The Financial Impact of Undocumented Immigrants in Emergency Rooms - Literature review Example

CHAPTER 2: LITERATURE REVIEW Introduction This chapter focuses on literature relevant to the costs associated with immigrant who utilize the hospitalemergency rooms as primary care treatment. This review includes the major concepts, sample information, and key results of previous related studies. The dilemma of uncompensated emergency services provided to undocumented immigrants has distant getting connotations beyond loss of hospital revenues. In recent years, the issue of uncompensated care and undocumented immigrants has received a growing amount of attention due to rising healthcare costs, increased levels of undocumented immigration, and serious economic strains at the country’s hospitals. Approximately half of 12 to 13 million of undocumented immigrants in United Stated have no insurance (Jordan, 2009). Similar to others who cannot afford medical care undocumented immigrants tend to seek out hospital emergency rooms as primary care facilities. As a result of lack of insurance coverage and lack of financial resources, many immigrants use hospital emergency rooms as their primary healthcare provider. However, there are indications of communities that offer health care to undocumented immigrants according to their needs. Visits to hospital emergency rooms have increased 26 percent between 1993 and 2003. According to the last published data in 2006, hospital emergency visits have jumped to 32 percent (Jordan, 2009). Unfortunately, this data does not include the total number of undocumented immigrants visiting the emergency rooms annually nationwide. This information is not available because is not require by law obtain such information from patients to offer them emergency care services. A study done by the General Accounting Office (GAO) concluded that less than five percent of the hospitals surveyed had a method to track the citizenship status of the patient. The Federation for American Immigration Reform (FAIR) estimated that the utilization rate of hospitals and clinics by undocumented immigrants is 29 percent, more than twice the rate of the overall U.S. residents which is 11 percent. While the national total of yearly unreimbursed medical operating expense at emergency care for undocumented immigrants is not accessible, it is possible that those expenditures are more than $10.5 billion. In addition, dozens of hospitals in the counties along the southwest border have either closed or face bankruptcy because of losses caused by uncompensated care (FAIR, 2003). Study conducted by MGT of America and reported to Border Counties Coalition (constitute 24 Counties) analyzed the cost of providing emergency care to undocumented and determined, that about $190 million or nearly 25 percent of the uncompensated expenses of these hospitals (border front line) incurred resulted from emergency medical treatment provided to undocumented immigrants. Furthermore, the study commented the crisis has become so unmanageable, that Mexican ambulance companies are being permitted to transport uninsured patient’s crossways the U.S. boundary to obtain treatments at no cost (MGT of America, 2002). States with elevated undocumented immigrants and impact in emergency rooms (This section is not ready yet. My friend is helping in this area because I can put the data togheter) Almost two-thirds of the undocumented immigrants presently live in six states: California (26 percent), Texas (12 percent), Florida (10 percent), New York (8 percent), Illinois (4 percent), and New Jersey (4 percent). But since 1990 the increase undocumented immigrant have been beyond these states (Passel, Capps, & Fix, 2004) (see table 1). Table 1 Estimated Number of Undocumented Immigrants by State California Texas New York Illinois Florida Arizona 2,830,000 1,640,000 540,000 550,000 980,000  500,000 (Source: U.S. Law.com, 2006) The following section will concentrate on the literature review in six states with major undocumented immigrant’s population. The data contained are estimated numbers because there are no exact statistics about the financial impact of the undocumented immigrants in hospitals emergency rooms. Arizona The Arizona Hospital and Healthcare Association estimated that the service provided to undocumented immigrants cost the hospital approximately $150 million annually and one hospital in Arizona has reported economic failure (bankruptcy) (U.S. Immigration Support, 2009). The Arizona Health Department uses 30 percent of its yearly nine million dollars funds to provide healthcare to undocumented immigrants. The Queen Hospital in Bisbee has exhausted $200,000 in unpaid emergency services from net operating resources of $300,000. The University Medical Center in Tucson absorbed one million dollars in the initial quarter in 2002 providing uncompensated care to illegal immigrants (CAIR). It must be highlighted that in last week of April (2010), Government of Arizona state signed a new and in simple words the “nation’s toughest bill” to curb illegal immigration