WASHINGTON, Jan. 24 (UPI) -- With illegal immigration increasingly becoming a hot-button issue, United Press International interviewed Jack Martin, special projects director with the Washington-based Federation for American Immigration Reform, about the burden of illegal immigration on the nation's emergency rooms, the most expensive segment of the U.S. healthcare system.
Q. Your group says the main burden of illegal immigration on the U.S. healthcare system is through emergency room care. Do you have any statistics on the annual costs of emergency room care rendered to those in the country illegally?
A. We've done cost estimates for a number of states -- largely derived from work that's been done by others -- but also based upon our estimates of the illegal alien population. And the estimates that we have come up with for emergency medical care use by illegal aliens run as high as $1.4 billion dollars a year in California, which is the highest, of course.
New York is less at $700 million a year; Texas, a bit more than $500 million a year; Arizona, about $400 million a year. The other (states we've studied) are Florida, which is lowest at about $165 million a year, and New Jersey, at about $200 million a year. Just those six states add up to almost $3.5 billion dollars a year. Those are the states with the biggest illegal alien populations.
(These estimates) are based upon a total number of illegal residents of somewhere between 11 million and 13 million.
Q. Is this burden to U.S. emergency room care starting to affect other areas of the country as well?
A. It has been a rising expense as the size of the illegal alien population has risen, and the primary reason is the fact that illegal aliens generally don't have any medical insurance, and therefore, tend to use emergency rooms as a care provider of last resort.
It is certainly being felt in emergency rooms in areas that have had recent and large increases in the illegal alien populations. There are areas in the Midwest, such as in Nebraska, where they have meat-processing plants that have hired large numbers of illegal workers. This was demonstrated in the Swift & Co. raids that took place last month. (And in) North Carolina, for example, and Alabama, both have very fast-rising illegal alien populations.
Q. Do you have data on what sort of healthcare services have the highest use among illegal immigrants?
A. There's a recent study out that estimated those medical costs in California for births in emergency rooms. A recent report (published Jan. 20 in) the North Country Times (contained) new information provided by the state that indicated there were more than 105,000 Medi-Cal-funded births in the state in 2004 at a cost of more than $400 million.
And California is the only state that I'm aware of that has pretty good estimates of the cost of medical care provided to illegal aliens because of their Medi-Cal program that picks up the costs for indigent patients who are not covered by Medicare.
Q. So when an illegal immigrant comes into the emergency room for care, medical personnel do not ask questions about residency?
A. That's correct, and that's one of the problems that we (also) see with regard to legal immigrants, who are sponsored for immigration. Their sponsor is legally responsible for any of their costs, so the fact that hospitals don't try to ascertain that means that the sponsors are not held up to that obligation (for which) they contract when they sponsor immigrants. By (hospitals) asking those questions, you would separate out those people who do have sponsors who would be legally responsible (for the immigrant's medical costs).
Q. Have there been any efforts to change the law on this issue?
A. There was an effort in the renewal of the (Emergency Medical Treatment and Active Labor Act) legislation in the last Congress to add on a provision that required hospitals to collect that information, and it was defeated.
Q. Any comment on California Governor Arnold Schwarzenegger's recently unveiled plan that would cover people under Medi-Cal regardless of legal residency status?
A. I think the (plan highlights) the distinction between emergency care and standard care. There is an argument that if you provide medical care to people when they have early symptoms of a medical problem, it is less expensive to treat than it is to treat them after the medical condition is aggravated and they have to go to an emergency room, which is the most expensive level of treatment that anybody receives.
We don't try to argue that medical service ought to be denied (to illegal immigrants). Our argument is simply that information should be collected on those people who are in the country illegally (and) who are using that service, and that information should be available to the immigration authorities, so they can have the opportunity of preventing repeat and continuing usage of those emergency medical services by somebody who shouldn't be in the country.
Then you would try to build the case that the immigration authorities aren't doing their jobs if they don't act on that information.
Q. So does the Schwarzenegger proposal to offer primary care under Medi-Cal to residents of the state regardless of immigration status make sense?
A. That's sort of a political question. I would say that the element of that proposal that does not make sense is extending (Medi-Cal) to people who are illegally in the country because that basically accommodates their status in the United States and it may even encourage more people to come and settle in the area where that type of service is being provided.
I can't imagine that the public in California is happy to encourage additional illegal aliens to come to the state, because it is a very large fiscal burden on the state.
Q. Do you think advocates of amnesty for illegal aliens will use healthcare proposals like that in Schwarzenegger's plan as a first step toward amnesty?
A. I guess I would say no in the sense that an amnesty provision really has to be adopted at the national level and even though California does act as a trendsetter in the country, I don't think that type of action at the state level is likely to significantly influence a national decision.
Q. How sympathetic do you think the new Democratic-controlled Congress will be toward the issue of illegal immigration's burden on U.S. emergency rooms?
A. I'm not sure that they're likely to do anything with regard to the (program whereby the federal government compensates state and local jurisdictions for the cost of caring for illegal immigrants).
(The Democrats) are under the same type of constraints that the Republicans were, because they criticized the Republicans for our growing deficit and in effect, they're going to look like hypocrites if they don't pay attention to the size of the budget.
Q. Which 2008 presidential candidates do you think will be the most receptive to your group's issues?
A. I think 2008 is getting out a little far. Basically, there has never been an election in which the immigration issue has been discussed as much as it has in the last mid-term election. I think that that set a precedent and I certainly would expect that, in the next presidential election, there is going to be a very strong effort by the American public to demand that the candidates address the immigration issue.
(FAIR) made a strong effort in the last presidential election to force a debate on immigration, and questions were asked of the presidential contenders, but in effect, they gave very pat answers that skirted the issue, and the fact that that was done mutually made it impossible to ignite a debate over the issue.
Q. Will the increased concerns of the public over healthcare costs make it harder for politicians to skirt the issue?
A. I don't put anything past politicians of what they can avoid commenting on.
