TheWeekInCongress.com

Week Ending May 21, 2004

HR 3722 Undocumented Alien Emergency Medical Assistance Amendments of 2004.

BRIEF

   The bill would limit federal reimbursement to hospitals for emergency care given to undocumented aliens. To receive reimbursement from the federal government the hospital would have to gather information regarding an alien's citizenship, immigration status, financial data, and employer as well as a fingerprint or photograph. Most of the information is already gathered by hospitals from their patients, but, under HR 3722 the employment information, photo or fingerprint would be additional. The data would be entered into a software program provided by the Department of Homeland Security (DHS). DHS could access the files when it wants the information.

   Care could be refused the undocumented alien if it would exceed certain cost limits or if deporting the alien would do no medical harm or affect a baby if the alien was pregnant.

   The Secretary of State would be directed to analyze the feasibility of effecting treaties for international medical evacuations in that the treaties may cover the cost of returning the alien. In the absence of such a treaty additional visa and other immigration fees could be levied.

   (Editor's Note: The bill as written would appear to provide the opportunity for an illegal alien to become legal by following procedures along with his / her employer. The employer would have to comply with all standard employment laws and would have to provide for health insurance for the alien. That provision, however, does not seem to be the aim of the bill.)

Sponsor: Representative Dana Rohrabacher (R-CA)

Vote: Failed to pass in the House 88 – 331 (RC 182)

Cost to the taxpayer: It was put forth in the debate that the US spends up to $9 billion yearly to pay for immigrant healthcare yet the Federal government reportedly provide $1 billion yearly to hospitals for treating uninsured patients.. It is not certain if this bill, should it become law, would eliminate that expense.

MORE INFORMATION

   The bill would assert that Congress has found that medical care by public or private health care providers to undocumented aliens is appropriate only if it protects the health and safety of United States citizens; saves the life of an undocumented alien in a life-threatening medical emergency; and / or stabilizes an emergency medical condition so that an undocumented alien can be returned to his / her own country for medical treatment.

   Hospitals would not have to provide care for an undocumented alien if the alien could be deported without significant likelihood of worsening the alien’s medical condition. In the case of a pregnant alien in active labor deportation is acceptable if no harm would come to the child.

   Hospitals would not be required to provide treatment if it involves an organ transplant or other “extraordinary medical treatment” or treatment with an estimated cost to exceed $50,000 or if the condition existed before the alien entered the US or if the condition is the immediate result of an accident in the US.

   The bill would hold the undocumented alien’s employer responsible for payment of the emergency services provided to the alien if the employer did not comply with employment authorization procedures such as checking on the validity of the alien's documentation.

  Federal reimbursement to the hospitals would be on the condition that sufficient information to promptly remove the alien is obtained by the hospital.  The required information must be acquired under Oath and signed by the alien, a guardian or representative. The information required would be the alien’s citizenship, immigration status, US address, personal or financial data as the hospital routinely requires, including information regarding health insurance. Also necessary would be information on the identity of any current employer of the alien for whom the alien has executed an Internal Revenue Service Form W-4.

   The hospital would not be liable for the accuracy of the information gathered so long as it exercises reasonable care and good faith in obtaining the information. The hospital must gain an identifier such as a fingerprint or photograph and must keep the information on record for five years and make it available to the Department of Homeland Security when requested. The transfer of information would be digital and computerized with software and training and technical support services provided by DHS at no cost to the hospital.

Who would be deportable and subject to the rules of the bill?

   An undocumented alien is an unauthorized alien (is not legally in the US) who has provided the employer with an Internal Revenue Service Form W-4; and who does not qualify for an exemption. (See below).

Who is Not?

   The alien could gain an exemption and stay in the US if the employer and the alien have fully complied with all requirements of the employment verification system, the employer has enrolled the alien in a State workmen's compensation plan, the alien is enrolled under a health benefits plan or health insurance coverage that provides emergency medical and hospitalization benefits and / or the employer has assumed responsibility for any cost-sharing (including applicable deductibles and coinsurance) that applies to the alien.

   Representative Rohrabacher explained the purpose of his bill with a rhetorical question, “Is America to have a policy of unrestricted health care for illegal immigrants at the expense of American citizens and legal residents? That is the issue we are discussing today.”

   The bill was brought to the floor in the context of the 2003 Medicare Prescription Drug, Improvement and Modernization Act that provided $1 billion to compensate US hospitals for the unpaid bills from emergency treatment of aliens without medical insurance and who do not otherwise pay.

