[Congressional Record (Bound Edition), Volume 150 (2004), Part 7]
[House]
[Pages 9688-9699]
[From the U.S. Government Publishing Office, www.gpo.gov]




   UNDOCUMENTED ALIEN EMERGENCY MEDICAL ASSISTANCE AMENDMENTS OF 2004

  Mr. BARTON of Texas. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 3722) to amend section 1011 of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 to impose 
conditions on Federal reimbursement of emergency health services 
furnished to undocumented aliens.
  The Clerk read as follows:

                               H.R. 3722

       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 ``Undocumented Alien Emergency 
     Medical Assistance Amendments of 2004''.

     SEC. 2. FINDINGS.

       Congress finds the following:
       (1) The provision of medical care by public or private 
     health care providers to undocumented aliens is appropriate 
     only--
       (A) to protect the health and safety of United States 
     citizens;
       (B) to save the life of an undocumented alien in a life-
     threatening medical emergency; and
       (C) to stabilize an emergency medical condition so that an 
     undocumented alien can be repatriated for medical treatment 
     in the alien's own country.
       (2) Federal reimbursement of emergency hospital services 
     furnished to undocumented aliens should be conditioned upon 
     obtaining sufficient information to promptly remove the 
     aliens.
       (3) Employers who employ undocumented aliens without 
     completing employment authorization verification procedures 
     should be held liable for uncompensated emergency services 
     furnished to such aliens.

     SEC. 3. CONDITIONS FOR RECEIPT OF FEDERAL ASSISTANCE FOR 
                   EMERGENCY SERVICES FOR UNDOCUMENTED ALIENS.

       (a) In General.--Section 1011 of the Medicare Prescription 
     Drug, Improvement, and Modernization Act of 2003 (Public Law 
     108-173) is amended--
       (1) in subsection (d)(1), by adding at the end the 
     following new subparagraph:
       ``(C) Application of requirement.--Under such process, the 
     Secretary shall not provide payment under subsection (c) to 
     an eligible provider that is a hospital for eligible services 
     for an alien described in subsection (c)(5)(A) unless the 
     requirements of subsection (f) are met by that provider with 
     respect to such alien.'';
       (2) in subsection (e)(2), by adding at the end the 
     following new sentence: ``Such term also includes, with 
     respect to an undocumented alien described in subsection 
     (c)(5)(A), costs for emergency medical transportation and 
     evacuation incurred by a hospital in transferring and 
     removing the alien to a foreign country for receipt of 
     appropriate health care services.''; and
       (3) by adding at the end the following new subsection:
       ``(f) Requirement for Collection of Immigration-Related 
     Information for Undocumented Aliens.--
       ``(1) In general.--No payment may be made under subsection 
     (c) to a hospital with respect to the provision of eligible 
     services to an undocumented alien described in subsection 
     (c)(5)(A) unless the following requirements are met:
       ``(A) The hospital has obtained in good faith from the 
     alien (or a legal guardian or other representative on behalf 
     of the alien) the following information in a document that is 
     signed by the alien (or such guardian or representative) 
     under oath or affirmation and that is in a form that includes 
     a notice that fraudulent or false statements constitute a 
     criminal act punishable under Federal law:
       ``(i) The citizenship of the alien.
       ``(ii) The immigration status of the alien.
       ``(iii) The address of the alien in the United States.
       ``(iv) Such personal or financial data regarding the alien 
     as the hospital routinely requires of non-indigent patients, 
     including information regarding health insurance.
       ``(v) Information on the identity of any current employer 
     of the alien for whom the alien has executed an Internal 
     Revenue Service Form W-4.

     A hospital is not liable for the accuracy of the information 
     provided under this subparagraph so long as it exercises 
     reasonable care and good faith in obtaining the information.
       ``(B) The hospital obtains one or more identifiers for the 
     alien and records such identifiers in a digital, electronic 
     format specified by the Secretary in consultation with the 
     Secretary of Homeland Security. Such format shall be 
     compatible with at least one interoperable database 
     maintained by the Secretary of Homeland Security for the 
     purpose of verifying the identity and immigration status of 
     aliens.
       ``(C) The hospital transmits to the Secretary of Homeland 
     Security, in a digital, electronic format and manner 
     specified by such Secretary, the information provided under 
     subparagraph (A) and the identifier (or identifiers) obtained 
     under subparagraph (B).
       ``(2) Maintenance of hospital records.--For a period of at 
     least 5 years, a hospital referred to in paragraph (1) shall 
     maintain the original documents described in paragraph (1)(A) 
     on file and makes such documents available for examination by 
     the Secretary and the Secretary of Homeland Security or their 
     designees.
       ``(3) Provision of technical support.--The Secretary of 
     Homeland Security shall provide hospitals under this section 
     with software, training, and technical support services, at 
     no cost to the hospital, to assist and enable hospitals to 
     comply with the requirements of paragraph (1).
       ``(4) Prompt action by dhs.--The Secretary of Homeland 
     Security shall take steps as may be necessary--
       ``(A) to obtain, process, and promptly review information 
     transmitted under paragraph (1)(C);
       ``(B) to determine whether an alien for whom such 
     information is transmitted is removable under any provision 
     of Federal immigration law; and
       ``(C) to initiate removal proceedings under the relevant 
     provisions of the Immigration and Nationality Act in the case 
     of any such alien who is identified as being removable.
       ``(5) Removability.--An undocumented alien who obtains 
     eligible services through a hospital and does not provide for 
     payment for such services and who fails to provide accurate 
     information described in paragraph (1)(A) or an identifier 
     (as defined in paragraph (6)) shall be treated as removable 
     on the ground described in section 237(a)(5) of

