Thursday, August 12, 2004

Compassionate Conservatism In The ER

Via Body and Soul, I discover that the Bush Administration's conservatism just keeps getting more and more compassionate.

Hospitals are required to treat anyone who shows up in the Emergency Room with a bona fide medical emergency, regardless of that person's ability to pay. If the person can't afford to pay anything, or can't be billed because they have no legal address, the hospital is required to absorb the cost. For hospitals in border states, a disproportionate number of these indigent ER patients are illegal immigrants. These hospitals have been arguing for years that illegal immigration is the government's problem, and that the government should reimburse them for the costs of emergency care given to undocumented patients.

Last year, they managed to convince Congress to set aside some money for it, and all seemed well. But now the Bush Administration has declared that, in order to be reimbursed, hospitals must ask all uninsured emergency patients about their immigration status, including placing photocopies of immigration documents in the medical record. They won't be required to turn the records over to the government unless they are audited, but the INS and local law enforcement officials will presumably be able to access them - as they can access the rest of the medical record - via subpoena.

This policy will obviously have the effect of keeping illegal immigrants out of the ER - and probably many legal immigrants, as well. Parents who are undocumented will hesitate to bring their U.S.-citizen children to the ER, for fear that the parents' immigration status will be questioned. Legal immigrants whose papers aren't at hand, or aren't perfectly in order, will be afraid of being misidentified as illegal. No one will trust that the hospital won't notify the INS.

People won't get the emergency health care they need.

Hospitals want to use common-sense methods of identifying cases eligible for reimbursement - for example, counting all indigent patients who give invalid Social Security numbers. The Bush Administration argues that "hospitals could ask the questions in 'an unobtrusive way' that would not discourage immigrants from seeking care." As if there's an unobtrusive, casual way to ask questions like:
Are you a United States citizen?

Are you a lawful permanent resident, an alien with a valid current employment authorization card or other qualified alien?

Are you in the United States on a nonimmigrant visa of the type issued to students, tourists and business travelers?

Are you a foreign citizen who has been admitted to the United States with a 72-hour border crossing card?
One of two things will happen under this new policy. Hospitals with a serious dedication to making emergency care accessible will refuse to ask immigration questions, foregoing reimbursement. Hospitals too financially strapped to forego reimbursement, or too focused on the bottom line to care, will be avoided by anyone whose immigration status is undocumented or ambiguous. More of those people will wind up seeking medical attention from unlicensed traditional healers, or going without care altogether. But here's what won't happen: large numbers of illegal immigrants declaring their status at the ER and receiving treatment for which the hospital is reimbursed.

Once again, the Bush Administration will have it both ways: they'll get a PR boost from a policy which seems humane and compassionate, and yet they won't actually have to pay for the provision of costly services.

Why should we care? If "human kindness" isn't a sufficient answer, then we should care for reasons of public health. You don't want someone with untreated Hepatitis A in the restaurant kitchen, making your salad. You don't want a child with ringworm or an untreated infection playing with your child on the playground. You don't want there to be a population in your city which is undervaccinated, living under poor sanitary conditions, and without prompt access to health care. That's how epidemics start.