Examining Care For Uninsured Immigrants

Ruzanna Harutyunyan's picture
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The New York Times on Sunday examined the "haphazard way in which the American health care system handles cases involving uninsured immigrants who are gravely injured or seriously ill." According to the Times, "Whether these patients receive sustained care in this country or are privately deported by a hospital depends on what emergency room they initially visit."

The Times reports that because of limited federal funding and a lack of government oversight, "it is left to individual hospitals, many of whom see themselves as stranded at the crossroads of a failed immigration policy and a failed health care system, to cut through a thicket of financial, legal and ethical concerns" in treating documented and undocumented immigrants. Hospitals are required to treat immigrants who need emergency care, but have "limited options in discharging immigrants who need continuing care: keeping them indefinitely, with or without providing rehabilitation; finding them charity beds or subsidizing them at nursing homes; sending them home to relatives; or repatriating them," according to the Times.

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The system "creates a burden" that could potentially lead to "neglectful and unethical if not illegal behavior by hospitals," the Times reports. Stephen Larson, a migrant health expert and physician at the University of Pennsylvania Hospital, said, "The opportunity to turn your back is there. You're given an out by there not being formal regulation." Hospitals contend that the federal government "ignores the burden posed by these patients," the Times reports. Immigration and Customs Enforcement spokesperson Kelly Nantel said the agency does not assume any responsibility for the health care of undocumented immigrants unless they are in federal immigration detention facilities and does not get involved with repatriation by hospitals.

The Times profiles several individual cases from across the U.S. involving seriously injured and ill immigrants that show "patients at the mercy of hospitals and hospitals at the mercy of a system that provides neither compensation nor guidance" and "reveal a playbook of improvised responses, from aggressive to compassionate."

According to the Times, repatriations by some hospitals "are routine," while for others it is used as a last resort, and "others do so only with consents -- although consent is a murky concept when patients are told they have no alternative." In addition, some hospitals "pay for an immigrant's repatriation and for their care in their homelands," while others "never make any inquiries into how deported patients have fared," the Times reports. The American Medical Association was scheduled to discuss repatriation practices at its national meeting in Orlando, Fla., on Sunday, and the California Medical Association in October approved a resolution opposing forced repatriation in response to a Times article about deportation of a brain-injured Guatemalan (Sontag, New York Times, 11/9).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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