   “Our hospitals today feel compelled to provide extensive and even long-term treatment to illegal aliens,” Rep. Rohrabacher continued. “(H.R. 3722)…makes sure that our hospitals are relieved of this enormous burden of trying to provide unlimited health care to any illegal that comes into an emergency room. We have been giving heart bypasses, even transplants. A young girl from Mexico had $5 million worth of expenditures in heart transplants just a few months ago, and then when the transplant did not work, her family, who were here illegally and actually had emigrated here with a $5,000 fee to a coyote (person who is paid to smuggle the alien across the US – Mexico border), then sued the hospital because the transplant did not work. Well, this cost us billions of dollars a year.”

   A life threatening emergency would be an exception, Rep. Rohrabacher explained, but if the alien could not pay his US employer would be expected to, “If it is a life-threatening emergency, the illegal alien will be treated. There is no doubt about that. This bill does not change that. But if he has no insurance, the alien's employer or former employer will be given the bill. Businessmen will be given the bill if they hire illegal immigrants who end up draining away our health care dollars.”

  Among the opposition to the bill was Representative James Kolbe (R-AZ) who proposed that the bill may get a different result than intended, “This bill would discourage illegal aliens from seeking treatment for possibly contagious diseases for fear of being deported. In close-knit communities, such as many border areas, disease can spread quickly. This would lead to a potential health crisis in areas throughout the country--especially the southwest, “ he said.

  Also in opposition was Representative Hilda L. Solis (D-CA) “This bill goes in the wrong direction because it asks for our hospitals to become enforcers of immigration law.” Rep. Solis also saw the potential for contagious diseases to go untreated. “What happens in a classroom when you have a sick child who may, under no fault of their own, be there and not be a U.S. citizen? When they go to kindergarten, there is nothing that says that the child next to them will not be infected by maybe a contagious disease that they have…”. Rep. Solis saw as an obstacle to proper treatment “…the fear that that family would have to go through to enter into the doors of a hospital knowing somehow they may not come back; that somehow Homeland Security is going to be there to pick them up and ship them back.”

   But Rep Rohrabacher was not swayed, “…what is going to happen (if this bill does not pass) is this: people who come to the emergency rooms who are American citizens or legal residents who have no insurance will be put behind and at the end of the line and the illegal immigrants will be put to the front of the line because the Federal Government is picking up the tab.”

   Representative Steve King (R-IA) supported the bill. “(In America) We have already a jobs magnet. The jobs magnet that is there is what draws so much illegal immigration into this country. The disincentive has not been put in place. This is not the first administration that has not aggressively enforced our immigration laws. This jobs magnet exists, and we have added to that a new magnet. The new magnet is called free health care for illegals, and then we tap into the American taxpayers (to pay for it)”.

   “Now, I hear my Democrat colleagues over on this side continually railing about overspending, overspending,” Rep. King continued. “This is overspending. And it is not just a billion dollars. That responsibility comes to $9 billion a year, and it is growing.”.

   Rep. King added that employers by about December 2004 will be able to call a telephone number or visit a web site and find out if the potential employee is a documented immigrant or not.

   Immigration law complications concerned Representative Joseph Crowley (D-NY) “On a recent New Year's Eve in a hospital in my district, an undocumented woman gave birth to a girl. That girl, by birth, is a U.S. citizen but her mother remains not. If this bill had been law, that mother would have likely faced deportation. If that mother were deported, in all likelihood her baby girl, a U.S. citizen, would have gone with her. In essence that baby girl, a U.S. citizen, would have been deported.”

  Representative Linda T. Sanchez (D-CA) typified the bill as confusing emergency room priorities. “The first order of business for the emergency physician, nurse, or whoever is attending the patient is not to ask them where it hurts and do a physical exam to see if their life is in imminent danger, but to ask their immigration status and get a sworn statement to that effect. If that patient at that particular moment cannot prove their legal status, that same doctor must make the choice not to provide care to this person, or they must at least report them to the immigration officials before providing lifesaving treatment., “she said.

   But Rep Rohrabacher explained differently and expanded the argument to one of fighting illegal immigration. “This bill does not require the first order of business to ask questions. This bill says if you (the hospital) wants to be reimbursed from that billion dollar fund, yes, you are going to have to ask some questions, anyway, and adds one other question: Who is your employer? It does not require the doctors to turn anybody into the INS, although we have heard that over and over again in this debate. It does not require that. It requires their files to be available to the INS and to the Department of Homeland Security. It is those agencies that then follow through. The doctors do not have to report anything. It just has to be available on a computer. Communicable diseases, we keep talking about that, that also is wrong. The bill exempts communicable diseases. Let us talk about the real issue, illegal immigration. How many services are we going to give people until we get tens of millions of more immigrating into our country?” he asked. ## All rights reserved. Reproduction in any form is prohibited without written permission from TheWeekInCongress.com