in United States. This new bill is an attempt to thwart this rising trend of illegal migrants (mainly from Mexico, Central America and Asia having entrance share in between 60-65 percent, 15-20 percent and 10-15 percent respectively) who have an inclination to enter United States of America through illicit channels. In fact, this law will provide more powers to local authorities, law enforcement agencies and police thereby assisting them in identifying and deporting those migrants. In addition, it will enable the state authorities to minimize the burden of healthcare costs over total financial expenditures. These healthcare costs are increasing since the undocumented immigrants can only apply for emergency health treatment that is free and has to be financed by either hospitals or government. (Gordon, 2009) and (Archibold, 2010) California The California Health and Human Services Agency revealed that undocumented immigrants might balance as much as $750 million yearly of the expense of unpaid emergency care in California hospitals. The amount spent on undocumented immigrant patients is approximately 10% of total budget allocated to total healthcare expenditures in California. It must be highlighted that these undocumented patients are approximately 10% of the California’s emergency room patients. (Okie, 2007) According to FAIR: In the last decade, 60 California emergency rooms have closed. California hospital losses totaled $316 million in 1999, were around $325 million in 2000 and increased drastically by 20% year-on-year basis to $390 million in 2001. The crisis reaches throughout the state, with 80 percent of emergency departments reporting losses. One-third of the patients treated by the Los Angeles county health system each year are undocumented immigrants, according to county health officials. In 2002, the county spent $350 million providing health care to illegal aliens, according to the Department of Health Services. Example of these hospitals are Scripps Memorial Hospital that estimates that loses $7 million to $10 million in uncompensated costs because about one quarter of patients who are uninsured and do not pay their bills are undocumented immigrants. Regional Medical Center and Pioneers Memorial Hospital lost over $1.5 million treating undocumented immigrants in 2001. It must be highlighted that California has retained the highest number of illegal immigrants over the years. The population of unauthorized immigrants has crossed 2 million figure in 2000 - 2001. Although, the growth rate has now slowed compared to other attractive states like Virginia, North Carolina and Georgia yet the figure is staggering. Despite the fact that these immigrants have resulted in severe financial burden for governments and in mammoth losses for hospitals, yet they are among revenue contributors that who happily work at extremely lower wages thereby resulting in significant cost savings for businesses and organizations. (Aizenman, 2009) Florida The Florida Hospital Association (2008) found that 8.2 percent of total costs for Florida hospitals were for uncompensated care. Between 1995 and 2005, four acute care hospitals were closed with a loss of 1,206 beds. I would like to provide an example of ‘spending money’ on undocumented immigrants by hospitals. In fact, Jackson Health System in Miami-Dade consumed $33 million to treat undocumented immigrants in the same year. Merely, the first half of 2009, undocumented immigrant’s expenditure to Jackson Health was $38 million. A report completed by FAIR, accounted that in 2007, 36 percent of all immigrants and their kids in the state had no insurance and 61 percent of undocumented immigrants and their U.S. born kids had no insurance coverage compared with an estimated 17 percent of the Native Americans who do not have any healthcare insurance. A recent report by FAIR estimated the total cost of uncompensated medical care provided to undocumented immigrants and their kids at $290 million yearly, which in light of more recent data now appears to be lower than the actual cost (FAIR, 2009). Texas “According to the Texas Hospital Association, Texas hospitals spent $393 million treating undocumented immigrants in 2002 alone and increasing yearly with $225 million to be paid by taxpayers. Texas, facing a $10 billion two-year state budget shortfall, plans to roll back Medicaid and coverage for children under the State Childrens Health Insurance Program to the minimum levels mandated by law” (Western Voices World News, 2008). FAIR estimated that uncompensated care provided to illegal aliens cost Texans $520 million in 2005. Today, that cost would likely have increased to about $700 million (Ruark, 2009). The above mentioned point can be further supported by the facts quoted by Rahman (2008). He highlighted the fact as mentioned in a new research report that state of Texas and domestic state and private hospitals spent more than $670 millions on undocumented illegal immigrants in fiscal year of 2007 - 2008 so that it could ensure medical treatment and cure as instructed by US top law