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Border town hospitals straddle care and costs

Health care is an often overlooked facet of the national debate over illegal immigration, but in Arizona's border region, the impacts on hospitals are apparent.

Cochise County, Arizona, is a place of fabled history involving the likes of Wyatt Earp, Doc Holliday and the "Gunfight at the O.K. Corral," which resulted in three deaths and several injuries

These days there is a still a lot of dangerous action here. Most of it involves the hundreds of thousands of Mexicans and other Latinos trying to get into the United States. Cochise County is ground zero in the border wars.

At night helicopters with huge searchlights circle in the sky. Swarms of people try to scale walls as high as 18 feet. Smugglers' cars or trucks stuffed with humans speed along desert roads, chased by border agents. 

These hazardous conditions land many people in tiny border hospitals such as Copper Queen Hospital in Bisbee, Ariz. Copper Queen, with its 40 beds, is the only hospital for many miles along the Mexico border.

"When you have that many people coming through, you’re gonna have heart attacks, broken bones ... and they end up coming here," hospital chief executive Jim Dickson says.

According to the Department of Homeland Security, its officers apprehended more than half a million people attempting to cross from Mexico into Arizona last year. Most estimates put the number who don’t get caught at double that.

Health care is an often overlooked facet of the national debate over illegal immigration, but in this border region, the impact on hospitals is apparent.

Federal regulations prohibit hospitals from inquiring about a person’s immigration status before offering treatment, but some like Copper Queen are kinder than others. The immigrants and their contacts know they will get good care here. Indeed, if a Mexican citizen not seeking to get into the United States is obviously injured or in an ambulance, border-crossing officers often let them through on a compassionate basis.

But the care is expensive. Since May 2005 the Bush Administration has paid hospitals in border areas and large cities for caring for undocumented immigrants, but the payment amounts to only pennies on the dollar. Dickson says Copper Queen now puts out $3,000 to $4,000 a month in free care. That cost is one of the reasons the hospital had to close several of its services, including obstetrics, he says. As a result, some local residents must now travel 100 miles for prenatal care.

The burden of caring for illegal immigrants is multiplied many times at University Medical Center, Tucson, which has the major trauma center for all of southern Arizona.

Dr. John Porter, who heads the unit, says highway accidents involving smugglers are a constant problem. “All of a sudden we get nine patients at once," he says. "That not only stresses the system from a financial point of view, but it stresses us from the ability to take care of people."

Viewed from one perspective, the problem of illegal immigrants and health care is just another aspect of the lack of universal health insurance.  After all, most undocumented immigrants work and their employers usually pay them less than American citizens and seldom offer health insurance.

A study last year from the Rand Corporation estimated that illegal immigrants use far fewer health services than citizens and residents with green cards. They tend to be young and healthier than most of the population and are often fearful of seeking care. The Rand study estimated that illegal immigrants use $6.1 billion in health services a year, of which only $1.1 billion is paid for by public sources. That’s a lot of money but still a tiny fraction of the country’s health care expenditure.

Tucson's University Medical Center says it spends about $4 million a year in uncompensated care, but illegal immigrants aren't the only ones being covered.

“The number of citizens we see who don’t pay is actually higher than the number of Mexicans that we see who don’t pay us,” Porter points out.

University Medical, like most hospitals, helps cover the cost of the uninsured — both citizen and illegal immigrants — by shifting the costs to those people who do have health insurance. 

As employers and health insurance companies struggle to cut costs, such accounting maneuvers will become more difficult — and calls for health care reform will grow ever louder.