[Congressional Record Volume 148, Number 53 (Thursday, May 2, 2002)]
[Senate]
[Pages S3872-S3874]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. McCain, Mr. Torricelli, and Mr. 
        Corzine):
  S. 2449. A bill to amend title XIX of the Social Security Act to 
allow Federal payments to be made to States under the medicaid program 
for providing pregnancy-related services or services for the testing or 
treatment for communicable diseases to aliens who are not lawfully 
admitted for permanent residence or otherwise permanently residing in 
the United States under color of law, and for other purposes; to the 
Committee on Finance.
  Mr. BINGAMAN. Mr. President, the legislation I am introducing today 
with Senators McCain, Torricelli, and Corzine entitled the ``Federal 
Responsibility for Immigrant Health Act of 2002'' is designed to 
address the hardship caused by Federal limitations on Medicaid 
reimbursement to health care providers and states for health services 
provided to immigrants. Despite the fact that immigration is a Federal 
responsibility, medical providers, who have a legal and ethical 
responsibility to save lives regardless of immigration status, and 
State and local governments bear most of the costs for services 
provided to immigrants.
  The bill expressly allows States and health care providers to receive 
Medicaid reimbursement for dialysis and chemotherapy services, prenatal 
care, and the testing and treatment of communicable diseases provided 
to immigrants; reauthorizes funding, which was provided between fiscal 
years 1998 and 2001 but expired this year, in the increased amount of 
$50 million annually for fiscal years 2003 to 2007 for unreimbursed 
emergency health services provided to immigrants; and clarifies that 
the federal government should not limit the ability of state or local 
governments to use their own funding to address the health care needs 
of immigrants within their communities.
  The Constitution of the United States establishes sole authority in 
the Federal Government to control immigration to this country. Despite 
that fact, the Federal Government often fails to take financial 
responsibility for the costs of immigration. Numerous studies also 
indicate that immigrants pay more to the Federal Government in the form 
of taxes than they receive in services, but State government and local 
communities and providers bear most of the costs of services provided 
to them.
  In Luna County, NM, for example, the Columbus Volunteer Fire 
Department and Ambulance Service has a contract with the county to 
provide emergency medical services to the people in Luna County. Luna 
County is one of the poorest counties in the Nation with almost one-
third of its citizens below poverty and with a per capita income at 
just 49 percent of the national average. Luna County has an extremely 
difficult time addressing the needs of its own citizens due to a high 
level of need and limited resources.
  And yet, with respect to emergency medical services, Luna County, the 
Columbus Volunteer Fire Department and Ambulance Service, and Mimbres 
Memorial Hospital must also respond to the numerous calls from federal 
officials at the port-of-entry near Columbus, NM, to treat or transport 
an injured or ill immigrants. The Columbus Volunteer Fire Department 
and Ambulance Service is located just three miles from the Columbus 
port-of-entry and is 32 miles from Mimbres Memorial Hospital in Deming, 
NM.
  Moreover, the ambulance service is also called in when individuals 
are apprehended after crossing illegally if injury or illness results, 
often while in the custody of the Federal Immigration and 
Naturalization Service, INS. Once treated, the Luna County Sheriff's 
Office is called to take them back from Deming to the Columbus port-of-
entry where they are returned across the border to their homes in 
Mexico.
  According to data collected by the United States/Mexico Border 
Counties Coalition through a grant from the Department of Justice, in 
1999, the Columbus Volunteer Fire Department and Ambulance Service 
responded to 264 calls, of which 56 percent were at the port-of-entry 
and 52 percent were for patients residing outside of the United States. 
Of services billed, 59 percent were for treatment of non-U.S. resident 
patients and the vast majority of those bills went unpaid. In fact, for 
both the EMS system and the hospital, a large majority of billings sent 
to patients residing outside of the United States are returned as 
either unclaimed or undeliverable much less paid.
  To help the County and ambulance service, I secured $200,000 last 
year through the Labor-HHS Appropriations bill for the costs of 
emergency medical services delivered to immigrants in this fiscal year. 
The funding, however, is just a temporary band-aid to a system that is 
poorly funded and cannot survive without the federal government living 
up to its responsibility to help pay the costs of health services 
delivered to immigrants. This bill helps address that responsibility.
  As Ronald Reagan, then Governor of the State of California, testified 
before the Senate Finance Committee in 1972, ``the support of citizens 
of other countries shall be a fiscal obligation of the federal 
government.'' He added, ``States should not be required to support 
citizens of another country, when the state and county governments have 
no effective voice in determining admission standards.''
  In response to such concerns, the Federal Government has taken two 
important steps over the years, providing for federal reimbursement for 
emergency care to low-income immigrants in 1986 and providing 
additional funding to states for unreimbursed costs delivered to 
immigrants in emergency situations in 1997. The first needs a technical 
change and the second, unfortunately, expired in 2001 and needs to be 
reauthorized.
  The first step that was taken occurred through the leadership of 
Senator Lloyd Bentsen and Representative Henry Waxman in 1986 and was 
signed into law by President Reagan. It provides for federal 
reimbursement through the Medicaid program to health providers for 
emergency care services provided to low-income immigrants. Services 
delivered to immigrants who are residents in the country may have the 
cost of their emergency care reimbursed through Medicaid--a joint 
federal and state program serving low-income and disabled people. 
However, in the case of Luna County, the majority of its cases are to 
immigrants who reside outside of the country, and therefore, do not 
qualify. This legislation clarifies that States may waive the residency 
requirement for an immigrant who either comes