making authorities. In addition, there was a primary research conducted by the Texas Health and Human Services Commission that pinpointed the fact that expenditures of around $600 millions were financed by domestic hospital districts while the remainder $75 millions was from state authorities under Texas Emergency Medicaid program. Quoting from Rahman (2008) to highlight the importance of Texas Emergency Medicaid program, “The state spent $80 million under the, which pays hospitals to provide life-saving care, including labor and delivery services, to patients living here illegally. The state also paid $1.2 million to provide services to undocumented immigrants in family violence shelters.” It is worthwhile to mention that local hospitals are heavily dependent on charities, donations etc. that are received from philanthropists. The money is then used to provide emergency room services to illegal immigrants who can not consult physicians or hospitals due to legal constraints. (Rahman, 2008) Illinois Illinois had more 0.4 million uninsured immigrants out of total 1.7 uninsured people in 2006. In simple words, these people did not have any health insurance policy and they had been depending upon emergency medical rooms for their health treatment. It must be pinpointed that Percentage of Uninsured Accounted for by Immigrants was 25.4%. In fact, the total amount spent on providing medical health treatment to undocumented state’s illegal population was nearly $340 millions in 2006 that have surged to more than $400 millions in 2009-2010. These facilities were provided at the expense of tax payers. Without any doubt, around $3.5 billions revenue generated from tax payers was allocated to provide education, healthcare and incarceration to illegal population. However, it must not be forgotten that illegal immigrants are also among the taxpayers who paid nearly ‘$0.5 billions in sales, income and property taxes’. Hence, the total expenditures still amounted to nearly $3 billions which had been a considerable amount. (EBRI Notes, 2008) and (Castella, 2007) New York As mentioned by Passel (2005), more than 65% of US illegal undocumented population lives in only eight states namely California (having highest share of 24%), Texas (14%), Florida (9%), New York (7%), Arizona, Illinois, New Jersey and North Carolina. Illegal or unauthorized immigrants crossed the figure of 600,000 in 2002 – 2004 that also escalated the emergency healthcare costs in the state. (Passel, 2005) As pinpointed in New York Immigration Coalition (2009), every New Yorker reserves the right of getting emergency and regular medical treatment from state hospitals, medical agencies, community health centres, private hospitals and clinics regardless of their age, gender, religion and immigration status for sake of humanity. Health Care News (2006) on the other hand highlighted that “New York State’s not-for-profit and public hospitals provide an extraordinary amount of care to uninsured and underinsured patients.” In addition, the agency quoted the NYS Department of Health which revealed the fact that New York’s hospitals “provided $1.6 billion worth of uncompensated care” to both legal and illegal immigrants plus poor residents. Government, however, only compensated $497 millions so that hospitals could finance these care costs. In addition, they incurred a colossal loss of $1.5 billion since they did not receive considerable compensation from government (Medicaid payments) to finance their running expenditures. (Health Care News, 2006) and (HANYS report, 2009) As quoted in HANYS report (2009) “Hospitals in New York recorded a net profit margin of scant 0.9% in 2007. In past nine years, New York hospitals reported combined losses worth $2.4 billion. A survey conducted in 2008 revealed that gross margins had fallen to negative 1.4% whereas bottom-line margins that normally higher than operating margins, had dropped to negative 2.2%” References: HANYS (2009) “2009 FEDERAL ISSUES BOOK - NEW YORK HOSPITAL AND HEALTH SYSTEM PRIORITIES” Health Care Association of New York State http://www.hanys.org/communications/publications/2009/2009_hanys_federal_issues_book.pdf HEALTH CARE (2006) “Hospitals’ Commitment to Charity Care” HEALTH CARE NEWS Passel, Jeffrey S. (2005) “Unauthorized Migrants: Numbers and Characteristics” Pew Hispanic Center Available at http://pewhispanic.org/files/reports/46.pdf Hanson, Gordon (2009) “The Economics and Policy of Illegal Immigration in the United States” Migration Policy Institute Available at http://www.migrationpolicy.org/pubs/Hanson-Dec09.pdf Wolf, Richard (2008) “Rising health care costs put focus on illegal immigrants” USA Today.com Available at http://www.usatoday.com/news/washington/2008-01-21-immigrant-healthcare_N.htm Rahman, Mizanur (2008) “Illegal immigrants health care costs state $677 million” Available at http://blogs.chron.com/immigration/archives/2008/12/post_208.html STRAYHORN, CAROLE KEETON (2006) “UNDOCUMENTED IMMIGRANTS IN TEXAS: A Financial Analysis of the Impact to the State Budget and Economy” Available at