- The Washington Times - Wednesday, November 26, 2003

As part of the horse-trading to win votes for the prescription-drug bill, House Republican leaders promised to hold a vote on a bill requiring hospitals that treat illegal aliens to report them to federal authorities.

The Medicare overhaul bill, which passed the House on Saturday and the Senate on Tuesday, includes $1 billion to reimburse hospitals for treating indigent illegal immigrants.

But in exchange for supporting the bill, Rep. Dana Rohrabacher, California Republican, extracted a promise from House Speaker J. Dennis Hastert of Illinois to allow a vote on making hospitals report illegal aliens.

“I told leadership that if they wanted my vote they would have to mitigate the damage that is done by financing illegal immigrant health services. They needed my vote, so they took the deal,” Mr. Rohrabacher said in a statement.

He initially had voted against the $395 billion bill on Saturday morning, but he reversed himself during the three-hour delay that Republican leaders used to persuade several party members to switch their votes, saving the bill.

Federal law says hospitals cannot turn patients away, even if they are unable to pay and even if they are not U.S. citizens.

Sen. Jon Kyl, Arizona Republican and a member of the House-Senate committee that wrote the final compromise Medicare bill, included the money to reimburse hospitals, which spend an estimated $1.45 billion a year on uncompensated treatment for illegal immigrants.

“This puts many of them on the brink of bankruptcy or, at a minimum, [theyll have to] cut back on many of the services they provide us,” Mr. Kyl said. “Without this reimbursement, they are not going to be able to take care of us.”

A hospital in San Diego was forced to close after losing more than $5 million a year in unreimbursed medical care, much of it for illegal immigrants, and other hospitals have reported losing millions of dollars a year in uncompensated care.

Hospitals and health care associations have demanded that the federal government pay for what they see as an unfunded mandate for care.

The Medicare bill allocates $250 million a year from fiscal year 2005 through 2008 for reimbursement, to be divided among hospitals by a formula and rules to be worked out by the Bush administration.

California and Texas expect to get about $70 million a year and $50 million a year, respectively, and Arizona would receive from $40 million to $45 million, according to senators from those states.

But some members of Congress who support stricter immigration controls object to the funding, saying the money will just bolster the incentives for illegal aliens to continue to enter the United States.

“Writers of this Medicare bill have apparently never seen the movie ‘Field of Dreams’ — if you build an illegal alien entitlement program, they will come,” said Rep. Tom Tancredo, Colorado Republican, who rallied fellow members to oppose the provision.

Mr. Tancredo and other opponents recently have begun to try to punish jurisdictions that accept cards issued by foreign governments as valid identification or that allow illegal aliens to obtain driver’s licenses, arguing that those jurisdictions are creating some of the incentives that draw illegal aliens and are helping them avoid detection by allowing them the means to integrate into society.

Mr. Rohrabacher’s proposal would require hospitals to report to authorities within hours of treatment that health care is being provided to illegal immigrants. The Border Patrol would then be required to put the illegal immigrants on a list for expedited deportation.

The deal was that the legislation would be included either as part of the omnibus spending bill now pending in Congress or as a stand-alone bill to be voted on early next year.

The final language of the omnibus bill was settled on Tuesday and the provision is not part of it, so Mr. Rohrabacher’s office now expects a vote next year on a separate bill.

Laurie Lange, vice president of public affairs for the Arizona Hospital and Healthcare Association, said she hadn’t seen Mr. Rohrabacher’s proposal, but she said hospitals don’t want to get mixed up with immigration issues.

“Health care providers are in the business of proving health care, not in the business of determining the citizenship status of our patients,” she said.

Hospitals say they aren’t supposed to ask about immigration status, but some seem to find out anyway.

Greg Pivirotto, president and CEO of University Medical Center in Tucson, told the Arizona Star this week that of 24 Mexican nationals admitted to that hospital last month, eight were in the United States illegally.

And because hospitals are responsible for care until the patients are released, some hospitals already have arrangements to transport indigent Mexican patients to hospitals in Mexico once they are stabilized.

For his part, Mr. Kyl said he understands Mr. Rohrabacher’s position, but he is hoping to broker a different solution.

“He’s frustrated, we’re all frustrated, about our inability to control the border,” Mr. Kyl said. “The question is, do you cut off your nose to spite your face?”

He said one reason he put the money for reimbursement in the bill was to “highlight to my colleagues the real nature of” the costs of illegal immigration.

“I want to do it in a constructive way. I hope these other members of Congress want to deal with it in the same way,” he said. “But there’s no question this provision has generated interest, and I intended it to.”

He said he wants to craft something with Mr. Rohrabacher that will not punish hospitals that have to treat the patients.

“I think the question here is whether the burden would be onerous, and therefore, the hospitals would never be able to participate in the program, or whether it would be reasonable,” he said.

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