[[Page 9689]]

     the Immigration and Nationality Act (8 U.S.C. 1227(a)(5)).
       ``(6) Definition of identifier.--In this section, the term 
     `identifier' means a fingerprint or other biometric 
     identifier as the Secretary of Homeland Security may require.
       ``(g) Responsibility of Certain Employers.--
       ``(1) In general.--In the case of an employer of an 
     undocumented alien worker described in paragraph (2) for whom 
     payments are made to a hospital for eligible services under 
     this section, subject to paragraph (3), the employer shall be 
     liable to the Secretary for the amount of the payments so 
     made.
       ``(2) Undocumented alien worker defined.--
       ``(A) In general.--For purposes of this subsection, the 
     term `undocumented alien worker' means, with respect to an 
     employer, an undocumented alien described in subsection 
     (c)(5)(A)--
       ``(i) who is an unauthorized alien (as defined in section 
     274A(h)(3) of the Immigration and Nationality Act (8 U.S.C. 
     1324a(h)(3));
       ``(ii) who has provided the employer with an Internal 
     Revenue Service Form W-4; and
       ``(iii) with respect to whom neither the conditions 
     described in subparagraph (B)(i) or the condition described 
     in subparagraph (B)(ii) have been met.
       ``(B) Conditions for exemption.--For purposes of 
     subparagraph (A)(iii)--
       ``(i) First set of conditions.--The conditions described in 
     this clause for an employer and alien are the following:

       ``(I) The employer and alien have fully complied with all 
     requirements of the employment verification system prescribed 
     in section 274A(b) of the Immigration and Nationality Act (8 
     U.S.C. 1324a(b)).
       ``(II) The employer has enrolled the alien in a State 
     workmen's compensation plan.
       ``(III) The alien is enrolled under a health benefits plan 
     or health insurance coverage that provides such level of 
     coverage with respect to emergency medical and 
     hospitalization benefits as the Secretary shall specify, in 
     consultation with the Secretary of Homeland Security.
       ``(IV) The employer has assumed responsibility for any 
     cost-sharing (including applicable deductibles and 
     coinsurance) that applies to the alien.

       ``(ii) Alternative condition.--The condition described in 
     this clause for an employer and alien are that the employer 
     has verified the employment authorization of the alien 
     through the voluntary basic employment verification pilot 
     program under section 403(a) of the Immigration Reform and 
     Immigrant Responsibility Act of 1996 (division C of Public 
     Law 104-208), where available, or by any other means made 
     available for such verification purposes by the Secretary of 
     Homeland Security.
       ``(3) Limitation on liability.--The liability of an 
     employer under this subsection shall be limited to an 
     employer that employs an undocumented alien worker at the 
     time (as specified under rules of the Secretary of Homeland 
     Security) the eligible services are provided for which 
     payment may be made by the Secretary under this section.
       ``(h) Limitation on Care Required.--Notwithstanding any 
     other provision of law (including section 1867 of the Social 
     Security Act, 42 U.S.C. 1395dd), a hospital is not required 
     to make available to an undocumented alien described in 
     subsection (c)(5)(A) care or services if--
       ``(1) the alien may be transported to the alien's country 
     of origin (as determined in accordance with rules of the 
     Secretary of Homeland Security) without a significant 
     likelihood of material deterioration of medical condition of 
     the alien (or, in the case of an alien in active labor, of 
     the child), within reasonable medical probability, resulting 
     from the transfer of the alien from the hospital; or
       ``(2) the care--
       ``(A) involves organ transplantation or other extraordinary 
     medical treatment (or other treatment the estimated cost of 
     which exceeds $50,000); and
       ``(B) is for treatment of a condition that existed before 
     the alien entered the United States or is not required as a 
     direct and immediate result of an accident in the United 
     States.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall be effective as if included in the enactment of the 
     Medicare Prescription Drug, Improvement, and Modernization 
     Act of 2003.
       (c) Regulations.--
       (1) In general.--The Secretary of Homeland Security, in 
     consultation with the Secretary of Health and Human Services, 
     shall issue interim regulations implementing the amendments 
     made by subsection (a) no later than 60 days after the date 
     of the enactment of this Act and shall permit a period of 
     public notice and comment of at least 90 days.
       (2) Final regulations.--The Secretary of Homeland Security, 
     in consultation with the Secretary of Health and Human 
     Services, shall issue final regulations implementing such 
     amendments not later than one year after the date of 
     publication of such interim regulations.
       (d) Annual Report on Implementation.--
       (1) In general.--The Secretary of Homeland Security, in 
     consultation with the Secretary of Health and Human Services, 
     shall submit to the chairman and ranking minority member of 
     the Judiciary and Appropriations Committees of the House of 
     Representatives and the Senate, the Select Committee on 
     Homeland Security of the House of Representatives, and the 
     Senate Committee on Governmental Affairs an annual report on 
     the implementation of section 1011 of the Medicare 
     Prescription Drug, Improvement, and Modernization Act of 
     2003, as amended by this section.
       (2) Items to be included.--Each annual report under 
     paragraph (1) shall include--
       (A) a cost analysis of Federal expenditures under such 
     section 1011;
       (B) a description of the assistance provided to hospitals 
     under subsection (f)(2) of such section;
       (C) the number of undocumented aliens removed under 
     subsection (f)(3) of such section; and
       (D) amounts recovered from employers under subsection (g) 
     of such section.
       (e) Feasibility of Effecting Treaties for International 
     Medical Evacuation.--
       (1) Study.--The Secretary of State shall conduct an 
     analysis of the feasibility and appropriateness of the 
     following:
       (A) Negotiating with foreign states treaties under which 
     such states provide payment for the cost of international 
     medical evacuation for their nationals who require emergency 
     health care in the United States and who do not otherwise 
     have insurance or other coverage for the costs of such care.
       (B) In the case of nationals of a foreign state for whom 
     significant costs are incurred under section 1011 of the 
     Medicare Prescription Drug, Improvement, and Modernization 
     Act of 2003 and for which state a treaty described in 
     subparagraph (A) is not in effect, imposing a visa, port of 
     entry, or similar surcharge the proceeds of which may be used 
     towards such costs and towards the cost of international 
     medical evacuation described in such clause.
       (2) Report.--The Secretary of State shall submit to the 
     committees described in subsection (d)(1) a report on the 
     analysis under paragraph (1).

