A provision in both the House- and Senate-passed immigration bills would increase uncompensated care by forcing hundreds of thousands of legal immigrants off Medicaid, hospital groups contend.
Both bills would require that the income of a legal immigrant's sponsor be considered as if it were the immigrant's income when determining eligibility for Medicaid.
For example, if a family with a combined income of $100,000 were to sponsor a legal immigrant who became unemployed, the immigrant still would be considered to have $100,000 in annual income, far above the Medicaid eligibility limit. Therefore, the immigrant would not qualify for Medicaid.
A number of welfare programs already consider the sponsor's income in determining eligibility, but this would be the first time the requirement would apply to Medicaid.
According to Congressional Budget Office estimates, making it tougher for legal immigrants to become eligible for Medicaid would save the federal government more than $2.7 billion over six years. State spending would decrease by a similar amount, meaning total Medicaid spending would decrease by more than $5 billion during the period.
"This will definitely lead to more uncompensated care," said Carl Luggiero, senior associate director of congressional relations for the American Hospital Association, one of the groups opposing the so-called "deeming" provision.
Luggiero said the costs of the bill would be felt disproportionately by states that have a high number of legal immigrants, including California, Florida, Illinois, New York and Texas.
Proponents of the plan say it's needed to reduce some of the enticements to illegally immigrate to the United States and to redirect Medicaid resources to U.S. citizens.
The Senate passed its version of the bill by a nearly unanimous vote May 2, and the House passed its version earlier this year. House and Senate staff have been working to hash out the differences between the bills; however, formal negotiations are not expected to begin until after Congress returns from its Memorial Day recess.
In a letter to lawmakers, a coalition of 20 hospital groups wrote that "many sponsors may be unwilling or unable to finance the healthcare costs of the immigrants they sponsor. Yet, because (of the bills' provisions), legal immigrants will be ineligible for Medicaid, although they will still need care."
Because both the House and Senate bills would require the federal government to consider a sponsor's income for purposes of Medicaid eligibility, hospital lobbyists say it will be nearly impossible to eliminate the provision from the final version.
However, a few measures in the House plan are preferable to the Senate version, the hospital groups said in their letter.
For example, the House plan would exempt emergency medical services and treatment for diseases that pose a public health hazard. The House bill also applies only to legal immigrants who enter the country after the bill is enacted, while the Senate bill would make the provision retroactive for a five-year period.