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 Health & Beauty | September 2007 
US Cancer Ruling Heats Up Immigration Debate
 BYLINE
| | Several hundred skilled immigrants, including doctors and engineers, rally on Capitol Hill in Washington to protest long delays in obtaining green cards. Federal officials have declared Medicaid will no longer approve reimbursement to states for illegal immigrants' chemotherapy treatments. (Jahi Chikwendiu/Washington Post) |
Chemotherapy for illegal immigrants no longer covered under Medicaid.
A long-simmering argument over what constitutes emergency medical care is shifting the financial burden for treating illegal immigrants with cancer to individual hospitals and charities, medical providers said Monday, adding fuel to the wider debate over immigration that has become a big issue in the presidential campaign.
Under federal law, Medicaid, the health care program for the poor, splits the cost of emergency medical treatment for undocumented aliens with the state. That provision has been the focus of dispute among state and federal officials since November 2001, however, when the federal government issued guidelines clarifying that dialysis and chemotherapy were to be considered treatments for chronic conditions, not emergencies.
Since then, the impact of the new definition has slowly become apparent as the federal Centers for Medicare and Medicaid Services, or CMS, conducts state-by-state audits of Medicaid emergency payments and declares that Medicaid will no longer approve reimbursement for illegal immigrants' chemotherapy treatments.
Last month, CMS sent such a notice to New York officials after a 3.-year-long audit, The New York Times reported in its Saturday editions, sparking a protest from state health officials.
Taking Decisions Out of Doctors' Hands
"It just doesn't make medical sense," said Richard F. Daines, the state's health commissioner, who maintained that a patient's doctor should be the sole judge of whether a condition is an emergency.
"An emergency is something that's acute and potentially life-threatening, and the position before has always been to let the patient's physician define that it's an emergency," Daines said Monday in an interview with MSNBC's Chris Jansing.
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, agreed.
"It's doctors who define emergencies, and no doubt some of these chemotherapy things are going to be emergencies to the people who have them," said Caplan, who suggested that doctors were being put in a bind in the service of politics.
"I know there are many who want to use this as a kind of pawn - including, apparently, the Bush administration - in this whole battle over illegal immigrants," said Caplan, a health columnist for MSNBC.com.
Fair Payment, Not Unfair Treatment
Illegal immigration has become a major issue in the presidential campaign, and some candidates have highlighted the costs of treating illegal immigrants as a contributor to rocketing medical costs.
Sen. Hillary Clinton of New York, who is leading the polls in the race for the Democratic nomination, said Sunday that "illegal immigrants would not be covered" under the health care plan she announced this month. Former Sen. John Edwards, D-N.C., has made the same promise, as have many of the Republican candidates.
The question is not whether illegal immigrants will be turned away from the emergency room. Instead, the question is who will bear the burden - the state and federal governments, or hospitals already straining under flat budgets and booming demand for care.
There are no figures cataloguing the costs of chemotherapy for illegal immigrants, but government figures show that overall payments under the emergency Medicaid program for illegal immigrants have risen 57 percent since the turn of the century. The RAND Corp., meanwhile, found in 2005 that about 70 percent of illegal immigrants had no health insurance.
That suggests that absorbing 100 percent of the costs for often highly expensive chemotherapy treatments could be difficult for hospitals and those states - about half of them - that have not already committed to covering the costs themselves.
"Our hospitals aren't in the business of denying treatment. This is [about] getting fair payment for the treatments that they render," Daines said. "Our options are to continue to use state sources of funding, charitable care and hospitals' taking a loss on that care."
Law Mandates Treatment But Won't Pay For It
But Caplan said there might be hope for doctors and other medical administrators if the dispute ever makes it to court.
"If anybody shows up at an emergency room, there's a federal law that requires that they be treated," Caplan said. "I don't think the federal government is going to have much to stand on to say they're not going to contribute their share."
That law is the Emergency Medical Treatment and Active Labor Act, which defines an emergency as a condition that "could reasonably be expected" to result in, among other things, "serious impairment to bodily functions, or serious dysfunction of any bodily organ or part."