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Texas (Mr. Barton) and the gentlewoman from California (Ms. Solis) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Texas (Mr. Barton).


                             General Leave

  Mr. BARTON of Texas. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous material on H.R. 3722.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BARTON of Texas. Mr. Speaker, I ask unanimous consent that the 
gentleman from California (Mr. Rohrabacher), the author of the pending 
legislation, be allowed to control debate on this bill on the majority 
side.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. ROHRABACHER. Mr. Speaker, I yield myself such time as I may 
consume.
  Today, Congress has the opportunity to reassure the American people 
that there are elected representatives on their sides. No vote could be 
more indicative as to the priorities of a Member of Congress.
  Is America to have a policy of unrestricted health care for illegal 
immigrants at the expense of American citizens and legal residents? 
That is the issue we are discussing today. Voting for H.R. 3722 means 
that my colleagues are not in favor of spending our limited health care 
dollars in an unrestricted way to give illegal aliens all the health 
care that they need in terms of today's standards.
  Those Members of Congress voting against H.R. 3722 are draining 
limited health care dollars that should be going to our own citizens 
and legal residents.
  H.R. 3722 would put some common-sense controls over the $1 billion 
fund that was created by a rider that was added onto the Medicare bill 
that passed just a few months ago.
  What does H.R. 3722 do? One thing it does not do is add a burden of 
paperwork to the hospital emergency rooms, and that is a bogus 
argument. I would warn my fellow constituents that that lie has been 
spread around this body in order to get people to vote in the wrong 
way. It is a bogus argument.
  To be reimbursed, the hospitals will be asking questions. To get part 
of that

[[Page 9690]]

$1 billion fund they will be asking questions anyway. This legislation 
does not add considerably to any major degree to those questions. It 
simply adds a following question: Who was the immigrant's last employer 
or his current employer? Plus, the hospital must then take a photo or a 
fingerprint, which may be required to get that fund money in the first 
place. This information would then be available to the Department of 
Homeland Security and the INS.
  This legislation does not require any reporting by the hospitals or 
the doctors or anyone else to the Department of Homeland Security. 
That, too, is a bogus argument that is going around, only we will hear 
it in the debate, I am sure. The hospitals do no investigating, no 
reporting; they simply have the information that is given to them when 
the patient is put into the system and that is made available to 
government agencies. It is the government agencies, the Department of 
Homeland Security and INS, that do the investigating, that do the rest 
of the work. Do not fall for bogus arguments.
  Our hospitals today feel compelled to provide extensive and even 
long-term treatment to illegal aliens. That is what our bill, H.R. 
3722, does second. It makes sure that our hospitals are relieved of 
this enormous burden of trying to provide unlimited health care to any 
illegal that comes into an emergency room.
  We have been giving heart bypasses, even transplants. A young girl 
from Mexico had $5 million worth of expenditures in heart transplants 
just a few months ago, and then when the transplant did not work, her 
family, who were here illegally and actually had emigrated here with a 
$5,000 fee to a coyote, then sued the hospital because the transplant 
did not work. Well, this cost us billions of dollars a year.
  If someone has a genetic disease or something like that, our 
emergency rooms should not be treating this in the first place; and the 
fact is, this bill will alleviate that burden by saying that only if a 
person's life is imminently threatened by that malady do the hospitals 
have to focus on that and treat someone whose life is immediately being 
threatened rather than provide hundreds of thousands of dollars of 
long-term cancer care, genetic problems, et cetera.

