Hospital board struggles over whether or not to provide care for illegal immigrants

May 15, 2009

A heated issue confronts JPS
By Patrick McGee
Fort Worth Star-Telegram
Friday, August 24, 2007

JPS board members are caught in a struggle involving immigration law, public health and public demands.

The already sticky issue of providing free healthcare for Tarrant County’s illegal immigrants is complicated by a clash between a consultant’s prediction of high costs to serve them and past data.

A report by an Austin-based consultant predicts that tens of thousands of illegal immigrants would sign up if JPS Health Network let them into Connection, the county hospital’s free preventive healthcare program for poor people. The cost would total more than $40 million in the first year and climb to more than $100 million in 10 years, according to Phase 2 Consulting.

Opponents of extending more care to illegal immigrants hold up the report as another example of illegal immigrants soaking up public services at a huge cost to the taxpayer.

But data from 2004, when illegal immigrants were allowed to enroll for eight months, suggest that the enrollments, hospitalizations and costs would be much smaller. The numbers from the consultant’s report are too high to be believable, say immigrant advocates and members of JPS’ board of managers who favor opening Connection to illegal immigrants.

“Not only do I question the report, but I hope that board members question the report based on data from 2004,” said Tonya Veasey, a member of the board of managers who favors opening Connection to illegal immigrants. “I know I’m going to get in trouble for saying this, but I am not surprised that JPS would pay for a report that would justify not changing the policy.”

Board Chairwoman Erma Johnson Hadley, who voted to bar illegal immigrants from Connection in 2004, said the $145,000 consultant’s report has reliable numbers. She said illegal immigrant enrollment could easily meet the high levels that Phase 2 predicts because immigrant advocates will surely get the word out that a new healthcare service has become available.

Indeed, one of the leaders of Allied Communities of Tarrant, the main group campaigning to open Connection to illegal immigrants, said the group is already telling illegal immigrants that JPS is expanding school clinics, which are open to all students.

County Judge Glen Whitley, head of the Tarrant County Commissioners Court, which appoints the JPS board, said the 2004 data cover too short a time to be meaningful.

“You’re not going to convince me that eight months has any relevancy to what happens over the long term,” he said.

Tense debate

Many of the JPS board meetings have been marked by county residents coming to urge them to keep illegal immigrants out of Connection.

“Taxpayers want to be fair and help the unfortunate, but you don’t want to be a sucker either,” said Dennis Killy of Arlington, who has attended the meetings. “If they shouldn’t be here, and they broke the law by coming here, we shouldn’t accommodate them in any way.”

Allied Communities has also been a constant presence, arguing that opening Connection to illegal immigrants is the humanitarian thing to do and smart health policy. Their report estimates that opening Connection to illegal immigrants would cost between $2 million and $4.2 million annually.

The wrangling over what to do in Tarrant County is part of the national debate. People get angry over illegal immigrants’ use of publicly funded hospitals because they see healthcare as riddled with so much wasteful spending, said James Smith, an economist at the RAND Corp., a think tank in Santa Monica, Calif.

“If you were concerned about the dollars, you would be debating schools, not healthcare,” Smith said. “But people have a sense that schools are good things, and healthcare is wasteful in many cases.”

Illegal needs

Allied Communities leaders introduced the Star-Telegram to three illegal immigrants who said they need care but can’t afford it. They live in Fort Worth and are originally from Mexico. They spoke to the Star-Telegram on the condition that their last names not be used.

Petra, 57, said she has sold scrap metal and her jewelry to try to come up with the money she needs to have a tumor removed from her breast. She said hospital officials quoted a different price on three different occasions, each higher than the last.

Petra said she will not ask more details about the cost or tell doctors about other symptoms she has because she fears it would just increase the bill. She does not know what she will do if she cannot raise enough money.

Enedelia, 45, who has tumors in her uterus, said she might return to Mexico to seek medical care.