[[Page S3873]]

across the border under a temporary visa or is paroled into the country 
by INS.

  The bill also clarifies that, since dialysis and chemotherapy are 
life-threatening conditions, these services qualify as emergency care 
and are eligible for reimbursement by Medicaid. Unfortunately, the 
Centers for Medicare and Medicaid Services, CMS, recently denied 
payment to the State of Arizona for such services and have forced the 
State to pay for such treatment with 100 percent state funding. This 
is, once again, a case of the federal government not fulfilling its 
responsibility and our bill corrects this problem.
  The ``Federal Responsibility for Immigrant Health Act of 2002'' would 
also provide states the option to reimburse providers for the costs of 
prenatal care and the testing and treatment of communicable diseases to 
low-income immigrants. A January 2000 study in the American Journal of 
Obstetrics and Gynecology found that undocumented women with no 
prenatal care were four times more likely to deliver low birthweight 
American citizen infants and seven times more likely to deliver 
premature infants than undocumented women with prenatal care. Moreover, 
a child born in the United States of undocumented parents is a United 
States citizen.
  Simply stated, if a pregnant women is denied access to prenatal care 
due to immigration status, it is her child who is denied the 
opportunity to be ``well-born'' and the financial costs associated with 
poor outcomes are high.
  In addition, States and local governments often seek to ensure that 
all of their residents, including immigrants, are tested and treated 
for certain communicable diseases. It is in the interest of all 
citizens to ensure that everybody residing in this country is treated 
for communicable diseases. As Dr. Richard Brown, Director of UCLA's 
Center for Health Policy Research says, ``Tuberculosis and other 
communicable diseases do not respect distinctions between citizens and 
non-citizens . . . The key to controlling an outbreak of tuberculosis, 
hepatitis, sexually transmitted diseases, or other communicable 
diseases is early identification of the source of infection and 
immediate intervention to treat all infected persons.'' Again, to 
address these problems, the bill would allow states to reimburse 
providers for the costs of prenatal care and the testing and treatment 
of communicable diseases to low-income immigrants through the Medicaid 
program.
  Another area where the Federal Government did take an important step 
to assume its responsibility for the costs of emergency health services 
delivered to immigrants was through $25 million in payments to States 
between fiscal year 1998 through 2001. The following 12 States were 
eligible for this additional funding over the four-year period, which 
expired at the end of last year: California, $11.3 million, Texas, $4.0 
million, New York, $3.1 million, Florida, $2.0 million, Illinois, $1.6 
million, New Jersey, $765,000, Arizona, $652,000, Massachusetts, 
$482,000, Virginia, $312,000, Washington, $295,000, Colorado, $255,000, 
and Maryland, $249,000. Unfortunately, that provision in law expired in 
2001 and needs to be reauthorized.
  The ``Federal Responsibility for Immigrant Health Act of 2002'' 
reauthorizes the program at $50 million between fiscal years 2003 and 
2007, extends the number of qualifying States to 15, and requires that 
States pass those payments on to health care providers who are 
providing this care. This helps cover the costs associated with care to 
immigrants needing emergency care that do not qualify for Medicaid, 
such as men who do not meet the categorical requirements for Medicaid 
coverage. In addition, the bill clarifies that the 15 qualifying States 
are those that have the highest percentage of immigrants rather than 
the highest numbers, which assures States such as New Mexico are not 
inappropriately left out of the funding in the future.
  And finally, the bill clarifies that the Federal Government should 
not limit State or local governments from using their own funding to 
provide health services to immigrants in their communities. The 10th 
Amendment prevents the Federal Government from interfering in the 
authority by State and local governments to spend their own revenue as 
they see fit.
  Unfortunately, a provision in the Personal Responsibility and Work 
Opportunity Reconciliation Act, PRWORA, in 1996 has been interpreted by 
Texas Attorney General John Cornyn and some in the State of New Mexico, 
including the University of New Mexico Hospital, to preclude state and 
local governments from providing non-emergency care services, with the 
exceptions of immunizations and the testing and treatment of 
communicable diseases, unless the State decides to override the law by 
passing its own legislation specifically authorizing such services.
  Others have disagreed. El Paso County Attorney Jose Rodriquez 
disagreed with the opinion of the Texas Attorney General in a August 
14, 2001, letter by saying, ``There is nothing in the PRWORA that 
expressly prohibits providing health care to undocumented aliens . . . 
There are no enforcement mechanisms in the PRWORA, and there are no 
penalties directed at state or local governments.'' As a result, the 
public hospitals in El Paso, TX, and elsewhere in Texas have largely 
ignored the Texas Attorney General's opinion.
  However, in New Mexico, the University of New Mexico Hospital has 
chosen to tighten eligibility requirements for its health care 
services. They argue they are complying with the ambiguous law.
  An article that appears in an Internet-based publication entitled 
Borderlines entitled ``Debate Over Immigrant Health Care Heats Up in 
New Mexico'' in November 2001 notes, ``Critics say the move to deny 
health care to some U.S. residents, regardless of the reasons, is 
dangerous, impractical, and inhumane. It is dangerous, they argue, 
because anyone with a communicable disease, illegal immigrant or not, 
can spread that disease if not treated. The policy is impractical, they 
add, because an untreated health problem will likely worsen and require 
more expensive treatments later, often in emergency rooms. And denying 
non-emergency health care to people with serious, chronic diseases like 
diabetes, asthma, or cancer means they must endure more pain and 
suffering, often as their conditions deteriorate.''
  As Dr. Catherine Torres of First Step Women's Health Center in Las 
Cruces, NM, and a member of the U.S.-Mexico Border Health Commission 
notes, ``When do you treat a child with asthma? When [the child] can't 
breathe?''
  This provision has also led to the unfortunate situation of imposing 
additional liability or malpractice exposure on health providers that 
work for state or local governmental health programs for denying needed 
health services to an individual. Health providers should not have to 
violate medical ethics of purposely denying needed health services to 
anyone and nor should they be exposed to additional liability because 
of a convoluted provision in federal law.
  As Dan Reyna, director of New Mexico's Border Health Office in Las 
Cruces, NM, adds, ``First, we're near an international border, we're 
not going to change that. Second, health care providers, both public 
and private, are not immigration officers for the Federal Government. 
And third, it's to the benefit of every state to protect community 
health and the quality of life of every resident. If you accept these 
primary premises, you have to provide preventative care services to 
everyone who needs it.''
  I urge the passage of this legislation. Although it may not be 
popular, the federal government should help assume its responsibility 
for immigration and the costs associated with health services. We talk 
a great deal about personal responsibility when talking about welfare 
reform. It is time for the federal government to take on its 
responsibility as well. State and local governments and health 
providers, already stressed by the fact that our country has around 40 
million uninsured residents, cannot take on these additional costs.
  I would like to thank Senators McCain, Torricelli, and Corzine for 
their support and help on this legislation. I ask unanimous consent 
that the text of the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

