April 07, 2005
ERs:
$10 Billion Subsidy To Immigrants—And Their Employers
"Too
many of our citizens go without health care," President Bush said during a January
2003 speech in Scranton, Pa.
"We've got a lot of people who go
to emergency rooms
for primary care....”
The President’s solution:
more
community health care centers—paid for by
the taxpayer.Memo to Bush: the ER crisis is not due to a shortage of supply. It’s due to a longage of
demand—notably from immigrants, especially illegal immigrants.
Between 1992 and 2001 visits to U.S. hospital emergency rooms increased by 20%.
Uninsured immigrants and
their children were certainly the fastest growing component. (There’s no official data on
immigrant ER usage specifically.) We know this from looking at exactly who lacks health insurance.
We are constantly told that there are “X million Americans
without health insurance.”
(The current estimate: 41.2 million [Source:
Current Population Survey, March
2002.])
But next time you hear this, ask this question: how many of them are immigrants—and their
native-born children?
Answer: 12.2 million – or about 30 percent of all uninsured persons.
They account for more than
half—59 percent –
of the growth in the uninsured population during the 1992-2001 period [Steven Camarota,
"Without Coverage: Immigration's
Impact on the Size and Growth of the Population Lacking Health Insurance, Center for
Immigration Studies].
Here are the uninsured rates for various immigrant
groups (Table 1):
The rapid escalation of ER usage by
uninsured immigrants has brought financial disaster to many hospitals.
Southwestern border hospitals lost
hundreds of millions before the recent federal bailout. In LA County the cost of caring for illegals
has diverted money from other services, forcing clinics,
trauma centers—and
emergency rooms—to close.
Federal law requires hospitals to
treat anyone who
shows up in their emergency rooms. Apparently it does not prohibit hospitals from closing
insolvent emergency rooms.
Or passing un-reimbursed ER costs on to insured natives or their employers, many of whom can hardly
pay their existing insurance premiums.
Let’s assume the average ER visit costs between $500 and $1,000 per person. (That seems reasonable
given that back in 1999
Medicare’s average ER tab was
$396 per person.) If each of the 12.2 million uninsured persons who live in immigrant families goes
to an ER once, the annual ER subsidy would be between $6.1 and $12.2 billion.
Many visit ERs several times a year.
Of course, some uninsured immigrants notoriously proceed to run up multi-million dollar
bills in
long-term care—which doesn’t
show up as an ER expense.
Any policy aimed at alleviating the
ER emergency must confront
the role played by uninsured immigrants.
A modest proposal: cut off ER demand at the
border. Simply enforce the laws
against illegal immigration – and cut off legal immigration with a
moratorium.
Edwin S. Rubenstein (email
him) is President of
ESR Research Economic Consultants in Indianapolis.
