Posted on 01/16/2004 10:03:10 AM PST by Dubya
County will fund nonemergency treatment of undocumented residents
FORT WORTH - Undocumented immigrants will get unprecedented access to the county's charitable health care system, which could cost Tarrant County taxpayers millions of dollars, JPS Health Network trustees decided Thursday.
The decision's proponents maintain that providing preventive care to indigent undocumented immigrants could save the county money in the future and would be a more humane way of dealing with vexing public-health problems.
But hospital administrators' concerns are rooted in the present.
"In the short term, I'm concerned about the capacity of the hospital to handle the new patients," said Gale Pileggi, the network's chief financial officer. "Do we have the physical capacity and the staff to handle this influx of patients?"
Pileggi said that an average patient in the JPS Connection program costs the district about $3,000 annually and that about 35,000 people are now enrolled. JPS Connection provides financial aid to people who need nonemergency care through the JPS Health Network.
"If enrollment goes up just 10 percent, that's more than $10 million," Pileggi said.
There is really no way to accurately forecast the cost because too many variables are involved, said David Cecero, the network's chief executive.
"We don't know whether we will have one or 1,000 new patients," Cecero said.
In fiscal 2003, more than 2,180 patients visiting John Peter Smith Hospital's emergency room were categorized as undocumented, according to hospital records. Hospitals are legally required to care for anyone who comes to their emergency rooms.
But until Thursday, JPS provided little nonemergency care to undocumented immigrants.
In fact, in 2001, Attorney General John Cornyn issued an opinion saying it was illegal for the state's public hospitals to subsidize nonemergency care for undocumented immigrants. Cornyn found that federal law denies state and local benefits to undocumented residents, unless specified by state law. Texas had no such law, Cornyn wrote.
In the 2003 session, the Legislature enacted a law addressing the issue. A provision allows public hospitals to provide nonemergency care to undocumented immigrants if they use only money raised from county taxpayers, said state Rep. Rick Noriega, D-Houston.
"The intent was not to mandate," Noriega said. "The intent was to allow the local decision-makers to serve whoever they want to serve, without fear of being sued or other repercussions."
Most state hospital districts are already providing preventive care to everyone because it is more cost-effective, Noriega said.
Because Texas' tax system is based on sales and property taxes, which undocumented immigrants pay, the income received from them far exceeds the expense incurred to provide them health care, Noriega said.
And the health problems that are forestalled by preventive care far outweigh the expense of providing such care, Noriega said.
"Disease doesn't ask whether a child is a citizen or not a citizen," Noriega said. "We are seeing outbreaks of TB and all types of other disease. From a health-policy perspective, it's more cost-effective to deal with this on the front end than the back end in your ERs."
JPS officials interpreted the law differently. They believe that the legislation mandated the nonemergency care and that they have to provide financial assistance to indigent undocumented immigrants.
"Now they are eligible to apply for reduced fees," Pileggi said. "They will still need to be Tarrant County residents. They have to be financially indigent, which is 200 percent of the federal poverty level or below, and they must have applied for everything else that they are eligible for."
JPS officials have also said that the assumption that preventive care will save the district money is untested.
The new state law prohibits providing nonemergency care to people who cross the border expressly for that purpose.
The hospital's goal is not to turn people away, Pileggi said.
"It's clearly the mission of this organization to take care of the indigent," Pileggi said. "The question is, Where is the money going to come from?"
$3000? Interestingly enough --- that's the typical cost of delivery and postpartum care.
Scoff.
They are appointed.
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