Where the Buck Stops with Free Medical Care for Undocumented Immigrants

By Lauren Fajkowski

Last August, Francisco Martinez, a Mexican national, fell from the roof of a shrimp packing plant where he worked in Galveston, Texas and suffered a severe spinal injury.  Mr. Martinez was taken to a hospital to receive treatment for his injuries.  Despite the initial efforts by doctors, Mr. Martinez is now paralyzed from the chest down and requires continuous medical care. This continuous medical care has so far been funded by the hospital, because Mr. Martinez does not have health insurance or a means to pay.[1]   And now the hospital wants to stop providing medical care, and has instead offered to help pay for a ticket for Mr. Martinez to return to Mexico to continue treatment there.[2]

The hospital’s proposed deportation of Mr. Martinez is not a novel alternative for dealing with patients who cannot afford their medical care.  In fact, the practice is fairly widespread, although more widely publicized in border states. This “deportation” has been called many names including: medical repatriation, international patient dumping, and medical deportation.[3] Medical repatriation occurs when a patient is sent back to their country of origin because they do not have insurance or an ability to pay for continued medical care in the U.S.

As an undocumented immigrant, Mr. Martinez does not receive health insurance through his employer, and further, Medicare and most Medicaid programs do not provide coverage for him and many documented immigrants.   The policy stems from the reluctance to spend tax dollars on individuals who are not lawfully in the country and individuals that have only been in the country legally for less five years.  Despite the lack of coverage under federal and state health care programs, undocumented immigrants are not completely left without access to medical care—they can receive medical treatment for emergency conditions.

If a U.S. hospital receives funding from Medicare it is required to screen and stabilize anyone, including an undocumented immigrant or those without insurance, who arrives in the emergency room with an emergency medical condition under the Emergency Medical Treatment and Labor Act  (EMTALA).[4] In fact, EMTALA requires the emergency room at the hospital is required to screen the patient for an emergency medical condition, and stabilize the emergency medical condition prior to transfer or discharge for all persons, regardless of race, creed, citizenship, or ability to pay under EMTALA.[5]

After a patient has been screened for an emergency medical condition and stabilized, U.S. hospitals are no longer required to continue to care for them.[6] When the requirement to provide care is lifted, U.S. hospitals are faced with a dilemma when a patient does not have insurance or ability to pay but requires continuous care since medical costs are extremely expensive. The hospital is forced to choose between providing free care or sending the patient elsewhere—such as another hospital, rehabilitation facility, or possibly back to their country of origin.  Hospitals often try to find other care facilities to take the patient, but many refuse services because the patient cannot pay for treatment they require.  When other care facilities will not accept the patient, the hospital may look to a more drastic means of discharging the patient—sending them back to their country of origin.

There exists great uncertainty in what happens to undocumented immigrants after the requirements of EMTALA have been met.  New health legislation, or Obamacare, does not help to determine the fate of undocumented immigrants after they are stabilized and discharged from the hospital either.  The Patient Protection and Affordable Care Act (PPACA), which extends health insurance coverage to millions of Americans, will not provide insurance coverage for undocumented workers. Undocumented workers have and will continue to have the fewest rights because they are ostensibly here illegally.

Many of these potential “repatriots” have been in the U.S for many years, some of them even decades, and have children that are U.S. citizens. These patients do not want to leave the U.S and return to their countries of origin because their families and lives are here.  The medical “repatriots” are afraid of leaving the U.S. because of the fear of substandard care or the potential lack of care that would be provided. Health law, immigration law, and social policy must be examined together in coming up with a solution.

Mr. Martinez does not want to return to Mexico and for the time being, it seems that he will not be repatriated and will be allowed to stay in Texas.[7]

Sources:

Houston Chronicle: http://www.chron.com/news/houston-texas/article/UTMB-offers-patient-a-ticket-to-Mexico-2234510.php

AZCENTRAL: http://www.azcentral.com/arizonarepublic/news/articles/2008/08/03/20080803hospitals0803.html

CNN US: http://articles.cnn.com/2011-10-27/us/us_texas-paralyzed-immigrant_1_illegal-immigrant-public-hospital-system-galveston?_s=PM:US

NY Times: http://www.nytimes.com/2008/08/03/us/03deport.html?pagewanted=all


[1] Since Mr. Martinez was injured while at work it seems possible that his workers’ compensation insurance would pay for his medical expenses.  Undocumented workers are not barred from receiving workers’ compensation benefits as long as their employment contracts did not aid their entry into the U.S.  Commercial Standard Fire and Marine Company v. Galindo, 484 S.W. 2d 635, 637.  However, Texas employers are not required to carry workers’ compensation insurance, and it is unclear whether Mr. Martinez’s employer carried such insurance.

[3] See coverage from Texas, California, AZ

[4] 42 U.S.C. § 1395dd

[5] 42 U.S.C. § 1395dd

[6] 42 U.S.C. § 1395dd

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3 comments

  1. “ostensibly here illegally”
    There is nothing “ostensible” about it (assuming he was determined to be an illegal alien, which seems to be the case from your description). Otherwise, a great summary.

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