http://www.window.state.tx.us/specialrpt/undocumented/undocumented.pdf Castella, Don (2007) “Illegal Aliens Cost Illinois Taxpayers $3 Billion+” Available at http://illinoisreview.typepad.com/illinoisreview/2007/07/illegal-aliens-.html RANDAL C. ARCHIBOLD (2010) “Arizona Enacts Stringent Law on Immigration” New York Times Available at http://www.nytimes.com/2010/04/24/us/politics/24immig.html EBRI (2008) “Notes” Employee Benefit Research Institute Vol. 29, No. 8 Available at http://www.ebri.org/pdf/notespdf/EBRI_Notes_08b-20081.pdf Aizenman, N.C. (2009) “Illegal Immigrants Legal Kids Snarl Policy” Washington Post Available at http://www.washingtonpost.com/wp-dyn/content/article/2009/04/14/AR2009041401433.html No author (2009) “Immigration to Florida” USA Immigration Support Available at http://www.usimmigrationsupport.org/florida.html New York Immigration Coalition (2009) “Access to Health Care for Uninsured Immigrants - Spanish, Chinese, Korean, Russian, Arabic and Haitian-Creole” thenyic.com Available at http://www.thenyic.org/templates/documentFinder.asp?did=19 Studies In recent years, the issue of uncompensated care and undocumented immigrants has received a growing amount of attention due to increasing healthcare expenses, increased levels of undocumented immigration, and serious financial effort at the nation’s hospitals. This research conducted a literature review to identify existing studies on the financial impact of undocumented immigrants in emergency health services. The review focused on studies during the past years. Technical articles, document analysis, and guidebooks on immigrant health care are not discussed below. Studies on the general issue of the financial impact of undocumented immigration in the United States emergency rooms (in general) were outside the ability of the evaluation. The literature analysis was performed by extensive web site search using terms such as undocumented immigrants or illegal aliens, uncompensated care and emergency health services. Agency web sites like American Hospital Associations, The Centers for Disease Control, The General Accounting Office, The Health Resources and Services Administration, Federation for American Immigration Reform, Kaiser Family Foundation and Pew Hispanic Center were reviewed as well. The literature review provided numerous studies related to the subject of immigration and health care. The most recent study of undocumented immigrants was conducted by Eric Ruark from FAIR in 2009. The data research describes the following fact: “in some hospitals, as much as two-thirds of total operating costs are for uncompensated care for illegal aliens,” but this is general information about the hospital service expenditure nothing is specific about the emergency rooms. In 2004, the United State General Accounting Office (GAO) saw the need to investigate the effect of undocumented immigrants on hospitals’ total uncompensated care costs. The study conducted by GAO is the most critical investigation performed about this topic. What GAO established is that hospitals do not have a collection of data on their patients’ immigration status, and as a consequence, a precise measurement of undocumented immigrants impact on hospitals’ unpaid services expenses remains unknown (GAO, 2004). The General Accounting Office also has published studies on topics related to unpaid care and undocumented immigrants. The GAO studies was necessary for the government and hospitals to methodically collect consistent facts on the quantity of uncompensated care offered to undocumented immigrants and to utilize ways of follow that data (MGT of America, 2002). In 2002 the MGT of America submitted a study to Border Counties Coalition about who pays the price for uncompensated emergency medical care along the Southwest Borders.  “The study reports that, in 2000, border hospitals spent more than $200 million to provide emergency health care to undocumented immigrants , $79 million in California; $74 million in Texas; $31 million in Arizona; and $6 million in New Mexico” (MGT of America, 2002). The results of this analysis clarified that the numbers were an approximation because hospitals are not permitted to ask the legal status of anybody, when they arrive looking for medical care at an emergency rooms. A RAND study in 2000 found that approximately 1.3%, or around $1.1 billion, of community resources used on U.S. health care was for undocumented immigrants. The study additionally established that the total costs, including public, not public and individual money, on undocumented immigrants, “who make up 3.2% of the U.S. population, was estimated at $6.5 billion, or 1.5% of total national medical costs” ( Kaiser Family Foundation, 2008). Also the study stressed that undocumented immigrants use less health services because they are uninsured, overall better general health, language barriers and the fear of being deported. The following table summarizes previous studies similar at topic in discussion. Table 2 Literature review of study and articles Article or study Organization Date Results “Paying the Costs of Medical and Public Safety Services for Undocumented Immigrants: Revisiting the Unfunded Federal Mandates Issue.” James D. Riggle School of Public Policy George Mason University April 2001 (Revised June 2001 · Cited several relevant public opinion polls that suggest most Americans believe undocumented immigrants should be entitled to receive emergency medical care and that the federal government (as opposed to local) should foot the bill. · In reference to uncompensated emergency medical care for undocumented immigrants, suggested that “the complexities of fiscal federalism make fully accurate apportionment of these costs extremely difficult.” “INS’ Southwest Border Strategy: Resource and Impact Issues Remain After Seven Years.” General Accounting Office August 2001 · Concluded that the Southwest Border Strategy’s effect on reducing overall illegal entry is unclear, but that the INS border control initiatives have had both positive and negative community impacts. · Reported that border control efforts have resulted in surges in illegal alien traffic in some border communities like Nogales, Arizona or Calexico, California. “Illegal Immigrants in U.S./Mexico Border Counties: The Costs of Law Enforcement, Criminal Justice, and Emergency Medical Services.” U.S Mexico Border Counties Coalition February 2001 · Conducted under a grant from the U.S. Department of Justice. · Estimated the cost of providing law enforcement, criminal justice, and emergency medical services to undocumented aliens in the 24 southwest border counties in 1999. Source: MGT of America, 2002 EMMTALA The Emergency Act was passed in 1986 in the middle of rising apprehension over the accessibility of emergency health care services to the poor and uninsured. The statute was planned predominantly to address the problem of "patient dumping," whereby hospital emergency rooms reject uninsured patients the same care offered to paying patients, either by refusing care absolute or by transporting uninsured patients to other amenities. This law is commonly known as the Patient Anti-Dumping Act or COBRA. The law established that in the situation of a hospital with a emergency room, if any individual comes to the emergency room and a demand is made on the individual’s behalf for exam or cure for a medical condition, the hospital must provide for an proper medical screening within the resources of the hospital’s emergency department, as well as additional services available to the emergency department, to decide whether or not an emergency medical condition. If the hospital establishes that the individual has an emergency medical condition, the hospital must provide either within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or for transfer of the individual to another medical facility, but if the individual’s medical condition has not been steady, the hospital probably will not transfer the individual unless the individual has requested a transfer. A joining hospital that carelessly breaches a requirement of this law is subject to a civil money penalty of not more than $50,000 or no more of $25,000 for hospitals with less than 100 beds for each violation (Emmtala.com). The most considerable effect is that, regardless of insurance status, every person in necessity of imperative medical assistance is legally assured to obtain it. According to the Centers for Medicare & Medicaid Services, 55% of U.S. emergency care now precedes uncompensated (ACEP, n. d.). Economic stress on hospitals in the last 20 years since EMTALA’s law has provoked them to consolidate and close facilities, contributing to emergency rooms overcrowding. According to the Institute of Medicine, between 1996 and 2003, emergency rooms visits in the United State grew by 26 percent, while in the same period, the number of emergency rooms declined by 425 percent. Ambulances are frequently diverted from overcrowded emergency rooms to other hospitals that may be father away. In 2003, ambulances were diverted over a half a million times (Institute of Medicine, 2006). Admission by illegal immigrants to U.S. emergency rooms through EMTALA remains a cause of argument. However, immigration restrictions groups like the Center for Immigration Studies and Federation for American Immigration Reform have argued that illegal immigrants still excessively load the emergency rooms as they have no insurance to a far elevated degree, and are therefore to a much upper boundary incapable to reimburse for their emergency room service. As well, they claim that because the kids of undocumented immigrants are frequently U.S. citizens, the expenditure of take care of them is unobserved (Cover, Writer, 2009). Care provided to undocumented immigrants beyond emergency rooms This section will concentrate on health care services provide to undocumented immigrants outside of the emergency rooms. Communities with large population of immigrants are better prepared to offer primary care to them over passing language barriers and culture disparities. Current reports point out that an escalating proportion of