[[Page S3874]]

                                S. 2449

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Federal Responsibility for 
     Immigrant Health Act of 2002''.

     SEC. 2. FEDERAL PAYMENTS UNDER MEDICAID FOR EMERGENCY MEDICAL 
                   CONDITIONS OF CERTAIN ALIENS.

       (a) In General.--Section 1903(v)(2)(A) of the Social 
     Security Act (42 U.S.C. 1396b(v)(2)(A)) of the Social 
     Security Act is amended to read as follows:
       ``(A) such care and services are--
       ``(i) necessary for the treatment of an emergency medical 
     condition of the alien or necessary for the prevention of an 
     emergency medical condition (including dialysis and 
     chemotherapy services),
       ``(ii) services related to pregnancy (including prenatal, 
     delivery, postpartum, and family planning services) and to 
     other conditions that may complicate pregnancy, or
       ``(iii) services for the testing or treatment for 
     communicable diseases,''.
       (b) State Option to Eliminate Residency Requirement for 
     Certain Aliens.--Section 1903(v)(2)(B) of the Social Security 
     Act (42 U.S.C. 1396b(v)(2)(B)) is amended by inserting ``, 
     or, at State option, in the case of an alien granted parole 
     under section 212(d)(5) of the Immigration and Nationality 
     Act or an alien admitted into the United States as a 
     nonimmigrant alien under section 101(a)(15) of such Act, any 
     residency requirement imposed under the State plan'' after 
     ``payment''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to medical assistance provided on or after the 
     date of enactment of this Act.

     SEC. 3. FUNDING FOR EMERGENCY HEALTH SERVICES FURNISHED TO 
                   UNDOCUMENTED ALIENS.

