Health Care And Immigration Challenge Hospital District System

healthcareFor people too poor to pay for their health care, residency, rather than citizenship, is the key to being admitted into the hospital district system for free or low-fee nonemergency care. If they live in Harris County, Texas — a status that can be demonstrated with utility bills, rental agreements, pay stubs, and other similar documents — they are generally entitled to services at the two public hospitals and a network of clinics. But for the past three years, the hospital district has asked all noncitizens for immigration documents.
The questions are not meant to exclude immigrants from public health care, district officials said, but to help pay for it. The federal government partially reimburses the hospitals for emergency care for immigrants, illegal or otherwise.

In the 12-month period ending February 1999, the hospital district treated undocumented immigrants 170,509 times, more often than not in neighborhood clinics rather than in hospital beds. Of the 11,000 women who gave birth in the district’s two hospitals in that time period, about two-thirds were undocumented aliens. The district treated a total of 1.5 million cases during that period. About 19% of the cost of treating the immigrants was covered by government or private insurance and payments from the patients themselves. The remaining cost to the hospital district was $51 million. Taxpayers picked up the bill, through the local property tax and, to a lesser extent, federal funds.

The largest group of undocumented immigrants came from Mexico and Central America, but others came from Iraq, Nigeria, Vietnam, Haiti, Canada, Cuba, and elsewhere.

“We have both a legal and moral obligation to take care of those people who come into the district,” Eckels said.

However, he does believe the screening process should be more exacting. He said that under current rules, two or more people can beat the system by sharing the identity of one immigrant approved for treatment, and that other people make up false addresses in Harris County, get medical services, and move on.

Three months ago, about 30,000 people applied for a hospital district “gold card,” which certifies they are Harris County residents unable to fully afford health care. Less than 2% of applications were rejected. Most of the rejections involved immigrants here on student or tourist visas. But some local advocacy groups and activists say hospital district rules for accepting undocumented immigrants are too narrow.

Former Houston Councilman Felix Fraga, vice president of community affairs for Neighborhood Centers Inc., said the rules exclude immigrants who live in Harris County but don’t have documents to prove it. In many cases, such people are laborers who get paid in cash and live in shared quarters, so their names do not appear on salary, rental, and utility records, he said.

Hospital District president John Guest, who has met with the advocacy groups, said the district’s guidelines for deciding county residency are too vague and should be changed. However, he rejected the idea that a significant number of people come to Harris County from other counties and countries just to receive public health care.

“For the most part, people that I think are in undocumented status are here because they are here to get employment, jobs, income — and they happen to get ill or injured while they are here,” Guest said.

As for undocumented immigrants’ giving birth to most of the babies in the Harris County facilities, Guest said that all Texas public hospitals relatively close to Mexico experience the same phenomenon because women want to give birth in the United States so their children will be eligible for automatic citizenship. Before taking the reins in Harris County this year, Guest was the director of the hospital district in the San Antonio area, where he dealt with the same issues, he said.

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