President Obama’s health care law is putting new strains on some of the nation’s most hard-pressed hospitals, by cutting aid they use to pay for emergency care for illegal immigrants, which they have long been required to provide.
The federal government has been spending $20 billion annually to reimburse these hospitals — most in poor urban and rural areas — for treating more than their share of the uninsured, including illegal immigrants. The health care law will eventually cut that money in half, based on the premise that fewer people will lack insurance after the law takes effect.
But the estimated 11 million people now living illegally in the United States are not covered by the health care law. Its sponsors, seeking to sidestep the contentious debate over immigration, excluded them from the law’s benefits.
As a result, so-called safety-net hospitals said the cuts would deal a severe blow to their finances.
The hospitals are coming under this pressure because many of their uninsured patients are illegal immigrants, and because their large pools of uninsured or poorly insured patients are not expected to be reduced significantly under the Affordable Care Act, even as federal aid shrinks.
The hospitals range from prominent public ones, like Bellevue Hospital Center in Manhattan, to neighborhood mainstays like Lutheran Medical Center in Brooklyn and Scripps Mercy Hospital in San Diego. They include small rural outposts like Othello Community Hospital in Washington State, which receives a steady flow of farmworkers who live in the country illegally.
No matter where they are, all hospitals are obliged under federal law to treat anyone who arrives at the emergency room, regardless of their immigration status.
“That’s the 800-pound gorilla in the room, and not just in New York — in Texas, in California, in Florida,” Lutheran’s chief executive, Wendy Z. Goldstein, said.
Lutheran Medical Center is in the Sunset Park neighborhood, where low-wage earning Chinese and Latino communities converge near an expressway. Hospitals are not allowed to record patients’ immigration status, but Ms. Goldstein estimated that 20 percent of its patients were what she called “the undocumented — not only uninsured, but uninsurable.”
She said Congressional staff members acknowledged that the health care law would scale back the money that helps pay for emergency care for such patients, but were reluctant to tackle the issue.
“I was told in Washington that they understand that this is a problem, but immigration is just too hot to touch,” she said.
The Affordable Care Act sets up state exchanges to reduce the cost of commercial health insurance, but people must prove citizenship or legal immigration status to take part. They must show similar documentation to apply for Medicaid benefits that are expanded under the law.
The act did call for increasing a little-known national network of 1,200 community health centers that provide primary care to the needy, regardless of their immigration status. But that plan, which could potentially steer more of the uninsured away from costly hospital care, was curtailed by Congressional budget cuts last year.
That leaves hospitals like Lutheran, which is nonprofit and has run a string of such primary care centers for 40 years, facing cuts at both ends.
On a recent weekday in Lutheran’s emergency room, a Chinese mother of two stared sadly through the porthole of an isolation unit. The woman had active tuberculosis and needed surgery to drain fluid from one lung, said Josh Liu, a patient liaison.
The disease had been discovered during a checkup at one of Lutheran’s primary care centers, where the sliding scale fee starts at $15. But the woman, an illegal immigrant, had no way to pay for the surgery.
Another patient, a gaunt 44-year-old man from Ecuador, had been in New York eight years, installing wood floors, one in Rockefeller Center. The man had been afraid to seek care because he feared deportation. Finally, the pain in his stomach was too much to bear.
Dr. Daniel J. Giaccio, leading the residents on their rounds, used the notches on the man’s worn belt to underscore his diagnosis, severe B-12 deficiency anemia. The woodworker had lost 30 pounds in a month, and his hands and feet were numb. Reversing the damage could take months.
“This is a severe case of sensory loss,” Dr. Giaccio said. “Usually we pick it up much sooner.”
In some states, including New York, hospitals caring for illegal immigrants in life-threatening situations can seek payment case by case, from a program known as emergency Medicaid. But the program has many restrictions and will not make up for the cuts in the $20 billion pool, hospital executives said.