immigrants lack health insurance and more newly inwards immigrants are undocumented immigrants, in part because of a refuse in visas granted after the 2001 terrorist attacks (Staiti, Hurley, & Katz, 2006). Latinos represent the majority of the undocumented group. Undocumented immigrants are unable to obtain Medicaid or SCHIP regardless of their time living in the United States. In addition, hospital emergency rooms must monitor and alleviate all individuals with an emergency medical condition under the federal Emergency Medical Treatment and Labor Act. The safety net providers are the group of hospitals, community health centers or free clinics, and, in particular cases, community health departments, that offer the volume of care to low salary and persons with no insurance, additionally impart health care to immigrants regardless the status. As part of their assignment, safety net providers are usually accessible to seeing all patients and often depend a lot on community financial support. Even without distinction in legal status, many respondents recognized the unique circumstances of illegal immigrant patients, coming loose on how providers and communities are taking action to the issues presented by this group, as well as those of the larger immigrant populace. The obvious dimension of the undocumented immigrant residents and the following demand on community health care methods diverge across the public. A number of issues influence communities’ answers to undocumented immigrants’ health care requirements including language and cultural barriers. Language and cultural barriers can influence entrance to health care and superiority of care. Troubles describing warning signs or therapy procedures can show the way to wrong diagnoses, in addition to patient non-cooperation with recommended treatment (Saiti, et el. 2006). This dilemma is allegedly overstated for undocumented immigrants. According with Health System Change (2006): Market observers noted that it is common for undocumented immigrants to withhold basic contact information and medical histories, which can hinder provider assessments. Health care providers and others consistently said that undocumented immigrants delay seeking care because they fear being detained or deported by immigration officials. Thus, when they do show up for care, they often are in more serious condition. In general, communities with high amount of immigrants, are more organized to provide services to undocumented immigrants patients who are uninsured, have limited English skill and confront many obstructions to incorporate into American society (Stati, et el., 2006). Areas with more immigrants overpass language disparities and make available ethnically sensitive care than neighborhoods with less cultural understanding. For example: in Phoenix, Orange County, Miami and northern New Jersey, safety net providers are often bilingual, and multilingual is normal in hospitals and clinics. Another example is the University Hospital in northern New Jersey which has all documents in Spanish and French Creole, in addition to Spanish speaking interpreters (Staiti, et el.2006). In most communities, there is little conflict to allowing publicly financed providers to care for undocumented patients, but most communities have not provided or received additional funds to support providers serving this population. Care is usually financed through general sources, including disproportionate share hospital payments, grants to federally qualified health centers, cross-subsidization through cost shifting by hospitals and in physician practices, and in some cases, emergency Medicaid coverage. Some states use state funds or a federal SCHIP option to cover undocumented children or pregnant women. Providers reportedly could start filing claims for emergency services provided to eligible patients beginning in May 2005. While federal officials dropped a requirement that hospitals inquire about patients’ immigration status to receive funds, confusion persists about how hospitals will seek information indirectly and with what impact on immigrants’ care-seeking behavior. It is a diversity of health care services for undocumented immigrants in special in comminutes with a high volume of them. So, why they do not access to this type of services and instead they use the emergency rooms after the condition is worst? The fear to the deportation stops them or is the inability to pay or maybe both? Read More

Study conducted by MGT of America and reported to Border Counties Coalition (constitute 24 Counties) analyzed the cost of providing emergency care to undocumented and determined, that about $190 million or nearly 25 percent of the uncompensated expenses of these hospitals (border front line) incurred resulted from emergency medical treatment provided to undocumented immigrants. Furthermore, the study commented the crisis has become so unmanageable, that Mexican ambulance companies are being permitted to transport uninsured patient’s crossways the U.S. boundary to obtain treatments at no cost (MGT of America, 2002).

