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By Pawel Styrna

In late March, the State of Florida released a report showing providing health care for illegal aliens cost the state $566 million in 2022.  The report was published by the Florida Agency for Health Care Administration (FAHCA), which describes itself as “the chief health policy and planning entity for the state.” FAHCA is responsible for administering Florida’s Medicaid program, the licensure of the state’s health care facilities and the sharing of health care data.

The report, one of the first of its kind among the states, is the result of pro-enforcement legislation (SB 1718) signed into law by Governor Ron DeSantis in May 2023. Among its many valuable provisions is a requirement that Florida hospitals that accept Medicaid collect the immigration status of patients and report that data quarterly, along with the total number of admissions and emergency room visits.  Then, the FAHCA, using that data and other cost data available, calculates the cost of uncompensated care provided to illegal aliens.

The methodology of the FAHCA report was simple. Based on hospital admissions and emergency department visits during the second half of 2023 (third and fourth quarters), FAHCA applied the percentage of patients who stated they were not lawfully present (0.82 percent) to the total annual hospital operating expenses in 2022 (the last full year of available cost data).

The FAHCA report makes clear that any uncompensated medical care offered to illegal aliens will have a negative impact on healthcare resources for all Floridians. To fill the gap, hospitals will have to resort to passing on the increased costs to “regular paying customers, insurers [through higher reimbursement requests], and government payers in order to remain viable and continue to deliver services.” Another important factor, according to the report, “is that as additional strain is placed on the health care system through increased utilization of services, operating costs will increase in the form of more nurses, hospitals [sic] beds, and equipment.”

Furthermore, the $566 million cost estimate presented by FAHCA is likely to be an underestimate. This is because even though hospitals are required by law to inquire about immigration status, patients may refuse to answer. In fact, the number of patients who declined to answer was nearly 9 times the number of patients who said they were not lawfully present (486,235 versus 54,444). Many of those declining to answer are likely to be illegal aliens, as there is little reason for anyone lawfully in the U.S. to not answer.

Despite the conservative nature of the estimate, the report and its findings were attacked by open borders advocates. Some have taken issue with the report’s methodology, arguing that it focuses only on expenses incurred without taking into account potential patient payments or reimbursements. However, the methodology suggests otherwise as the calculation is based on a percentage of uncompensated care, which excludes reimbursements by government programs, insurance, or self-pay.  As Rep. Randy Fine, a co-sponsor of SB 1718, said “generally, [these costs get] paid back in one of two ways, either higher prices on Americans or reimbursement from the state,” i.e. from Florida taxpayers.

Other critics complained that FAHCA could not find a direct correlation between uncompensated care and the number of illegal aliens the reporting hospitals served.  The official report doesn’t directly address this issue, but the agency discussed it in a briefing it gave to state legislators.  While it is hard to address this point without more data, the failure to draw a correlation could be due to the fact that patients are not required to report their status, and, as noted above, the number of patients that declined to report was 9 times the number that reported they were not lawfully present.

The pro-mass-immigration lobby is understandably uncomfortable discussing costs incurred by illegal aliens. Indeed, the Director for the Florida Center for Fiscal and Economic Policy said, “It’s all just a colossal waste of resources to even be focused on this.”

FAIR, however, has estimated in its cost study on the fiscal burden of illegal immigration that Florida taxpayers are on the hook for over $8 billion in annual costs (as of early 2023) attributable to illegal immigration across a range of expenses (education, health, welfare use, incarceration, etc.) This includes $4 billion for education and $1.6 billion for law enforcement expenses, while the remaining $2.4 billion goes to public assistance, general government services expenses, and healthcare. This means that, methodological criticisms aside, Florida’s cost estimate appears reasonable.  The estimate may also become more refined moving forward as the state will be collecting full-year data, which was not possible this year because the law only took effect in July 2023.

FAIR believes the American people deserve to know how much they are being forced to pay for health care provided to illegal aliens.  An increase in uncompensated care provided to illegal aliens will increase the cost of healthcare for all Americans– especially if the illegal immigration population continues to increase.

Author: FAIR


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