Lawsuit Filed Over Immigrant Medical Costs

Supporters of stricter immigration law enforcement have filed suit against Los Angeles County in an effort to force health officials to seek reimbursement from the sponsors of legal immigrants for medical services the patients receive from public hospitals.

Sponsors of legal immigrants to the United States must submit an “affidavit of support,” promising to pay for certain public services -- such as non-emergency medical assistance -- as part of the admissions requirements for the immigrant. The law was introduced in 1996 and was billed by supporters as a means to prevent the U.S. welfare system from serving as a primary magnet to newcomers.

But Los Angeles County, along with most other local governments throughout the state, have never sought to bill the sponsor of an immigrant. As a result, the plaintiffs contend, taxpayers end up paying for medical costs that the immigrants or their sponsors should pay.

“The law is outlined, but the county has been able to ignore it,” said James E. Bame, attorney for the plaintiffs. “Given the current California budget crisis, it is important for looking at areas where [financial] waste is established.”

Backers of the suit believe that, if successful, the case could have a ripple effect and subsequently obligate state governments and hospitals across the country to collect money from the sponsors of immigrants.

It is impossible to say what percentage of Los Angeles County patients are legal immigrants with sponsors because such information is not documented, but it is estimated that 800,000 patients are low-income adults and children.

“Only a subset of immigrants are going to have sponsors, and only a few will have sponsorship liability,” said Gabrielle Lessard, staff attorney for the Los Angeles branch of the National Immigration Law Center, which works to promote the rights of low-income immigrants.

A sponsor’s obligation to financially support a legal immigrant expires once the immigrant becomes a citizen or has fulfilled a minimum standard for working in the United States, generally a maximum of 10 years, Lessard said.

Lawyers for the Department of Health Services argue that there is no legal mandate that requires the county to fulfill the plaintiffs’ demands by inquiring into the details of a legal immigrant’s sponsorship. And such a task would be expensive and cumbersome.

“We have to consider the time involved, the human resources, the cost of collection,” said Sharon Reichman, the county’s lead attorney in the case.

“It’s not as simple as simply sending out a bill. This is a very complex area, just deciding which services are actually billable, let alone who is responsible,” she added. “The crux of the matter is the cost-benefit analysis: What is it going to cost to go through these efforts, versus what is going to be gained?”

Few, if any, states bill the sponsors of legal immigrants for reimbursement of healthcare-related funds, said Lessard, the health policy attorney.

“States have just not implemented sponsor liability into their healthcare programs, because it is administratively burdensome, they are unlikely to get any kind of reimbursement, it’s not cost effective,” she said.

A hearing in the lawsuit, filed last year by residents Terry Anderson and Hal Netkin, is scheduled next week.

The Washington-based Friends of Immigration Law Enforcement, a volunteer association of attorneys, researchers, law enforcement officers and legislators working to ensure that immigration laws are upheld, is sponsoring the suit. The plaintiffs are listed as Anderson and Netkin because California taxpayers are needed to file the suit against Los Angeles County, lawyers explained.

“We are concerned by the widespread disregard for immigration law,” said Craig Nelson, executive director of the association. “Whatever the law is, it has to be respected by either Americans or foreigners.”

Nelsen said that almost 1,000 Californians had signed up on his group’s website to be included as plaintiffs in the case, and to support other causes relating to tighter immigration law enforcement in California.

Critics contend that the county’s failure to collect money owed from the sponsors of immigrants has contributed to the already cash-strapped health system’s need to close down many clinics that serve the poor.

County officials refute that claim.

“The closure of healthcare clinics has nothing to do with its lack of reimbursement efforts,” attorney Reichman said. “It’s due to structural problems -- the way in which healthcare is financed at a state and federal level.”

Furthermore, Reichman explained, all county patients are screened to determine their ability to pay, and the county usually ends up recouping its expenses through various means, such as a patient’s private insurance, personal funds or Medi-Cal.

Nelson argues that the county’s resistance to billing immigrants’ sponsors primarily hinges on its reluctance to inquire about a patient’s immigration status. This could lead to the mass exposure of undocumented immigrants, Nelson said.

Concerns were raised among immigrant advocacy groups earlier this year over a new bill that sought to pressure healthcare providers into documenting their patients’ citizenship and immigration status, collecting biometric data, such as fingerprints, and turning suspected illegal immigrants over to the Department of Homeland Security.

The measure, introduced by Rep. Dana Rohrabacher (R-Huntington Beach), was defeated on a vote of 88 to 331, much to the disdain of supporters, who view the government’s general enforcement of immigration laws as being too lax.

“From a social and political standpoint, you have to say whether it is responsible for a democracy not to look at the long-term consequences of flouting the law,” Nelson said.