                              {time}  1500

  This alone will save billions of dollars that should be going to the 
American people. The doctor will only determine how much treatment is 
necessary to get this person to a transportation source that will get 
them back to their home country so their home country can pay for the 
health care costs, rather than our senior citizens and our young people 
being deprived of the resources for their health care.
  Number three. If it is a life-threatening emergency, the illegal 
alien will be treated. There is no doubt about that. This bill does not 
change that. But if he has no insurance, the alien's employer or former 
employer will be given the bill. Businessmen will be given the bill if 
they hire illegal immigrants who end up draining away our health care 
dollars. This makes all the sense in the world.
  Now, the businessmen are coming out against this, saying how can we 
judge? In 2005, there is a system already being worked on and being 
established that with one phone call they will be able to determine if 
they are hiring an illegal immigrant. If a businessman has not made 
that phone call and has hired someone without checking it out, then he 
will pay for the health care costs rather than having the taxpayer pay 
for it.
  We will hear a lot of people trying to tell us there are a lot of 
other things in this bill that are not. But it comes down to this: 
Whose side are we on? Do we care about our own senior citizens more 
than we care about strangers from overseas? Do we care more about our 
own people than we care about strangers from overseas?
  If we keep trying to provide everything for everybody, our system is 
going to break down, and it is doing so right now in California. I 
would urge my colleagues to support 3722 and prove to their 
constituents just whose side they are on. We could have corrected this 
a long time ago, but we hear people all the time, and we will hear it 
today, with every excuse for not doing something. But the fact is some 
people in our country are benefiting from illegal immigration. They are 
very powerful. But it is hurting American citizens, and this bill tries 
to put a stop to that, or at least turn that situation around today 
with H.R. 3722.
  Mr. Speaker, I reserve the balance of my time.
  Ms. SOLIS. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Arizona (Mr. Kolbe).
  Mr. KOLBE. Mr. Speaker, I thank the gentlewoman from California for 
yielding me this time, and I rise in opposition to H.R. 3722.
  Mr. Speaker, if enacted, The Undocumented Alien Emergency Medical 
Assistance Amendments will turn our hospital caregivers into ``de 
facto'' border patrol agents for the Federal government. The measure 
would require hospitals to take biometric ``identifiers''--fingerprints 
or digital photographs--of any patient whom they suspect of being an 
illegal immigrant and send that information to the Department of 
Homeland Security (DHS), in order to receive funding for the 
uncompensated costs of providing emergency care to undocumented 
immigrants. Hospitals are already understaffed and they do not have the 
resources needed to collect this information while trying to administer 
emergency care.
  This bill would discourage illegal aliens from seeking treatment for 
possibly contagious diseases for fear of being deported. In close-knit 
communities, such as many border areas, disease can spread quickly. 
This would lead to a potential health crisis in areas throughout the 
country--especially the southwest.
  Illegal immigrants are in the United States as a direct result of the 
government's inability to control our borders, and our hospitals are 
bearing the brunt by not being reimbursed. Controlling immigration is a 
Federal responsibility--not the responsibility of doctors and nurses 
trying to administer care. Border Patrol agents are not taking illegal 
immigrants into custody who need medical treatment to avoid paying for 
the care. Federal agencies should be responsible for what is a Federal 
problem.
  The Emergency Medical Treatment and Active Labor Act (EMTALA) 
requires hospitals to provide emergency care to anyone who comes to 
their emergency rooms, without regard to race, creed, color, financial 
ability to pay, citizenship, or immigration status. H.R. 3722 goes 
directly against EMTALA by forcing hospitals to guess which patients 
they believe are illegal immigrants, take down information about their 
immigration status, employer and address, and report to the Department 
of Homeland Security. It would burden hospital workers with a 
staggering amount of administrative work and subject them to charges of 
discrimination for singling out certain individuals for identification.
  The Centers for Medicare and Medicaid Services is creating 
regulations to keep hospitals accountable for how they are reimbursed 
for treating illegal aliens. Those regulations are due in September. 
Passing this legislation would directly preclude CMS--the agency that 
knows best how to handle this situation. If it is deemed these 
regulations are not adequate, we should revisit this debate.
  Do not turn doctors and nurses into police officers. Oppose H.R. 
3722.
  Ms. SOLIS. Mr. Speaker, I yield myself 3\1/2\ minutes.
  Mr. Speaker, I rise in strong opposition to H.R. 3722. I think this 
is one of the most outrageous pieces of legislation I have seen this 
year, and unfortunately I believe it is a misguided bill. I believe 
that this bill does not stand for all of those that we represent in our 
districts.
  I understand that through the census count we account for everyone in 
our districts, and that goes for the gentleman from Orange County, 
California (Mr. Rohrabacher), where I know he has an undisclosed number 
of people who may not be registered or accounted for; but he gets 
credit for that. Those numbers are put into place because we represent 
every single person, whether they are accounted for or not legally.
  This bill goes in the wrong direction because it asks for our 
hospitals to become enforcers of immigration law. I cannot underscore 
how important it is to discuss this matter. Because as it is now, in 
California, we have already gone through the battle of 187 and trying 
to keep health care services and

[[Page 9691]]

