Hospitals aren’t obligated to track the cost of providing unreimbursed care for the millions of uninsured, undocumented immigrants in the United States.
And area health care providers would like it to stay that way. By law, hospitals must treat and stabilize anyone who shows up in the emergency room regardless of their citizenship and insurance coverage.
The result often leaves the hospital to pick up the tab for the treatment. In the case of undocumented immigrants, patients who require post-hospital treatment might often stay at the hospital weeks and months at a time, since nursing homes and rehab facilities are reluctant to accept the cost of serving those patients.
But at Centegra Health System, that is often the cost of doing business as a community health care provider. It also is an issue that applies to every patient who is uninsured or underinsured, said Astrid Larsen, director of care coordination at Centegra.
“It’s increasingly becoming more difficult to get patients placed when they are uninsured, but not necessarily because of their immigration status,” Larsen said. “It’s pretty much across the board.”
Larsen’s department is tasked with putting together discharge plans for patients who received treatment at Centegra’s hospitals. Her case managers encounter daily challenges with putting together plans for uninsured and underinsured patients often because their resources are tighter and their health issues are complex.
Immigrants often don’t have health insurance coverage. More than 13.5 million foreign-born residents in the United States have no health insurance. Of that total, 10.5 million don’t have citizenship, according to Pew Research’s Hispanic Trends Project.
The unreimbursed cost of providing that care for all uninsured or underinsured patients totaled a record-high $41.1 billion in 2011, according to data from the American Hospital Association.
In Illinois, unreimbursed cost in 2012 totaled $1.5 billion, said Danny Chun, a spokesman for the Illinois Hospital Association. He said some portion of that total would cover undocumented patients, but added, “we would have no way of knowing that.”
Undocumented patients would face deportation if they admitted their status and hospitals aren’t required to ask about status, Chun said. Hospitals’ main priority is to provide the care.
“We treat regardless of citizen status,” Chun said. “We don’t ask. We just treat.”
Other challenges remain for immigrants’ access to health care. Medicaid also does not cover long-term care for illegal immigrants or even newly legalized immigrants.
Hospitals have been known to coordinate cross-border flights that allow an immigrant to receive long-term treatment in their home country. Larsen said she has talked with some inner-city organizations in Chicago that have arranged those transfers, but she was not aware that Centegra ever had to do it.
Immigration status or not, a patient’s health should be the top priority for any community hospital, Larsen said.
“For us, we are incredibly committed to serving our community, regardless of status,” she said. “What is important is that they walk out of our doors better than when they walked in.”
The cost of unreimbursed care
Unreimbursed care includes charity care and bad debt, and adds up to billions for hospitals nationwide.
• 4,973 hospitals in 2011 provided $41.1 billion in unreimbursed care
• 4,985 hospitals in 2010 provided $39.3 billion in unreimbursed care
• 5,008 hospitals in 2009 provided $39.1 billion in unreimbursed care
In Illinois, hospitals spent $1.5 billion in unreimbursed care in 2012
• Centegra Health System spent $40.2 million in 2012
Sources: American Hospital Association, Illinois Hospital Association, Centegra Health System