Officials of R.E. Thomason Hospital in El Paso, Texas, know well the financial toll of providing care to illegal immigrants.
As a public hospital in the largest Texas city bordering Mexico, Thomason must depend on local tax support to finance care to an increasingly large number of undocumented immigrants, care that costs the hospital an estimated $15 million a year.
For the fiscal year beginning Oct. 1, the hospital receives $20.7 million in city and county tax support for operations. That funding level hasn't increased in three years.
"Everybody keeps passing the buck," laments Pete Duarte, the hospital's chief executive officer. But, as the county's Level I trauma center, Thomason won't pass the buck. The next closest trauma center is 250 miles away in Albuquerque, N.M..
Thomason serves a border region of 600,000 residents in El Paso and another 800,000 in Ciudad Juarez, Mexico.
Last month, the state of Texas said the buck needs to stop at the doorstep of the federal government, and it is preparing to sue over the issue.
Texas Attorney General Dan Morales hopes to recover from Washington the estimated $1 billion in total costs the state incurs for services to some 550,000 undocumented immigrants, including healthcare, education, social services and law enforcement activities.
However, the $1 billion figure is low compared with estimates prepared earlier this year.
The nearly 2 million immigrants who have settled legally and illegally in Texas since 1970 cost state taxpayers $4.7 billion in 1992, according to a new study released earlier this year by Donald Huddle, an economics professor at Rice University, Houston. That amounts to $270 for each of Texas' 17.6 million citizens, he said.
Mr. Huddle also calculated that the costs will reach $6.7 billion by 2002 from the influx of 920,000 new legal and 340,000 illegal immigrants expected to settle in Texas during the next 10 years.
Mr. Huddle's cost figures are higher than those of some other organizations because they include a wider range of benefits available to legal immigrants, such as state costs for Aid to Families with Dependent Children.
However, officials with the Washington-based Urban Institute said Mr. Huddle underestimates the economic benefits of immigration. Urban Institute researchers have calculated that, nationally, legal and undocumented immigrants pay $70 billion in taxes each year. Mr. Huddle puts the figure at $20 billion.
Obviously the benefits of immigration are a key issue in Texas, which is expected to reap significant economic benefits from the North American Free Trade Agreement. By the year 2000, Texas is expected to gain $160 billion from trade with Mexico, up from $75 billion in 1992, according to a study by Perryman Consultants, Waco, Texas. Those expenditures likely will include increased business for Texas healthcare providers that may expand to Mexico or attract Mexican nationals across the border to their medical centers.
Even so, health officials differ on whether the effects of NAFTA will be positive. Thomason's Mr. Duarte fears the worst. Border communities' populations will increase, he predicts, and "we have never been able to build the infrastructure" to deal with them.
However, the booming economy in Texas border communities has benefited some hospitals there.
For example, last month, Universal Health Services won a bidding war for 94-bed Edinburg (Texas) Hospital. The King of Prussia, Pa.-based firm will buy the not-for-profit hospital in a deal valued at more than $44 million.
Edinburg is located in Hidalgo County, the nation's fourth-fastest-growing metropolitan area from 1990 to 1992, according to Census Bureau reports.
Universal owns another hospital in that county, 428-bed McAllen (Texas) Medical Center, which recently was expanded and has been the hospital chain's most profitable (June 6, p. 10).
Hospitals on the border, however, have been helped significantly by Medicaid's disproportionate-share program, which pays higher reimbursement rates to hospitals that treat large numbers of the poor. Even so, federal funding for that program is being cut and may be eliminated under some healthcare reform proposals.
About 64% of the $16 billion in Medicaid funding spent in Texas comes from the federal government.
Texas officials claim the healthcare costs of immigration are just a symptom of long-ignored border health problems. Texas' border population is larger than New Mexico's and Arizona's, and poorer than California's, according to figures compiled by the state comptroller's office. In a new report, Texas Comptroller John Sharp estimated that 35% of the population in Texas border communities lives below the poverty rate, compared with 11.5% in California.
Texas health officials have advocated the establishment of a U.S.-Mexico Border Health Commission, and urged that it be included in healthcare reform legislation. Earlier this year, Laurance Nickey, M.D., director of the El Paso City-County Health and Environment District, told a congressional panel that the border's health issues must be addressed soon.
"How will an employer-based healthcare system meet the needs of unemployed resident aliens?" Dr. Nickey asked about the reform bills under consideration. "Medicaid and local funds are already stretched to the limit."