Undocumented immigrants to strain safety-net hospitals in Connecticut

[lostinblue 1,989]

Undocumented immigrants to strain safety-net hospitals in Connecticut

By MAGALY OLIVERO Conn. Health I-Team Writer

Publication: The Day

Published 12/13/2013 12:00 AM

Updated 12/13/2013 12:00 AM

COMMENTS (10)

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.

Connecticut's diverse immigrant community comes from many countries from South America, Mexico, Central America, the Caribbean, Asia, Europe and Africa. Many are here legally, but an estimated 55,000 to 100,000 are undocumented. An exact count is difficult because they are not part of the Census, and many hide their immigration status.

"There is a misperception that everyone will be covered by the law,'' said Andrea Rynn, director of public and government relations for Western Connecticut Health Network, which includes Danbury Hospital and New Milford Hospital. Uncompensated care costs Danbury Hospital $14.3 million and New Milford Hospital $1.8 million in fiscal 2012.

Leticia Colon, outreach public relations coordinator for Optimus Health Care, worries that hospital budget cuts will leave uninsured patients, including undocumented immigrants, with limited access to the specialized expertise and services only found at hospitals.

"What is going to happen to these human beings who cannot afford coverage or do not qualify for any insurance because of their legal status?" asked Colon. Optimus Health Care operates federally funded health clinics in Bridgeport, Stamford and Stratford that serve special populations, including the uninsured, underinsured and undocumented.

"A lot of times, you'll find (uninsured) Asian Pacific Americans accessing emergency treatment instead of going to a primary care physician. They don't access services until it gets so severe they can't take it anymore," said Mui Mui Hin-McCormick, executive director of Connecticut's Asian Pacific American Affairs Commission, which represents 50 countries.

"We want to be in a position where (undocumented immigrants) can go to the doctor for preventive services, which is key to health care reform," added Yanil Teron, executive director of the Center for Latino Progress, which has a grant from Access Health to educate and enroll Hispanics in the new coverage options.

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."

So far, budget cuts have had a "fairly large impact'' on hospitals, leading to layoffs and cutbacks on new hires, patient services, research and technology - while millions are being spent to cover uncompensated care and government reimbursement shortfalls, said Stephen Frayne, senior vice president for health policy at the Connecticut Hospital Association.

Connecticut hospitals spent $504.2 million in 2012 to cover Medicaid reimbursement shortfalls, the first time the amount exceeds half a billion dollars, reports CHA.

A study from the UCLA Center for Health Policy Research and The Commonwealth Fund warns that safety-net hospitals in states with large concentrations of undocumented residents "will be particularly affected."

"All of our five hospitals function as safety-net hospitals. So sadly, we look at the elimination of DSH payments as another cut from the federal government because the additional revenues from some incremental bump in Medicaid enrollment will in no way" close the budget gap, said Dr. Rocco Orlando III, senior vice president and chief medical officer of Hartford HealthCare, which includes Hartford Hospital, The Hospital of Central Connecticut, MidState Medical Center, Windham Hospital and The William W. Backus Hospital.

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."

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).

http://www.theday.com/article/20131213/NWS01/312139944/-1/NWS

[Darnell 8,478]

Excellent News !

Bonus points for hiring 2 ICE Liason Staffers during the Christmas Season.

[The Nature Boy 4,224]

You mean illegal aliens I think ..I know the title thing

[RhettVoe 282]

I see a solution over the horizon....deportation. Cheaper than providing free health care to millions.

[lostinblue 1,989]

I see a solution over the horizon....deportation. Cheaper than providing free health care to millions.

Undocumented Democrats will not get sent home. We all need to support them for many years. Future kenyan voters you know..... It does not matter what destruction it does to the country,

[GandD 5,966]

Undocumented Democrats will not get sent home. We all need to support them for many years. Future kenyan voters you know..... It does not matter what destruction it does to the country,

Are you suggesting that undocumented people will be asked their party affiliation before a deportation decision is made or that all undocumented immigrants are Democrats?

[The Nature Boy 4,224]

Are you suggesting that undocumented people will be asked their party affiliation before a deportation decision is made or that all undocumented immigrants are Democrats?

I would suggest that you would have to live in an igloo with no TV or internet and have a 50 IQ to not know that the vast vast majority support dems. Also to not know that the Dream act Obama implemented was all about votes and that the Dems court them for a reason.

Would you need to go down the list of Augusta National members and ask to know most are Repubs?

[Dakine10 5,452]

Undocumented Democrats will not get sent home. We all need to support them for many years. Future kenyan voters you know..... It does not matter what destruction it does to the country,

"Undocumented democrats" can't vote. Who cares what party they support? just another red herring from a master baiter.

There were just as many of them when Republicans are in the white house. The political affiliation is not an issue except to those looking for something to whine about. Neither party wants to deal with the issue.

[Penny Lane 8,159]

Undocumented Democrats will not get sent home. We all need to support them for many years. Future kenyan voters you know..... It does not matter what destruction it does to the country,

There's going to be another Kenyan running for President?

[The Nature Boy 4,224]

"Undocumented democrats" can't vote. Who cares what party they support? just another red herring from a master baiter.

There were just as many of them when Republicans are in the white house. The political affiliation is not an issue except to those looking for something to whine about. Neither party wants to deal with the issue.

What % of Latinos swung Democrat the last election and why...Give me a break

[Darnell 8,478]

This is a Connecticut Problem.

Connecticut can choose to fix it, having a holding cell area with 2 ICE staffers. Their money drain will cease within 3 months as the word is spread around.

[GandD 5,966]

What % of Latinos swung Democrat the last election and why...Give me a break

Are you suggesting illegal immigrants won the election for Obama?

[Dakine10 5,452]

What % of Latinos swung Democrat the last election and why...Give me a break

I didn't post anything about Latino's and the topic is not about Latino's. We should try to stay on topic here. The board is already cluttered with spam.

I suggest you look up the definitions of "Latino's" and "undocumented immigrants" and we can continue once you've figured out the difference.

[Penny Lane 8,159]

Are you suggesting illegal immigrants won the election for Obama?

Illegal immigrants and all those people wanting free sh*t!

[Mr. Big Dog 10,747]

Illegal immigrants and all those people wanting free sh*t!

And the dead. Don't forget the dead vote. It made the difference.