States with elevated undocumented immigrants and impact in emergency rooms (This section is not ready yet. My friend is helping in this area because I can put the data togheter) Almost two-thirds of the undocumented immigrants presently live in six states: California (26 percent), Texas (12 percent), Florida (10 percent), New York (8 percent), Illinois (4 percent), and New Jersey (4 percent). But since 1990 the increase undocumented immigrant have been beyond these states (Passel, Capps, & Fix, 2004) (see table 1).

Table 1 Estimated Number of Undocumented Immigrants by State California Texas New York Illinois Florida Arizona 2,830,000 1,640,000 540,000 550,000 980,000  500,000 (Source: U.S. Law.com, 2006) The following section will concentrate on the literature review in six states with major undocumented immigrant’s population. The data contained are estimated numbers because there are no exact statistics about the financial impact of the undocumented immigrants in hospitals emergency rooms.

Arizona The Arizona Hospital and Healthcare Association estimated that the service provided to undocumented immigrants cost the hospital approximately $150 million annually and one hospital in Arizona has reported economic failure (bankruptcy) (U.S. Immigration Support, 2009). The Arizona Health Department uses 30 percent of its yearly nine million dollars funds to provide healthcare to undocumented immigrants. The Queen Hospital in Bisbee has exhausted $200,000 in unpaid emergency services from net operating resources of $300,000.

The University Medical Center in Tucson absorbed one million dollars in the initial quarter in 2002 providing uncompensated care to illegal immigrants (CAIR). It must be highlighted that in last week of April (2010), Government of Arizona state signed a new and in simple words the “nation’s toughest bill” to curb illegal immigration in United States. This new bill is an attempt to thwart this rising trend of illegal migrants (mainly from Mexico, Central America and Asia having entrance share in between 60-65 percent, 15-20 percent and 10-15 percent respectively) who have an inclination to enter United States of America through illicit channels.

In fact, this law will provide more powers to local authorities, law enforcement agencies and police thereby assisting them in identifying and deporting those migrants. In addition, it will enable the state authorities to minimize the burden of healthcare costs over total financial expenditures. These healthcare costs are increasing since the undocumented immigrants can only apply for emergency health treatment that is free and has to be financed by either hospitals or government. (Gordon, 2009) and (Archibold, 2010) California The California Health and Human Services Agency revealed that undocumented immigrants might balance as much as $750 million yearly of the expense of unpaid emergency care in California hospitals.

The amount spent on undocumented immigrant patients is approximately 10% of total budget allocated to total healthcare expenditures in California. It must be highlighted that these undocumented patients are approximately 10% of the California’s emergency room patients. (Okie, 2007) According to FAIR: In the last decade, 60 California emergency rooms have closed. California hospital losses totaled $316 million in 1999, were around $325 million in 2000 and increased drastically by 20% year-on-year basis to $390 million in 2001.

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