English educational services for children. The courts found that 
unconstitutional. Do we have to go to battle again?
  Why does this bill have to direct our resources that right now are 
so, so important for every single person in our districts and be used 
to ask our hospital administrators, doctors, nurses, aides, to now 
require to have 5 years' worth of records that they must maintain 
giving some kind of evidence that they serve people who may be 
undocumented? That, in and of itself, I would say is a waste of time 
and money, money that should be afforded to sick people.
  What happens in a classroom when you have a sick child who may, under 
no fault of their own, be there and not be a U.S. citizen? When they go 
to kindergarten, there is nothing that says that the child next to them 
will not be infected by maybe a contagious disease that they have. 
Hopefully, that never happens; but the fact that they would be 
prevented from health care services, and just knowing the fear that 
that family would have to go through to enter into the doors of a 
hospital knowing somehow they may not come back; that somehow Homeland 
Security is going to be there to pick them up and ship them back. And 
what about a woman going through active labor? She will be deported, 
because under the gentleman's bill that is what it says. The bill goes 
in the wrong direction.
  I am standing with people in my district. And, in fact, there are 
several hospitals in the gentleman's own district who are against the 
bill. Some of the hospitals in Orange County: Garden Grove Hospital 
Medical Center, Loma Linda University, Queen of Angels Hollywood 
Presbyterian Hospital, Scripps Mercy Hospital, Suburban Medical Center, 
Sutter Medical Center in Santa Rosa, and Western Medical Center in 
Santa Ana.
  Throughout the State of California we are finding many of our 
friends, both in public and private sector hospitals, are against this 
bill. So I do not think we are standing alone here. I think we are 
standing very united that we see a very misguided bill, unfortunately, 
that is being presented to us today.
  The Federation of American Hospitals, the American Hospital 
Association, the Catholic Health Association of the United States, and 
the National Association of Children's Hospitals are all in agreement 
that this bill goes in the wrong direction.
  I would ask for Members to consider the people who are joining us 
today that are saying this is the wrong message. We all have an 
obligation, I believe, to provide under our own laws service to people 
who come to our hospitals. That is a given. We do that. And maybe it is 
an unfunded mandate, but it is one we all abide by. I do not think we 
are in a position to turn people away.
  Mr. Speaker, I reserve the balance of my time.
  Mr. ROHRABACHER. Mr. Speaker, how much time remains on each side?
  The SPEAKER pro tempore (Mr. Culberson). The gentleman from 
California (Mr. Rohrabacher) has 14 minutes remaining, and the 
gentlewoman from California (Ms. Solis) has 16\1/2\ minutes remaining.
  Mr. ROHRABACHER. Mr. Speaker, I yield myself 30 seconds and just note 
that this fund of a billion dollars that was created that we now have 
to put some controls on, and that is what 3722 is trying to do, creates 
a perverse incentive. If we let this go through as it stands, what is 
going to happen is this: people who come to the emergency rooms who are 
American citizens or legal residents who have no insurance will be put 
behind and at the end of the line and the illegal immigrants will be 
put to the front of the line because the Federal Government is picking 
up the tab.
  This is a perverse priority. We should be taking care of our own 
citizens before we take care of illegal aliens.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Iowa (Mr. 
King).
  Mr. KING of Iowa. Mr. Speaker, I thank the gentleman from California 
for bringing H.R. 3722 here before us and before the floor.
  We have already a jobs magnet. The jobs magnet that is there is what 
draws so much illegal immigration into this country. The disincentive 
has not been put in place. This is not the first administration that 
has not aggressively enforced our immigration laws. This jobs magnet 
exists, and we have added to that a new magnet. The new magnet is 
called free health care for illegals, and then we tap into the American 
taxpayers.
  Now, I hear my Democrat colleagues over on this side continually 
railing about overspending, overspending. This is overspending. And it 
is not just a billion dollars. That responsibility comes to $9 billion 
a year, and it is growing. So we add to the jobs magnet the free health 
care magnet.
  And by the way, I want to point out that the system the gentleman 
from California (Mr. Rohrabacher) addressed, where an employer has an 
ability now, and will have by December 31 everywhere in the country, to 
verify the hiring and the legal status of a prospective employee, is 
called the SAFE Act. It has been in six States now. I have run that 
system myself. It is Web-based, as well as a phone call, but Web-based, 
and it is as close to infallible as anything we can put out, and it is 
going to get better. Employers can guarantee that they are hiring legal 
employees.
  We do not need to be subsidizing the health care for illegals. That 
is another way of subsidizing employers who are taking advantage of the 
cheaper labor that sets our hardworking Americans back and puts them in 
the unemployment lines. This is a national security issue, it is a 
national budget issue, it is a cultural continuity issue, and it is a 
commonsense issue.
  I thank the gentleman from California for bringing the bill, and I 
enthusiastically support H.R. 3722.
  Ms. SOLIS. Mr. Speaker, I yield 3 minutes and 20 seconds to the 
distinguished gentleman from New Jersey (Mr. Menendez).
  Mr. MENENDEZ. Mr. Speaker, I rise in strong opposition to a fiscally 
irresponsible, unsafe, and discriminatory bill that is only on the 
House floor due to a back-room deal that was reached late at night to 
gain passage of the Republican Medicare prescription drug bill. That 
deal was reached at the expense of Americans of Hispanic descent and of 
other immigrant groups that are now legal and also U.S. citizens, as 
well as our Nation's health is disgraceful. We continue to see elements 
of the xenophobic face of the Republican Party.
  What does this bill do? If you are rolled into an emergency room and 
you do not have insurance, then you are to be asked whether or not you 
are here legally in the United States. Now, I get rolled into an 
emergency room, Mr. Menendez, or maybe someone who might even be 
described as more characteristically Hispanic, or maybe Asian, or some 
other group, and I do not happen to have insurance, as unfortunately 40 
million Americans who are here as U.S. citizens do not have, and I get 
asked whether or not I am a citizen of the United States. That is 
shameful. You would not ask any other citizen that. But because I 
happen to have the misfortune of not having health insurance, you ask 
me. And of course those of us who look a certain way will for sure be 
asked.
  And then what else do you do? While I am suffering, not only do you 
want that information, but then we are going to go through an Orwellian 
process of getting some type of digital electronic identifier of this 
U.S. citizen who does not have insurance but cannot prove that he is or 
is not a U.S. citizen lying there in that emergency room. That is what 
the bill of the gentleman from California (Mr. Rohrabacher) does. Do 
not be deceived.
  Now, I know he says there are a lot of lies going on about his bill. 
I guess the hospitals of the Nation are lying as well. Let me tell you 
what they say. Here is what the American Hospital Association said. It 
says,

       America's hospitals treat everyone who walks through their 
     doors, and we are opposed to Mr. Rohrabacher's bill because 
     it is bad policy, bad policy for hospitals, nurses, doctors, 
     and other health care personnel who work in hospitals, but 
     most importantly it is bad policy for patients.