       (a) Funding.--Section 4723(a) of the Balanced Budget Act of 
     1997 (8 U.S.C. 1611 note) is amended to read as follows:
       ``(a) Total amount available for allotments.--There are 
     available for allotments for payments to certain States under 
     this section--
       ``(1) for each of fiscal years 1998 through 2001, 
     $25,000,000; and
       ``(2) for each of fiscal years 2003 through 2007, 
     $50,000,000.''.
       (b) Determination of State Allotments.--Section 4723(b) of 
     the Balanced Budget Act of 1997 (8 U.S.C. 1611 note) is 
     amended--
       (1) in paragraph (1), in the first sentence, by striking 
     ``The Secretary'' and inserting ``Subject to paragraph (3), 
     the Secretary''; and
       (2) by adding at the end the following new paragraph:
       ``(3) Fiscal years 2003 through 2007 allotments.--
       ``(A) In general.--Notwithstanding paragraph (1), the 
     Secretary of Health and Human Services shall compute an 
     allotment for each of fiscal years 2003 through 2007 for each 
     of the 15 States with the highest percentage of undocumented 
     aliens. The amount of such allotment for each such State for 
     a fiscal year shall bear the same ratio to the total amount 
     available for allotments under subsection (a) for the fiscal 
     year as the ratio of the percentage of undocumented aliens in 
     the State in the fiscal year bears to the total of such 
     percentages for all such States for such fiscal year. The 
     amount of allotment to a State provided under this paragraph 
     for a fiscal year that is not paid out under subsection (c) 
     shall be available for payment during the subsequent fiscal 
     year.
       ``(B) Determination.--For purposes of subparagraph (A), the 
     percentage of undocumented aliens in a State under this 
     section shall be determined based on the most recent 
     available estimates of the resident illegal alien population 
     residing in each State prepared by the Statistics Division of 
     the Immigration and Naturalization Service.''.
       (c) Requiring Use of Funds to Assist Hospitals and Related 
     Providers of Emergency Health Services to Undocumented 
     Aliens.--Section 4723(c) of the Balanced Budget Act of 1997 
     (8 U.S.C. 1611 note) is amended to read as follows:
       ``(c) Use of Funds.--
       ``(1) In general.--From the allotments made under 
     subsection (b), the Secretary shall pay to each State amounts 
     described in a State plan, submitted to the Secretary, under 
     which the amounts so allotted will be paid--
       ``(A) to hospitals and related providers of emergency 
     health services to undocumented aliens that are located in 
     areas that the Secretary or a State determines to be 
     substantially impacted by health costs related to 
     undocumented aliens; and
       ``(B) on the basis of--
       ``(i) each eligible hospital's or related provider's 
     payments under the State plan approved under title XIX of the 
     Social Security Act for emergency medical services described 
     in section 1903(v)(2)(A) of such Act (42 U.S.C. 
     1396b(v)(2)(A)); or
       ``(ii) an appropriate alternative proxy for measuring the 
     volume of emergency health services provided to undocumented 
     aliens by eligible hospitals and related providers.
       ``(2) Definitions; special rules.--For purposes of this 
     subsection:
       ``(A) The term `hospital' has the meaning given such term 
     in section 1861(e) of the Social Security Act (42 U.S.C. 
     1395x(e)).
       ``(B) The term `provider' includes a physician, another 
     health care professional, and an entity that furnishes 
     emergency ambulance services.
       ``(C) A provider shall be considered to be `related' to a 
     hospital to the extent that the provider furnishes emergency 
     health services to an individual for whom the hospital also 
     furnishes emergency health services.
       ``(D) Amounts paid under this subsection shall not--
       ``(i) be substituted for Federal payments made under title 
     XIX of the Social Security Act to reimburse a State for 
     expenditures for the provision of emergency medical services 
     described in section 1903(v)(2)(A) of such Act; or
       ``(ii) be used by a State for the State share of 
     expenditures for such services under title XIX of such 
     Act.''.
       (d) Effective Date.--The amendments made by this section 
     shall apply beginning with fiscal year 2003.

     SEC. 4. PERMITTING STATES AND LOCALITIES TO PROVIDE HEALTH 
                   CARE TO ALL INDIVIDUALS.

       (a) In General.--Section 411 of the Personal Responsibility 
     and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 
     1621) is amended--
       (1) in subsection (b)--
       (A) by striking paragraphs (1) and (3); and
       (B) by redesignating paragraphs (2) and (4) as paragraphs 
     (1) and (2), respectively; and
       (2) in subsection (c)--
       (A) in paragraph (1)--
       (i) in the matter preceding subparagraph (A), by striking 
     ``(2) and (3)'' and inserting ``(2), (3), and (4)''; and
       (ii) in subparagraph (B), by striking ``health,''; and
       (B) by adding at the end the following new paragraph
       ``(4) Such term does not include any health benefit for 
     which payments or assistance are provided to an individual, 
     household, or family eligibility unit by an agency of a State 
     or local government or by appropriated funds of a State or 
     local government.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to health care furnished before, on, or after the 
     date of the enactment of this Act.
                                 ______