Undocumented immigrants are expected to make up a larger share of Connecticut’s uninsured population next year, putting “new financial pressures on safety-net hospitals” that provide emergency care to everyone, state and national health experts predict.
The Affordable Care Act (ACA) provides coverage options for legal immigrants, but those in the U.S. illegally cannot apply for Medicaid, even if they are poor, or buy coverage at Access Health CT (the new insurance marketplace), even if they have cash. That means undocumented residents without coverage will continue turning to local emergency departments for care at a time when Connecticut hospitals face the loss of millions of dollars in federal and state subsidies to help defray the cost of uncompensated care.
“This is a global problem that isn’t going away. This population (of undocumented residents) is not being addressed by any state or federal initiatives. It’s operating under the radar screen,” said William Gedge, senior vice president for payor relations for Yale New Haven Health System, the state’s largest provider of uncompensated care. The system includes Yale-New Haven Hospital, Bridgeport Hospital and Greenwich Hospital.
The dilemma sheds light on the uncertain future of the so-called safety-net hospitals in Connecticut and the nation as health care reform unfolds. Often located in urban areas, safety-net hospitals treat a disproportionate number of low-income, uninsured, and otherwise vulnerable populations, including undocumented residents. Federal law requires hospitals to provide emergency care, regardless of a patient’s ability to pay or immigration status.
Experts say that workers and visitors to the state’s two casinos contribute to the caseload.
In 2012, Connecticut hospitals spent $233.6 million in uncompensated care, including charity care and bad debt, according to the state Office of Health Care Access. These facilities spent another $868.3 million to cover Medicaid and Medicare reimbursement shortfalls in 2012, reports the Connecticut Hospital Association.
Hospital officials expect the budget gaps to widen in 2014 when the health law begins to sharply reduce government subsidies known as “disproportionate share hospital (DSH) payments” on the assumption that more people will be covered by Medicaid or private insurance due to reform. Connecticut hospitals also face a $550 million cut in state funds that previously covered Medicaid expenses.
In extreme cases, undocumented immigrants travel thousand of miles from their native country intent on seeking medical care at an emergency department in the United States.
“They just show up,” said Gedge. “We’ve tracked many uninsured patients who literally flew into JFK and within 48 hours were in one of our emergency departments.”
Other undocumented immigrants require care while “passing through Connecticut,” such as the patient who experienced a brain aneurysm while visiting a local casino. He spent a year at Yale-New Haven Hospital at a cost of about $5 million before being medically transferred to Beijing, also at the hospital’s expense.
“One of our major sources of undocumented residents are the casinos,” Gedge said. “These individuals have no family. No money. No identification. The only thing they have is a Wampum Card.”
For now, experts expect little change in the near future for undocumented immigrants. Stalled plans to overhaul immigration do not address health insurance, and the odds of lawmakers changing the federal law to include unauthorized immigrants are slim.
“I don’t see any solutions in the horizon,” Gedge said. “It’s going to get worse.”