[[Page 9692]]

       Rohrabacher's legislation is bad policy because it takes 
     hospitals away from what we do best, caring for and healing 
     our patients. The requirements for reimbursement under the 
     legislation would turn hospital workers into border patrol 
     agents. That is not our jobs. We are caregivers, not cops. 
     And hospital caregivers are already burdened with paperwork 
     which requires at least 30 minutes, often an hour for every 
     patient. The additional burden of policing suspected 
     undocumented immigrants would take health care workers away 
     from their primary mission of healing and caring.

  And not only that, it hurts everyone else waiting in that emergency 
room for care. Because as we are trying to get all this documentation, 
for which we give these hospitals no funding to do it, we are also 
taking away from the care of everyone else there, and we are allowing 
communicable diseases to spread in communities like that. That is 
outrageous.
  This bill should be defeated. It is shameful that it is even on the 
House floor.
  Mr. ROHRABACHER. Mr. Speaker, I yield myself such time as I may 
consume.
  What is shameful is how shameful some of my colleagues are getting 
the facts totally wrong and do not know what they are talking about. 
Someone must have briefed them with the wrong information.
  This bill does not require our hospitals to gather any significant 
more information. The information that is being gathered that my 
colleague is complaining about, what we just heard, the great 
condemnation of all the questions that must be asked and all the 
information that must be gathered from this U.S. citizen, who might be 
an illegal, is already required of the hospital in order to get the 
funding, the billion dollars, that was set aside for them. It is not 
required by my bill. It is required in order to get reimbursement.
  My bill simply says that if they are going to ask those questions, 
and they are going to expect to get reimbursed, they also have to ask 
who the employer is and get a fingerprint or a picture, which they are 
probably going to have to get in order to be reimbursed in the first 
place. So the gentleman's complaints are not against 3722. His 
complaints are that the Federal Government is now going to have an 
unlimited reimbursement for illegal immigrants and they are going to 
ask some questions for it. Do not blame 3722.
  And let me note this also: we have had an example given to us of an 
American citizen who is there, and he is being threatened because he 
has to answer whether or not he is an illegal immigrant or not. The 
greatest threat to the treatment of American citizens and legal 
residents is that we are going to spend all of our available health 
care dollars taking care of illegals who should not be getting that 
money. The greatest threat to our senior citizens, to our young people 
is that we have a limited amount of health care dollars and my 
colleagues want to spend it on people who have come here illegally.

                              {time}  1515

  My colleague pointed out this will bring tens of millions of more 
people here and even a greater drain until the system breaks down.
  The bottom line is the people who are in favor of spending our 
limited dollars on American citizens and a very doable system here that 
is no more complicated than what the hospitals are going to have to go 
through to get reimbursement in the first place should be voting in 
favor of H.R. 3722. If they want to spend their money on people who 
came here illegally, rather than our own citizens, waste those dollars, 
make sure more illegals get in, go ahead and vote against H.R. 3722.
  Mr. Speaker, I reserve the balance of my time.
  Ms. SOLIS. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
California (Mr. Waxman).
  Mr. WAXMAN. Mr. Speaker, I rise in opposition to this legislation. 
Seldom has this House had before it a more ill-considered proposal. 
This legislation purely and simply attempts to turn our frontline 
medical care providers into Border Patrol police.
  Unlike what was just told us by the gentleman from California (Mr. 
Rohrabacher), this is not their mission. They do not ask these 
questions now. It is not their professional responsibility. It is not 
the appropriate role for those committed to saving lives and protecting 
the health care of our communities.
  What does society gain by forcing undocumented aliens to forgo 
emergency care because, as a practical matter, that will be the result 
if they are asked these questions on their immigration status? What 
benefit does it make for a woman in labor not to come in for medical 
care because she is fearing that she will be deported? And what does 
society gain by discouraging people with contagious conditions, who may 
put us all at risk, from going in and getting the diagnosis and 
treatment they need? Do we want someone who might have SARS to be 
afraid to go in for treatment?
  We need to help our hospitals and emergency systems have the 
resources to treat all people who are eligible for those services. What 
we do not need to do is to stretch their resources further on a mission 
that is not theirs to fill. This is not an appropriate action for 
Americans or appropriate policy on health care for those in need. That 
is why all of the hospitals oppose this legislation.
  I urge that we oppose this bill.

