Care for Uninsured Non-Citizens

PRESS RELEASE

NEW REPORT FROM THE FLORIDA HOSPITAL ASSOCIATION REVEALS THAT CARING FOR UNINSURED NON-U.S. CITIZENS COST FLORIDA HOSPITALS $40.5 MILLION

As Medicare and Medicaid reimbursement continues to decrease and medical liability premiums soar, Florida hospitals are seeing a dramatic increase in costs associated with caring for uninsured non-U.S. citizens. Providing care to these individuals places a huge financial burden on hospitals' already limited financial resources. Federal laws, such as the Emergency Medical Treatment and Active Labor Act, require hospitals to treat everyone presenting to the emergency room, regardless of citizenship or ability to pay. While some limited sources for payment exist, these patients usually do not qualify, leaving Florida hospitals to absorb the unreimbursed costs or providing this care.

"The noise from Florida's hospitals on this issue has been deafening," said Congressman Mark Foley (R-Palm Beach Gardens), a member of the House Ways and Means Committee who requested the General Accounting Office conduct a major study of this entire issue. "With our health care system in crisis, we can no longer allow the hospitals to shoulder this burden."

A new study by the Florida Hospital Association (FHA) found:

• 49.2% of Florida's estimated 1.6 million non-citizens do not have health insurance;
• The number of uninsured non-U.S. citizens admitted to the hospital almost doubled between 1997 and 2001, reaching 7,670 in 2001;
• 70% of patients who are not U.S. citizens were admitted to the hospital through the emergency room in 2001 - compared to 52% in 1997;
• A limited study of the issue in 2000 identified 14 cases of hospitalizations of non-citizens in which the total cost of care was $5.8 million or $413,000 per case;
• An FHA request for information in 2002 identified 705 cases of uninsured non-U.S. citizens, with hospital care costs totaling $40.2 million. Hospitalizations for uninsured non-citizens admitted for a non-obstetric-related case averaged $63,155 per patient;
• Thirty-two of the 705 patients incurred charges in excess of $250,000. Combined, costs associated with caring for these 32 cases totaled $21.4 million;
• While the average length of stay for uninsured non-citizens was 22.1 days; 48 patients stayed in the hospital for longer than a month; and
• Hospitals expended considerable time and effort transferring the patient back to their own country or finding appropriate long-term care. Hospitals frequently paid to return the patient to his/her home country and/or absorbed the cost of any follow up care.

Given this growing burden, there is a need to:

• Clarify existing federal emergency service laws regarding the hospital's obligation for continuing care after stabilizing the patient;
• Require tourist visas to be issued on the condition of documented health status and financial responsibility for health care services;
• Require countries to accept medical transfers of their citizens;
• Require more resources and better coordination for sick or injured immigrants among Immigration and Naturalization Service, international embassies, immigration attorneys and patient families; and
• Offer workers and resources to hospitals on better Medicaid coverage, disability insurance, foreign aid debit, crime victim compensation, KidCare insurance, vocation rehabilitation, home health and long term care services.

"This report is a good first step in illuminating the pending crisis," Foley added. "Hopefully, the GAO study will help inoculate our hospitals from financial disaster."

The Florida Hospital Association will continue to work with the Florida Congressional Delegation to find legislative answers to alleviate or reduce this burden on hospitals.

The report is attached. If you have questions, please contact Kathleen Whyte, Senior Vice President/Federal Advocacy at kathyw@fha.org, 202/347-7878 or Kim Streit, VP/Health Care Research and Information at kims@fha.org, 407/841-6230.