants are to pursue this tactic than others.
I was citing the study in support of the fact that some of the uncompensated costs are not for illegal immigrants. The study pretty clearly supports the idea that a non-trivial amount of uncompensated costs are not for illegal immigrants.
I mentioned the fact that it’s on the border to establish that wasn’t done in some place like Maine, with very limited immigration.
No one was trying to get as precise as determining whether illegal immigrants were more or less likely to have uncompensated costs.
Its pretty common for people to use a false identity, fake SSN, etc at the ER. Heck, even if they give their real info all the hospital can do is file for collections. I dont care if youre illegal or 4th generation, no one can afford a serious ER bill without lots of hefty insurance.
The primary key of economic life in the US is your SSN. Illegals dont have one. So a Juan Perez with no SSN in Los Angeles will be pretty hard to find.
Not to mention there are liability issues here. Even if you dont have insurance and say so, they must treat you if they think you are dying or if non-treatment will make your condition worse before they can ship you out to the county hospital. That has a cost.
Being unable to pay an emergency room bill – whether you are an illegal resident, a legal immigrant, an unemployed natural born citizen, or even a poorly insured hard-working regular son-of=a=gun – does not make you a deadbeat. There may be hundreds of different reasons why you haven’t paid the bill. Most of the time, if you pay a little each month on a regular basis, they won’t send it out to collections.
IANAL.
joebuck20, had you rather these people suffer or possibly die than get free treatment?
This can’t be too big of a problem. If it were, California would be going broke right about now!
The last time I went to the ER was probably three years ago, too. I had my husband drop me off at the entrance, while he parked the car. I went up to the front desk, wheezed at the intake person, and was promptly whisked to a treatment room without them so much as taking my name. I had an oxygen hose hooked up to me, and then I was asked about my condition and history and medications. I tried to fish out my insurance card, but was told to put it away until I was breathing better.
The only reason they were interested in my name was because they wanted to look up my history. They were far more interested in getting me stabilized than my ability to pay, at least at first. When my husband came in, they sat HIM down and got the financial end taken care of.
I had either bronchitis or pneumonia which wasn’t responding to the antibiotics my doctor had given me for this episode. I’d seen her on Thursday, and finally went to the ER on Sunday morning, when I seemed to be getting worse rather than better.
My experience (at a suburban hospital) was a lot like Lynn’s. I was staying with my parents when I suddenly had sharp pains in my side. Dad drives me to the ER, they think its a kidney stone, I get morphined up, and they run the tests. They didn’t even bother to ask me about insurance, my dad did all of that while I was only asked about symptoms/history. My only involvement was to hand my wallet to my dad to fish out the relevant cards.
I would venture to say that the vast majority of ER docs and nurses care solely about the patients, regardless of their ability to pay; that’s why most go into medicine in the first place. They fix you up as best they can and then let others worry about payment. Does this hurt hospitals? Sometimes, but caring for people is the primary concern with financial matters being secondary at best.
If you are a low-income citizen, you can fill out the paperwork and the Hospital can recover under Medicaid/related programs if you qualify; if you are not a citizen or do not qualify (because you have a job and your income exceeds the threshold) then the Hospital is generally out of luck and must try to collect from you as best it can.
Harriet is correct–it is illegal under EMTALA to refuse to treat (at least stabilize) a person who shows up at the ER. It is not illegal for clinics/doctors’ offices to refuse to treat someone who has no means of paying. The difference is justified on the basis that if it is an emergency, you could die without treatment; if it is not, you have time to save up, find a free clinic, work out a payment plan, etc.
This “must treat/need not treat” difference pushes people to ERs with less severe conditions where care costs substantially more than in a doctor’s office, and is one of the reasons for high medical costs in the US.
There’s also an issue of leaving communicable diseases untreated. If someone with no insurance (for whatever reason) shows up at the ER with something catchy, shoving them out the door may needlessly expose many more people to whatever it is, resulting in more harm and more overall expense than treating the first patient. Same thing for routine treatment, such as immunizing all kids even if they’re illegal immigrants. I don’t necessarily like having to pay for that but the cost of NOT doing it could be much higher.
Cutting off your nose to spite your face and all that.
I’ve known three seriously ill US citizens who have racked up insanely high medical bills due to no insurance. You’re right. The illegal population is an easy target, but it’s by no means the whole story. Inadequate health care is the story here.
I wasn’t saying that all people who don’t pay their medical bills are deadbeats. I myself have known a few people who had the misfortune of getting ill while not having insurance and I feel for them.
Basically, the point I was trying to make was that if someone who can’t even speak English can so easily game the system, what’s to stop any number of legit citizens from doing the same. The likes of Tom Tancredo would have you believe that the high cost of healthcare is due entirely to illegal immigrants abusing the system. But there surely have to be plenty of other people who, rather than pay $100 to go see a regular doctor, just show up at the ER and then welsh on the bill.