                                                      May 7, 2004.
       Dear Member of Congress: We understand that the House of 
     Representatives is expected to soon consider legislation 
     (H.R. 3722) proposed by Representative Rohrabacher (R-CA). 
     The undersigned organizations, representing America's 
     hospitals and health systems, health care providers, and 
     safety net systems, are united in our opposition to H.R. 
     3722, the ``Undocumented Alien Emergency Medical Assistance 
     Amendments of 2004,'' and urge you to oppose this 
     legislation. We believe it will severely undermine Section 
     1011 of the Medicare Prescription Drug, improvement, and 
     Modernization Act of 2003 (MMA) and create unnecessary 
     barriers to life saving treatments at hospitals nationwide.
       After months of careful deliberation by the Medicare 
     conferees, the Congress and Administration included essential 
     resources for hospitals providing life saving emergency are 
     to undocumented aliens. The undersigned organizations deeply 
     appreciated the inclusion of Section 1011 in MMA.
       We are deeply concerned that H.R. 3722 would weaken Section 
     1011 by imposing new burdensome requirements on hospitals in 
     order to receive any of the resources from Section 1011. In 
     addition, H.R. 3722 would virtually ensure that illegal 
     immigrants will avoid getting the appropriate and timely life 
     saving health care they need, when they need it. H.R. 3722 
     could pose a significant public health threat for entire 
     communities because the fear of deportation would inevitably 
     preclude undocumented immigrants from seeking care for 
     communicable disease until these individuals are extremely 
     ill.
       Hospitals provide care to anyone who walks through their 
     doors,--regardless of race, ethnicity or citizenship 
     status,--twenty-four hours each day, seven days a week. That 
     is the role of community hospitals. Rep. Rohrabacher's 
     legislation, however, seeks to create a new role for 
     hospitals in their communities--that of border patrol agents. 
     In order to qualify for Section 1011 funding, the Rohrabacher 
     legislation would require that hospitals demand and upload 
     personal data--including such ``identifiers'' as fingerprints 
     and digital photographs--on undocumented aliens to an 
     electronic database set up by the Department of Homeland 
     Security (DHS) and the Department of Health and Human 
     Services (HHS) for deportation purposes. Furthermore, the 
     bill requires hospitals to retain original documents and data 
     for a period of at least 5 years, thus imposing additional 
     paperwork on an already overwhelmed system.
       We do not believe this is in the best interest of the 
     patients we serve and the nurses and physicians that provide 
     emergency care. Today's health care delivery system in very 
     fast-paced and in an emergency situation, the urgency of 
     providing life-saving care takes precedence over anything 
     else. Requiring hospitals to collect these data diverts us 
     from doing our job of caring for patients. Hospitals do not 
     have the expertise or the resources to interrogate and 
     investigate patients in the pressured environment of an 
     emergency.
       We respectfully ask that you oppose this legislation should 
     it come up for a vote.
           Sincerely,
       Federation of American Hospitals.
       American Hospital Association.
       National Association of Public Hospitals and Health 
     Systems.
       Association of American Medical Colleges.
       Catholic Health Association of the United States.
       National Association of Children's Hospitals.
       VHA Inc.

[[Page 9693]]

     
                                  ____
                                 American Medical Association,

                                        Chicago, IL, May 13, 2004.
     Hon. J. Dennis Hastert,
     U.S. Capitol,
     House of Representatives,
     Washington, DC.
       Dear Speaker Hastert: On behalf of the American Medical 
     Association (AMA) and its physician and medical student 
     members, I am writing in strong opposition to H.R. 3722, the 
     ``Undocumented Alien Emergency Medical Assistance Amendments 
     of 2004'' (Rohrabacher, R-CA). This bill would amend Section 
     1011 of the Medicare Prescription Drug, Improvement, and 
     Modernization Act of 2003 (MMA) to impose conditions on 
     Federal reimbursement of emergency health services furnished 
     to undocumented individuals and require physicians and other 
     health care providers to report undocumented patients to the 
     Department of Homeland Security so that they could be 
     deported.
       This provision would effectively negate Section 1011 of the 
     MMA which will provide funds to reimburse physicians and 
     hospitals for treating undocumented individuals. The AMA has 
     been working with the U.S.-Mexico Border Health Commission 
     and state medical societies in Arizona, New Mexico, Texas, 
     and California, as well as the Centers for Medicare and 
     Medicaid Services, to determine the best way to implement 
     Section 1011. Physicians in these states believe these funds 
     are critically needed to provide necessary health services to 
     undocumented individuals who cannot afford to pay their 
     medical bills.
       This bill would effectively turn physicians and other 
     health care providers into border patrol agents. By requiring 
     physicians to report patients and perhaps withhold necessary 
     care, this bill would in effect require physicians to violate 
     their Hippocratic Oath. Finally, by discouraging undocumented 
     individuals from seeking medical care for problems that might 
     cause harm to others, such as communicable diseases, this 
     bill could have very negative effects on existing public 
     health efforts.
       The AMA urges you to oppose this bill when it is considered 
     on the House floor.
           Sincerely,
                                        Michael D. Maves, MD, MBA,
     Executive Vice President, CEO.
                                  ____



                                                  FamiliesUSA,

                                     Washington, DC, May 17, 2004.
       Dear Member: On behalf of FamiliesUSA, the voice for 
     America's health care consumers, I am urging you to reject 
     the Undocumented Alien Emergency Medical Assistance 
     Amendments of 2004, H.R. 3722. This bill would require 
     hospitals to report to the Department of Homeland Security 
     the name of any undocumented immigrant who receives care 
     within two hours of their treatment. If adopted, this 
     provision would have damaging effects on the care of all 
     Americans, especially on the Hispanic population.
       If they are faced with fear of deportation if they present 
     at a hospital, undocumented immigrants who are in need of 
     treatment may not seek it. As a result, health problems may 
     go untreated, endangering the health of the individual, and 
     also creating potentially serious public health problems. 
     Confusion about the applicability of this proposal may deter 
     even some legal immigrants from seeking treatment. What is 
     more, our nation's hospitals and health care providers will 
     be forced to divert their time and attention from saving 
     lives to acting as immigration officials, resulting in 
     diminished care in the hospitals.
       We urge you to vote against this legislation which creates 
     a public health danger.
           Sincerely,
                                                      Ron Pollack,
                                               Executive Director.

