Medha Makhlouf on Migrant Health Care, Community Benefit and Nonprofit Hospitals

The Associated Press reports that the two scowling governors in Texas and Florida are doing their best to scare migrants from nonprofit hospitals.  Both governors and their political machines thoroughly benefit from political donations from wealthy sugar and cotton farmers, by the way. Their scare tactics apply to all hospitals that participate in state health insurance, Medicaid and CHIPS.  That means the harshest impact is felt in nonprofit emergency rooms where the poorest go when they can't stand the pain anymore. Shutting nonprofit hospital doors to migrants is precisely the goal.  Here is a bit from the AP:

For three days, the staff of an Orlando medical clinic encouraged a woman with abdominal pain who called the triage line to go to the hospital. She resisted, scared of a 2023 Florida law that required hospitals to ask whether a patient was in the U.S. with legal permission.  The clinic had worked hard to explain the limits of the law, which was part of Gov. Ron DeSantis’ sweeping package of tighter immigration policies. The clinic posted signs and counseled patients: They could decline to answer the question and still receive care. Individual, identifying information wouldn’t be reported to the state.

“We tried to explain this again and again and again, but the fear was real,” Grace Medical Home CEO Stephanie Garris said, adding the woman finally did go 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 Nov. 1 — just before the end of a presidential election in which immigration is a key topic.

Cheap migrant labor keeps the cost of produce low and grower profits high.  In Maine, for example, migrants compose 62% of the farm labor, picking most of the potatoes, broccoli, and blueberries grown there and enjoyed throughout the United States. The statistics are no doubt similar in California and all over the country.  We already know that migrant farmworker life is exceedingly precarious:

In spite of their varying geographical focus, scope, unit of analysis and settings, most of the studies reviewed highlighted that migrant farmworkers work under very poor working conditions and face numerous health and safety hazards, including occupational chemical and ergonomic exposures, various injuries and illnesses and even death, discrimination and social exclusion, poor pay and long working hours, and language and cultural barriers. Many studies also reported poor enforcement of labour regulations and a lack of health and safety training on the farms, difficulty accessing medical care and compensation when injured or ill. The studies have also pointed out the lack of research in relation to labor, health, psychosocial, and wage conditions of migrant farmworkers. The accumulated results of the study indicate that the issues and problems migrant farmworkers face are multidimensional, and there is a need for both policy development and further research in order to address migrant workers’ problems.

So denying migrant workers basic health care, even as they harvest our fruits and vegetables, and while some are accused of eating our pets, is the sickest sort of political and economic exploitation. Medha Makhlouf recently posted her interesting article in the Houston Journal of Health Law and Policy regarding community benefit and migrant healthcare in nonprofit health care systems:

Non-profit hospitals have long been required to provide certain benefits to the community in which they reside in order to maintain tax-exempt status. The nature of these community benefits has evolved since the mid-twentieth century, but “charity care”—free or discounted care for patients who are unable to pay for it—is the quintessential hospital community benefit. Although the Patient Protection and Affordable Care Act of 2010 (ACA) extended eligibility for subsidized health coverage to many more people living in the United States, some noncitizens—including those without a valid immigration status—were excluded. As a result, this group is disproportionately likely to need financial assistance to afford health care because they lack insurance. However, some hospitals exclude noncitizens from eligibility for charity care because of their immigration status.

This Article explores the development of prohibitions against discrimination on the basis of immigration status in hospital charity care programs in certain states and the relative inaction by the majority of the states and the federal government. When non-profit hospitals exclude patients from charity care on the basis of immigration status, they contribute to health care inequity among noncitizens—the population in the United States least likely to have access to health care. These actions contravene the longstanding tradition of non-profit, tax-exempt hospitals providing benefits to the community of people living in the geographic areas from which the hospitals draw their patients. Congress, state legislatures, and hospitals themselves are in a position to prohibit discrimination in charity care programs; failure to act further entrenches the exclusion of noncitizens from the threadbare health care “safety net” and perpetuates inequity in access to health care for noncitizens.

. . . 

Excluding patients from charity care based on their immigration status contravenes the longstanding tradition of non-profit, tax-exempt hospitals providing free or discounted care to needy people living in the geographic areas from which the hospitals draw their patients. Tax agencies’ failure to sanction such hospitals implicitly undermines the conception of “community” in the Community Health Needs Assessment introduced in the ACA because it endorses an arbitrarily limited conception of community, precisely excluding noncitizen members of the community who may be most affected by barriers to accessing health care.

 

darryll k. jones