Free Healthcare

Your Baby Budget: Where does it come from; where does it go?
How do some people get it for free?

As of this writing, the cost to have a baby in the United States ranges from $10,000 to $25,000, depending on the region of the country in which you live. The highest cost states are those with the largest malpractice insurance premium burdens: New York, Pennsylvania, and Florida. There is a direct correlation between your cost of delivering your baby and the area in which you live.

Imagine being able to walk into a clinic or hospital and get your prenatal care and delivery for free? Would you stand in line for this?

I’ve practiced obstetrics in semi-rural Colorado since 1996. During that time I’ve witnessed the births to illegal immigrants rise to 70% from 30% of births at the hospital at which I deliver babies. Fifty percent of these births at my local hospital were paid for by “Emergency Services Only Medicaid” (ESO). The other fifty percent went entirely unreimbursed. In most states, illegal migrants do not qualify for public assistance. However there are two major exceptions: Medical or surgical emergencies and labor. A laboring woman is automatically defined to be in an “emergency” condition as dictated by EMTALA laws.

EMTALA laws governing hospital emergency care and transport require facilities and medical personnel to provide services to people in an “emergency situation” regardless of citizenship status, race, gender, and ability to pay. Although several states such as New Mexico and California have attempted to restrict non-citizen's access to free medical care in recent years, these measures have failed because they place the burden of identifying citizenship status on hospitals and healthcare providers, a practice that goes in direct violation of EMTALA laws and health care providers’ obligations to treat.

In 2006 an estimated 600,000 to 1 million of the 4.4 million babies born in the United States were to illegal migrants. This impacts some states more than others. By some estimates 70% of the births in California in 2006 were to illegals. As of 2006 Parkland Hospital in Dallas Texas delivered roughly 11,000 illegals annually.

At the low end, 600,000 births X $15,000 = $90,000,000,000 in uncompensated care for births to illegal migrants in 2006.

To put that number in some perspective, there are an estimated 43 million uninsured legal U.S. citizens and an additional estimated 12 million illegal migrants, most of whom are uninsured. So the 90 billion only addresses the cost of births to illegal migrants, not the overall cost of indigent care.

Where does this $90 billion come from? You. Your property tax, your income tax, your health insurance premium and “cost shifting”.

A 2003 study of 49 counties of varying populations in 24 different states revealed 80% of these counties have been paying for increased uninsured medical costs through general funds raised primarily through property taxes. So if you own your residence part of your property tax is paying for your county’s unreimbursed medical costs.

A significant portion of your federal and state income tax goes to fund Medicare and Medicaid. In many states the majority of Medicaid recipients are for “Emergency Services Only” (i.e. illegals, ESO). For example, at my local hospital 95% of the recipients of Medicaid obstetric services are ESO.

If you are a small business owner, self-employed, or just purchase your own health insurance out of pocket, you’ve seen astronomical increases in your health insurance premium over the past decades. At the same time, your deductible is higher, and/or you may have an “HSA” (Health Savings Account, another manifestation of “high deductible”). Part of your premium dollar is funneled into “cost shifting” by insurance companies and healthcare facilities.

Cost shifting occurs at several levels and is the unofficial practice by hospitals of charging ridiculous amounts of money for simple items (i.e. $10 for an ibuprofen or $500 for a bag of intravenous fluid) to supplement the enormous hit hospitals are taking in the indigent care arena. If you’ve been hospitalized recently, just for grins take a look at your itemized bill. Warning: sit down and take some Tums first. You’ll be shocked at what you see.

Cost shifting takes place in other fashions: the income from elective surgeries paid by insurance is used to offset losses for indigent care. Higher paying departments such as surgery, cardiology, and gastroenterology offset money losers such as obstetrics units and emergency departments.
The exact degree to which cost shifting occurs is impossible to ascertain because it doesn’t directly appear on a hospital’s balance sheet.

So don’t go into your local hospital and demand to see the CEO to interview him or her about cost shifting– at best they won’t be able to tell you; they might laugh at you, or at worst, they might rake you over the coals.

What to do about this problem? I can’t ethically argue for denying illegal immigrants access to care. This remedy is fraught with the moral dilemma of providing people in need with medical care. Requiring hospitals to establish citizenship prior to initiating is impossible and places too great a burden on these institutions and contradicts patient privacy laws.

A couple measures which may “stem the tide” are rescinding automatic citizenship: Requiring people to be citizens in order to give birth to citizens.

Stricter enforcement of who can receive Medicaid would help. My local County Medicaid office is staffed by Hispanics, many of whom are recent immigrants. The office has a reputation for handing out benefits to those who don’t qualify and of looking the other way regarding a family’s income producers in determining levels of benefit. It’s a classic case of the fox watching over the henhouse; these people are defrauding the system of your hard-earned tax dollars.

Raising income or property taxes to fund the 90 billion would cause economic disaster and be unfair because many illegals are paid on a cash basis and the income goes unreported and therefore untaxed. Perhaps a tax on something that even illegals would have to pay such as on gasoline household items (I’ll call it the Wal-mart tax). Although these measures might strain the economy in other ways, increasing the expense exposure (number of people needing the product or service) is really the only way to equitably fund medical care for illegal immigrants.

Or for those who want to issue driver's licenses to everyone, why not tie them to proof of payinig taxes, owning auto insurance, and health insurance?

At any rate, it’s time to think outside the box and design an equitable solution to fix this problem. The sheer number of births to illegal immigrants has strained the system beyond the breaking point, resulted in closures of obstetrics units, and caused obstetrics care providers to leave the field.

Anyone ready for a revolution? I think we’re long overdue for another Boston Tea Party…or a Texas Tequila Party?…