Young Conservatives of Texas Files Complaint With Bexar County AG Seeking Investigation into Free Care for Undocumented Immigrants

The Young Conservatives of Texas (YCT) has filed a complaint with the county's district attorney's office against the Bexar County Hospital District alleging that the hospital district is providing "illegal socialized medicine" by administering free non-emergency care to undocumented immigrants, the San Antonio Business Journal reports. The complaint is the group's second challenge to a state hospital district based on a legal opinion issued by state Attorney General John Cornyn (R) (Bailey, San Antonio Business Journal, 8/20). Last month, Cornyn said the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (national welfare reform) prohibits public hospitals from providing health services -- except emergency room care, immunizations, treatment of communicable diseases and care for child abuse -- to undocumented immigrants. Although Cornyn said that states may bypass the federal law with legislation, he said that "no such law exists" in Texas. After Cornyn issued the opinion, the YCT filed a complaint against Harris County's hospital district for continuing to provide care. In response, Harris County Attorney General Charles Rosenthal launched a criminal investigation (Kaiser Daily Health Policy Report, 7/31).

Care Not Free
Marc Levin, vice chair of YCT, said the group realizes the hospitals are providing care for "humanitarian" purposes, but said doing so is a "flagrant and costly violation of federal law." He added, "We think hospitals should be humanitarian ... [and] we know the [undocumented immigrants] don't make a lot of money. But [the hospitals] should at least work with these patients on long term payment plans." However, Leni Kirkman, a spokesperson for Bexar County's University Health System, said that contrary to what YCT suggests, the county hospital district "follows the letter and the spirit of the Texas Constitution" with its policies regarding care for undocumented immigrants. She noted that uninsured county residents are required to join the hospital system's CareLink program to receive non-emergency care. Patients then pay a monthly membership fee based on family size and income to receive treatment. "[I]n addition to their ad valorem contributions, uninsured residents, regardless of their immigration status, are paying at least part of the cost of the non-emergency services they receive," she said. While YCT has asked Bexar County District Attorney Susan Reed (R) to open an investigation into the county hospital district's policy, Reed said that she would not open an investigation "at this time," and instead would "watch" for developments in Harris County. "If Harris County wants to work a test case out of this, we can ... review where it leads," she said. However, she said that the issue was a "federal" concern that should be handled by the U.S. Attorney General's office (San Antonio Business Journal, 8/20).

NPR Reports on Controversy
With a million and a half undocumented immigrants living in Texas, hailing mostly from Mexico, hospital administrators were "stunned" when Cornyn cited the five-year-old federal law in his recent decision, NPR's "Morning Edition" reported on Aug. 22. State public hospital administrators have disputed Cornyn's decision, saying that expanding preventive care for health concerns "just makes sense." Parkland Hospital CEO Dr. Ron Anderson said, "It is mandatory under federal law to provide emergency services for people regardless of ability to pay or nationality, so if people wait until they get sick enough, we have to care for them. It's been our view from a good public health policy perspective we would provide preventive care so as to avoid the higher cost emergency care or hospitalization that we would be forced to provide." And Anne Dunkelberg, senior policy analyst at the Center for Public Policy Priorities in Austin, Texas, said that the attorney general's opinion may result in thousands of undocumented immigrants being turned away from public hospitals and "forced to live with" chronic, serious, but non-emergency ailments that "if ... not treated properly, can lead to some fairly catastrophic health conditions and expensive emergency room and patient bills, that the local governments might be able to avoid." For his part, Cornyn seems to have "distanced himself" from his opinion's consequences, according to "Morning Edition." Cornyn spokesperson Jane Shepperd said, "The decision to treat people is not a decision that can be made by the attorney general of Texas. It is a decision that is made at the local level, at the county level." However, Cornyn's office also "seems to be warning" the hospital districts, as Shepperd noted, "A county hospital that provides other health care services free of charge or at a reduced cost can jeopardize its future federal funding." The audio report will be available online after noon ET ("Morning Edition," NPR, 8/22). For further information on state health policy in Texas, visit State Health Facts Online.