Chicago Tribune - August 23, 2004

This is a case of clumsy execution crushing a good idea. The U.S. Department of Health and Human Services ought to devise simpler and less intrusive methods to distribute and audit the funds.

As is, the federal government would require paperwork that, some hospitals say, could eat up most of the federal money. It also could discourage the target population--undocumented immigrants--from seeking essential medical care.

Only Washington could come up with such paperwork hell. Hospitals seeking reimbursement would have to ask all of their emergency room patients about two pages worth of questions, chiefly whether they are U.S. citizens and, if not, which type of visas--if any--each of them holds.

The hospitals would be asked to keep detailed records, including photocopies of passports and other documents. Hospital personnel would sign forms certifying that the information collected was true and complete. Not all this stuff would go to Washington, but hospitals would need to keep detailed files in case federal auditors dropped by.

All of that costs money. By one estimate, $7 million of the $12 million going to New York would be wasted on extra personnel and paperwork.

More critical, though, is that such a program--no matter how well intended as a check on the use of federal funds--would sow fear of legal penalties or deportation among illegal immigrants and lead many of them to avoid needed medical care. That could lead to medical complications for sick people, and even the spread of communicable diseases.

A similar conundrum arose a few years back with an Illinois proposal to require doctors to report the names of patients who test positive for the AIDS virus. The state wanted to map out the spread of the disease. But fear of being identified--and penalized by employers or insurance companies--would have discouraged people at risk from getting tested. The idea was shelved.

The National Association of Public Hospitals proposes an indirect formula for estimating the number of undocumented immigrants treated at individual emergency rooms, using existing Medicaid and community data. The federal government should work with this formula, which provides accountability without affecting access to emergency services.

Debate over what sort of social or other government benefits should be extended to undocumented immigrants will continue until the U.S. immigration system is overhauled. But there is common agreement that an essential safety net--including emergency care--should be available to them.

The proposed $1 billion federal reimbursement program is badly needed. Illegal immigrants should receive medical care and the federal government ought to underwrite the local costs of that care. Let's just do it right.

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