In this photo taken Thursday, March 25, 2010, Dr. Carlos Ruvalcaba, left, examines Paula Medrano, one of the many patients he treats, at the Clinica Sierra Vista Elm unit in Fresno, Calif. Medrano is an undocumented immigrant. One of the 7 million uninsured people living in the United States who were explicitly excluded from the legislation, according to estimates by the Congressional Budget Office. The question of whether to extend coverage to illegal immigrants was so politically contentious that, under the approved legislation, they will not even be able to buy health insurance in the newly created purchasing pools called exchanges if they pay entirely out of their own pocket. (AP Photo/Marcio Jose Sanchez)
While Congress debates immigration and health reform, one aspect of care for undocumented immigrants is not likely to change. That is the often invisible hospital practice of transporting sick and sometimes comatose patients to other countries. Stephen Colbert recently covered the issue after the story broke of two undocumented but insured immigrants in Iowa being deported back to Mexico while unconscious.
Stories like this seem like nightmares. In one instance, an Arizona hospital processed the deportation of a two-day-old American citizen born with Down’s syndrome from the neo-natal unit because his parents were undocumented. In another, a nineteen-year-old girl died after being wheeled out of a hospital’s back entrance used for garbage disposal and transferred to Mexico.
The practice of deporting hospital patients after discharge is called medical repatriation. Hospitals send patients back to their home country because of the cost of treating them as inpatients. This occurs with the tacit approval of American immigration authorities, although without their overt involvement. Two public interest organizations, the Center for Social Justice at Seton Hall University School of Law and New York Lawyers for the Public Interest, have cited more than 800 cases of attempted or actual medical reparations in recent years.
The reason behind medical repatriation lies in the conflict between treatment requirements and health care costs. In the United States, hospitals are required to treat all people who come to the emergency room for care, regardless of their ability to pay or immigrant status. They must provide care until the patient is stabilized, but at that point, additional treatment may still be needed. If it is, the hospital can try to transfer the patient to another facility that will take them, but in the case of the undocumented, such a facility can be difficult to find. Many hospitals turn to medical repatriation instead as a solution.
The practice of medical repatriation may increase once the Affordable Care Act (Obamacare) comes into full effect in 2014. That law excludes undocumented immigrants from its guarantee of coverage. As a result, they are projected to become the largest sector of the population to remain uninsured. The immigration reform bill currently under debate in Congress does not change this situation. Some states use their own funds to fill the funding gaps for the undocumented left by federal programs, but many do not.
Since the current immigration bill continues to exclude the undocumented from health reform, hospitals are often left holding the bag. Sen. Marco Rubio (R-Fla.) points out that “Expanding [the immigration bill] to provide health care benefits for people who have violated our immigration law, in addition to being unfair, would, quite frankly, raise the cost of the bill to an unsustainable level.” However, the undocumented will continue to receive health care services, and someone will have to pay for them. As of now, that someone is hospitals.
Both sides of the immigration debate have one thing right - things aren’t adding up. Hospitals are required to provide services, those services costs money, the federal government is prohibited from reimbursing them for most of those costs, and many hospitals are responding by dropping unconscious patients off at airports.
A solution to this complex issue is not going to be easy. However, the practice of medical repatriation deserves a critical eye. It is not good for anyone.
From Obamacare to Medicare to managed care, read more of The Field Clinic here >>