Claudia, 37, said JPS would not remove steel pins set in her broken ankles until she paid $5,000. She said she found a private doctor to remove them six months after they were supposed to be out.

“I think they should give us an opportunity to pay in installments; they shouldn’t turn us down completely,” she said. “Many of us here without documents came to work, and I think working is not a crime. We can’t have all the rights as a U.S. citizen, but at least healthcare should be a right.”

Peter Fears, Allied Communities lead organizer, said excluding illegal immigrants from Connection can put U.S. citizens at risk.

“You don’t want people with contagious disease going to school or going to the mall,” he said.

The 2004 experience

JPS let illegal immigrants enroll in Connection in January 2004 when a new state law seemed to require public hospitals to extend indigent care to all regardless of immigration status. When a state attorney general’s opinion said hospitals had discretion, the board voted 6-4 in August 2004 to bar illegal immigrants.

Illegal immigrants were out, but data on their use of the program surfaced in a November 2004 staff report. Only a fifth as many illegal immigrants enrolled and only a third of them were hospitalized in 2004 compared with what Phase 2 says would have happened in the first six months of 2007. Care for illegal immigrants cost Connection less than $1.2 million for the first six months, not including professional fees. Phase 2 says it would have cost $9.85 million, including professional fees, for the first six months of 2007.

George Gilbert, an associate math professor at Texas Christian University, reviewed the 2004 numbers and the report and said he would not trust the report.

He said that if he were a board member, he would want to consult the 2004 data.

Phase 2 Consulting’s report also predicts that 27 percent of eligible illegal immigrants would use Connection if it opened to them.

The report based the 27 percent figure by averaging the percentage of eligible poor people who use public hospitals’ free care programs in Dallas, Houston, San Antonio and El Paso. Illegal immigrants are allowed into all four of those programs.

Gilbert said the portion of people using each hospital’s program for the poor varied too much for an average of all four of them to be a trustworthy number.

He said he would feel more comfortable using Dallas County as the comparison because it seems the most likely to be similar to Tarrant County. Seventeen percent of poor people use the indigent care program in Dallas County.

“The 27 percent seems to me questionable,” Gilbert said. “I wouldn’t trust 27 percent more than 17 percent.”

Splintered board

The debate is expected to come down to a board vote next month. A close vote is expected, but too many board members refused to say what they will do to make any prediction possible.

In 2004, board member Steve Montgomery voted with the minority to keep illegal immigrants in Connection and said he will vote the same way next month.

“It is the sensible thing to do, and it’s the right thing to do,” he said. “I know people say, ‘What part of illegal don’t you understand?’ I ask, ‘What part of contagious don’t you understand?’”

Scott Fisher, who was not on the board in 2004, said he is reluctant to have taxpayer dollars serving illegal immigrants.

“As a Republican, I’m very opposed to taxpayer-funded benefits for noncitizens or nonlegal residents,” Fisher said. “Ultimately, it comes down to should the taxpayers of Tarrant County be forced to give services to people who are not here legally.”

Whitley said he wishes the board would not even take up the issue. He wants to avoid having the kind of fights Farmers Branch saw among the public when the City Council pressed forward with a ban on renting apartments to illegal immigrants.

Whitley acknowledged that not voting on the issue would continue to keep illegal immigrants out of Connection: “I think what the taxpayers are saying at this point in time is they don’t want to see the tax dollars go there.”

Whitley said he would like to address the issue by establishing federally funded, locally managed health clinics that see anyone who walks in the door.

Enedelia, the illegal immigrant with tumors in her uterus, said she has been to the one such clinic in Fort Worth. The clinic can give her morphine for the pain but cannot perform surgery to remove the tumors.

Many board members do not want to say what they will do about tough cases like this.

Don O’Neal, who was not on the board in 2004, epitomized the difficulty of the issue by equivocating over how he will vote.

“I appreciate the ACT people that have real compassion for people and want to help,” he said. “I also appreciate the taxpayers who are tired of more and more taxes. You know, they all have valid points.”