America's health care system is in crisis: Costs and insurance premiums are skyrocketing, the number of the uninsured is rising rapidly, providers are reducing staffing and services and increasing rates, and hospitals are closing or facing bankruptcy.

As states cut their health care budgets to try to make ends meet, high rates of immigration are straining the health care system to the breaking point.

• One out of every four uninsured people in the United States is an immigrant.
  
  
• When the 3.5 million immigrants receiving insurance through publicly funded Medicaid are factored in, almost half of immigrants have either no insurance or have it provided to them at taxpayers' expense.
  
  
• In some hospitals, as much as two-thirds of total operating costs are for uncompensated care for illegal aliens.
  
  
• Although a national total of annual unreimbursed medical expenses for illegal aliens is not available, it is clear that those costs are more than one billion dollars, given estimates for Texas ($393 million), Los Angeles ($350 million), Florida ($40 million), and U.S.-Mexico border counties ($300 million).
  
  
• The problem is on the rise: Immigrants (legal and illegal) who arrived between 1994 and 1998 and their children accounted for 59 percent of the growth in the size of the uninsured population in the last ten years.

Federal laws requiring hospitals to treat anyone who enters an emergency room regardless of ability to pay have created an unfunded mandate for states and localities to fund health care for non-U.S. citizens and illegal aliens. Yet at the same time, lack of enforcement of federal laws against illegal immigration has led to a pool of nine to eleven million illegal aliens in the U.S.—and state and local taxpayers are being forced to foot the bill. Although immigration law enforcement is a federal responsibility, most hospitals receive little or no reimbursement for the care to immigrants that the federal government mandates that they provide.

• Lack of insurance leads many immigrants to use hospital emergency departments—the most expensive source of health care—as their primary care provider. Emergency room visits increased by 20 percent in the last decade. The problem has become so out of control that some Mexican ambulance companies are now instructing their drivers to drive uninsured patients across the border to the United States, where they will receive free treatment.
  
  
• The increase in uncompensated care for immigrants has forced some hospitals to reduce staff, increase rates, cut back services, and close maternity wards and trauma centers.

The escalating burden incurred by hospitals and other health facilities for the uncompensated treatment of aliens is driven by both rampant illegal immigration and a legal immigration system that allows large numbers of people to gain permanent residence despite the fact that they are unlikely to be working in jobs with health care coverage or have personal resources sufficient to pay for health services.

At the same time that Washington is neglecting to pick up the tab for aliens whom it has failed to prevent from settling here illegally, the problem is exacerbated by state and local policies that grant costly benefits to people who violate immigration law.

Reversing the escalating burden of uncompensated health care for immigrants and illegal aliens will necessitate enforcing laws against illegal immigration; reimbursing states and localities for the costs of failures in federal immigration policy but denying reimbursement to communities that work against federal efforts to combat illegal immigration; identifying foreign users of publicly funded medical treatment (and their immigration status); establishing guarantees of medical bill payment prior to admission to the country; clarifying existing federal emergency service laws regarding the termination of a hospital's obligation for continuing care after the provision of emergency treatment to stabilize the patient.

It will also require a change in public officials' mindset: Instead of shifting the burden to local taxpayers (often to those least able to pay when confronted with rising insurance premiums and medical bills), lawmakers must squarely face the consequences of immigration policy decisions. Our immigration system must be made consistent with U.S. national needs and priorities.

Yet quite the opposite is occurring. At a time when the country is struggling to provide affordable care to millions of uninsured residents, President Bush's immigration proposal would bring in hundreds of thousands more uninsured—and officially sanction a massive illegal population already here and already draining health care funds from struggling communities.

February 2004

The full report is available in pdf format (see below).