In the view of Daines - and of officials in Arizona and Washington state, which have also wrangled with EMC over the ruling - that covers many manifestations of cancer, such as internal bleeding from breast cancer or intestinal blockages from colon cancer.
"We know that there are certain medical emergencies that need to be treated with chemotherapy," Daines said. "... It clearly falls within the intention of the Medicaid program."
"The ethic is you treat everyone the same," Caplan said. "You don't sort out the illegals from the poor from the rich...."
"If we start doing that, we're going to start losing lives, because that takes time and gets in the way of delivering care quickly."
MSNBC's Chris Jansing contributed to this report.
New York, Faulting US, Says It Will Pay for Cancer Care for Illegal Immigrants
Sarah Kershaw - NYTimes
go to original
Gov. Eliot Spitzer, stepping into a brewing battle between federal and state health officials over emergency medical care for illegal immigrants, called a new federal directive to limit coverage "morally and clinically and legally wrong" yesterday and said he was prepared to sue the federal government over it.
Federal health officials have told New York State that they will no longer help cover the cost of chemotherapy for illegal immigrants with cancer because it does not qualify under an emergency Medicaid program. But yesterday, state health officials said they would cover all the costs no matter what the federal government does.
The state health commissioner, Richard F. Daines, who joined Mr. Spitzer yesterday at a news conference in Manhattan, said the state would pay the full cost of chemotherapy for illegal immigrants, estimated at $5 million to $10 million annually.
That announcement, coming after weeks of intense lobbying by advocates for immigrants, marked a reversal of the state's position of only two weeks ago, when state officials said New York could not shoulder the costs itself.
Most illegal immigrants are not entitled to Medicaid coverage, except for emergency care. At the crux of the New York dispute is what constitutes an emergency. The federal government said the New York claims did not qualify because they were part of continuing treatment plans. Other states and Medicaid experts say the Bush administration has been more closely scrutinizing and challenging state spending on health care for illegal immigrants, touching off criticism that bureaucrats, not doctors, are being allowed to make life-or-death medical decisions.
The dispute in New York, home to more than 500,000 illegal immigrants, comes as many states are fighting proposed federal restrictions under the national health insurance program for poor children.
"They are picking on the most vulnerable populations - here immigrants who need chemotherapy, alternately children who are without health insurance - and saying to those two groups, 'You will bear the brunt of our new-found fiscal conservatism,' " Mr. Spitzer said at the news conference, held at Bellevue Hospital Center, which serves a large number of illegal immigrants. "It is wrong. It's bad policy."
Officials with the federal Centers for Medicare and Medicaid Services declined to comment yesterday on New York's challenge.
After an audit of New York's Medicaid spending, the centers told the state in August that it should stop filing reimbursement claims for chemotherapy for illegal immigrants.
The State Health Department on Friday sent a letter of protest to federal officials, but has received no response, officials said.
From 2001 to 2006, the federal government denied the state about $11 million in matching funds for the cancer treatment, state officials have said. They have not yet decided whether to try to recoup the money.
Advocates for immigrants praised the governor for taking up the cause.
"He's doing the right thing," said Adam Gurvitch, director of health advocacy with the New York Immigration Coalition, which represents more than 150 advocacy organizations.
But critics said that at a time when millions of uninsured American citizens are struggling to pay for health care, the government should not be subsidizing the care of illegal immigrants.
"For every million on chemotherapy for an illegal immigrant, something has to give somewhere," said Steven Camarota, director of research at the Center for Immigration Studies, a research group in Washington. "There's no printing press for money in New York City."
The crux of the problem, he said, is that large numbers of unskilled immigrants in the country work at low-paying jobs with no health insurance.
Under state law, New York cannot turn away anyone in need of emergency medical care. If a patient is not covered by private or public insurance, hospitals can seek reimbursement from a state fund, but state officials said the $847 million fund is not sufficient.
Winter Miller contributed reporting. |
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