County Faces Big Tab for Alien Law : Immigration Reform May Cost Millions in Health, Social Services

The immigration reform legislation approved by Congress last year could cost San Diego County millions of dollars to provide various health and social services to newly legalized aliens, county supervisors were told Tuesday.

During a briefing on the potential local impact of the Immigration Reform and Control Act of 1986, county officials warned the supervisors that implementation of the law could be very costly and strain already overburdened health and welfare programs.

In particular, county officials fear that one provision of the law barring most newly legalized aliens from receiving federal aid based on need for five years could saddle the county with a multimillion-dollar burden of providing needed services.

“It’s going to be an incredible morass to try to implement, and in the meantime, it looks like the county is left holding the bag,” Supervisor Susan Golding said. “This is another example of legislation that is passed at another level of government . . . without many times a clear understanding of the impact that it has on the communities it affects.”

The central message that came through at Tuesday’s meeting is that county officials are worried about the potential financial and other impacts of the immigration law, but are not certain how worried they ought to be. That disquieting uncertainty exists because, as Golding put it, the county’s projections are “based on guesses that themselves are based on estimates, with the unknown mixed in.”

One of the major unknowns concerns how many of the estimated 90,000 undocumented aliens now living in San Diego County will apply for citizenship under the new law later this year. The task of trying to assess the law’s potential impact also is hampered by uncertainty over how much federal and state financial aid will be available to help compensate the county for the associated costs.

“We don’t really know if there are going to be two people or 2,000 people or 200,000,” Supervisor Brian Bilbray said. “We don’t really have the facts, and we won’t have them until it’s too late to plan for. We’ll just have to react to it.”

The new law is designed to curb illegal immigration to this country, primarily through sanctions against employers who hire undocumented aliens and a so-called “amnesty” clause enabling illegal aliens who have lived in the United States since 1982 to become legal residents.

Congress has authorized $1 billion a year for four years to reimburse state and local governments for providing health, education and social services to those new citizens. The cost of those services, however, is expected to substantially exceed that figure, prompting county officials’ concern that the shortfall will become their financial problem.

Under the immigration law, newly legalized aliens would be ineligible for five years for all federal assistance targeted at the poor, such as public housing and Aid to Families with Dependent Children (AFDC). Exceptions to that ban include emergency medical or pregnancy-related services, and certain limited benefits for the aged, disabled and persons under 18 years old.

That ineligibility provision could create a major financial burden for the county, which is required by state law to provide various health services to indigents. In short, the problem facing the county is that it will have to provide services for which federal funds will not be forthcoming and which it cannot pay for without reducing existing services. The supervisors plan to press state legislators for increased aid, but they acknowledge that obtaining additional money from Sacramento also will be difficult.

The areas of county government likely to be most affected by the new law, county administrators said Tuesday, are the departments of health and social services. To help coordinate the county’s planning for that impact, Bilbray has proposed the creation of an Office of Border Health Affairs within the Health Department.

The county reimburses the UC San Diego Medical Center for emergency medical care for indigents, regardless of their citizenship. In fiscal 1985-86, that program cost the county $5 million. About 80% of that, or about $4 million, went for treatment for undocumented aliens. Based on a 30% increase in emergency medical care for illegal aliens last year, county officials estimate that it could cost $1.5 million more to provide that care this year.

Another county program, County Medical Services, provides medical care only to indigents who are legal residents of the county. The current $44-million annual cost of that program also is expected to increase as now-illegal aliens become legal residents and, therefore, eligible to receive benefits.

A report prepared by the office of county Chief Administrative Officer Norman Hickey states that the County Medical Services program could become the “only inpatient health services program available to many . . . newly legalized aliens.”

“A likely prospect is that the demand for services could outstrip the level of funding provided by the state,” the report added, leaving the county with the choice of either spending general funds on the medical program or cutting services.

The immigration law also is expected to financially affect a variety of other health and welfare programs, including mental health services, aid to the physically handicapped and tuberculosis care. County officials estimate that newly legal residents could cause general relief costs to grow by as much as $7 million a year, but the exact magnitude of the potential impact on most programs remains unknown.

“That’s one of the most troubling things about this,” Golding said. “We know it’s going to cost more, but we don’t know how much more or where the money is going to come from.”