For three days, the staff of an Orlando medical clinic encouraged a woman who called the triage line to go to the hospital. She resisted, frightened by a 2023 Florida law requiring hospitals to ask if a patient was in the United States with legal permission.
The clinic had worked hard to explain the limits of the law, which was part of Gov. Ron DeSantis’ package of stricter immigration policies. The clinic published signs and advised patients: They can refuse to answer the question and still receive care. Individual, identity information would not be reported to the state.
“We tried to explain this over and over and over, but the fear was real,” said Stephanie Garris, CEO of Grace Medical Home, adding that the woman eventually went to an emergency room for treatment.
Texas will be the next to try a similar law for hospitals enrolled in state health plans, Medicaid and the Children’s Health Insurance Program. It takes effect on November 1 – just before the end of the presidential election in which immigration is a key issue.
“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Texas Republican Gov. Greg Abbott said in a statement announcing his mandate, which differs from those of Florida in which providers do not have to tell patients that their status has won. Do not share with the authorities.
Both states have a high number of immigrants, ranging from people who are in the United States without legal permission to people who have pending asylum cases or who are part of mixed families. And while the medical rate without insurance in these two states – neither of which have expanded Medicaid – is higher than the national average, research has shown that immigrants tend to use less and spend less on health care.
Texas and Florida have a long history of challenging the federal government’s immigration policies by passing their own. And its Republican leaders say the hospital laws counter what they see as lax enforcement of the border by the Biden administration — although Florida’s early data is, by its own admission, limited.
Florida GOP state Sen. Blaise Ingoglia, who sponsored the hospital bill, said in a written statement that the law is “the strongest, and most comprehensive, state-led anti-ILLEGAL immigration law.” but he did not respond to The Associated Press’ questions about the impact of the law on the immigrant community or on the patients of the hospital.
Luis Isea, an internal medicine doctor with patients at hospitals and clinics in central Florida, said the law “creates that extra barrier” for patients who are already exposed to many disparities.
Immigrant advocacy groups in Florida said they sent thousands of text messages and emails and held clinics to help people understand the law’s limitations — including that law enforcement agencies the law does not know the status of the individual because the data will be reported in aggregate.
But several calls for outreach from health workers went unanswered. Some patients said they were leaving Florida because of the law’s impact on health care and jobs; The DeSantis administration tied the hospital mandate to other initiatives that invalidated some driver’s licenses, criminalized the transportation of migrants who lacked permanent status, and changed employment verification policies.
Verónica Robleto, program director at the Rural Women’s Health Project in north central Florida, received a call before the law took effect in July 2023 from a young woman who did not have legal permission to be in the United States and fear that she will be separated. from her child if she gave birth in the hospital.
“He was very scared (but) he ended up going after talking to me,” Ms. Robleto said.
Whatever data Florida and Texas collect will likely be unreliable for several reasons, the researchers suggest. Health economist Paul Keckley said the report released by Florida state officials could have “incomplete or inaccurate or misleading” data.
For one, it is self-reported. Anyone can refuse to answer, an option chosen by nearly 8% of people admitted to the hospital and about 7% of people who went to the emergency room from June to December 2023, the Florida state report said . Less than 1% of people who went to the emergency room or were admitted to the hospital said they were in the United States “illegally.”
The Florida Agency for Health Care Administration acknowledged major limitations in its analysis, saying it did not know how much of the care provided to “illegal aliens” was unpaid. He also said he was unable to link high levels of uncompensated care with the level of “illegal aliens” coming into a hospital, saying it is “more associated with rural county status than illegal immigration percentages.” .
The agency did not immediately respond to requests for comment and more information. Their report noted that for most of the past decade, the amount of unpaid bills and uncollected debts held by Florida hospitals has decreased.
In Florida and Texas, people who are not in the United States legally cannot enroll in Medicaid, which provides health insurance for low-income people – except in the case of a medical emergency.
Several factors can affect the cost of care for people who are in the United States without legal permission, experts said, especially the lack of preventive care. That’s especially true for people who have progressive illnesses, said Dr. James W. Castillo II, the health authority for Cameron County, Texas, which has about 22% of the population without insurance compared to the state average of 16.6 %.
At that point, he said, “It’s usually much more difficult to treat, much more expensive to treat.”
Texas community groups, policymakers and immigration advocates are partnering with Every Texan, a nonprofit organization focused on public policy and health care access, to encourage people to doesn’t answer the status question, said Lynn Cowles with Every Texan.
And in Florida, deportation fears are easing, but questions remain about the law’s purpose.
“How much of this is substantive policy and good policy versus how it went, I leave for others to speculate,” said Ms. Garris with the Orlando clinic. “But I know that the practical effect of the law was insignificant and degrading for the patients who live here, work here. It’s just insulting.”
This story was reported by The Associated Press.