  Mr. ROHRABACHER. Mr. Speaker, I yield myself 30 seconds.
  Mr. Speaker, again we hear this bogus argument that this bill is 
going to create more paperwork. The paperwork and the questions that we 
are talking about are required by hospitals who are going to be trying 
to get reimbursement through this billion dollar fund, which was snuck 
into the Medicare package with a back room deal, I might add. It is not 
required by my legislation; it is required to get reimbursement. If a 
hospital does not want to be reimbursed, they do not have to ask any 
questions, they can do whatever they want.
  Let me note, all contagious diseases have been exempted by this 
legislation.
  Ms. SOLIS. Mr. Speaker, I yield 20 seconds to the gentleman from 
California (Mr. Waxman).
  Mr. WAXMAN. Mr. Speaker, I want to repeat, my good friend from Long 
Beach and Orange, California, is absolutely incorrect. The hospitals do 
not have to ask this question of emergency care patients. We do not 
know what the emergency is when they come in, if it is a communicable 
disease that they are suffering from such as SARS. Hospitals do not ask 
this question. They give care to the patients.
  Ms. SOLIS. Mr. Speaker, I yield 1 minute to the gentleman from 
California (Mr. Dreier).
  Mr. DREIER. Mr. Speaker, it is painful for me to rise in opposition 
to this legislation. The gentleman from California (Mr. Rohrabacher) 
and I have worked together on immigration issues for years, and I will 
take a back seat to no one when it comes to the issue of protecting our 
borders. I have had legislation to dramatically increase the size of 
the Border Patrol, and I believe it is very important for us to deal 
with the issue of illegal immigration.
  But I happen to have come to the conclusion, while I support the 
right to offer this legislation, I believe it is wrong. My concern is 
that it will send a message to many people who may not know that they 
have a contagious disease that the threat of deportation is on the 
horizon. Safety and security for the American people is our number one 
priority.
  I strongly support anything that we are going to do to ensure that 
the American people are safe and secure, that we are able to protect 
our families. My concern is that someone who could conceivably see the 
threat of deportation as they go through this process, and when I think 
about the process of State and local governments shouldering the 
responsibility of having to deal with possible incarceration of these 
people, the cost is tremendous and the possibility of the spread of 
disease is very great.
  I appreciate the fact that there is an exemption, but people may not 
know whether or not they have a contagious disease, and it is for that 
reason I think the right thing for us to do now is to oppose this 
legislation and work in a broad way to deal with the challenge of 
illegal immigration, which is a very serious and important one for us.
  Mr. ROHRABACHER. Mr. Speaker, I yield myself 30 seconds.
  Let me note that if we really want to have the spread of disease in 
this country, let us set ourselves up as the HMO for the whole world. 
Let us make sure that everybody in the world knows that if they can get 
their kids to the United States, we will take care of them, and see how 
many diseases we are going to get.
  That is what is happening in California right now. Diseases are 
beginning to materialize because people have brought their children and 
brought their seniors as well to come to the United States to be 
treated. We have got to end that syndrome because the money is coming 
directly from the health care dollars that should go to our own 
citizens, and it is luring more people with disease into our country.
  This is a catastrophe. The best way to prevent it is to vote yes on 
H.R. 3722.
  Mr. Speaker, I yield 3\1/2\ minutes to the gentleman from Georgia 
(Mr. Norwood).
  Mr. NORWOOD. Mr. Speaker, I rise to support H.R. 3722, and I would 
note if safety and security is the main concern of our country, then 
perhaps we ought to start at the borders and enforce the laws that we 
have on the books. Were we doing that, this legislation would not be 
needed.
  Between 1990 and 2000, the number of illegal aliens in Georgia rose 
300 percent. That was from 33,000 to 226,000 according to the U.S. 
Citizenship and Immigration Services. Nationwide, the estimates of how 
many illegal aliens live in our country range from 8 to 11 million, it 
sort of depends on who one talks to. Those that do work do not have 
health insurance, and technically the law forbids them access to 
Medicaid.
  However, document fraud led many to question how many illegal aliens 
are fraudulently obtaining Medicaid today where we have a problem for 
our own citizens in every State having enough money to take care of 
Americans.
  Last month, the Atlanta Business Chronicle reported that Grady 
Memorial Hospital in Atlanta is on the verge of closing its doors. 
Grady treats more illegal aliens than any other hospital in the State 
of Georgia. It only gets 7 percent of its revenues from patients with 
private insurance.
  In 2002, the State of Georgia paid $58 million in emergency Medicaid 
reimbursements to hospitals that treated

[[Page 9694]]

more than 15,200 illegal aliens, according to the Georgia Department of 
Community Health. About 75 percent of the funds went to pregnant women 
delivering babies. The total was a 33 percent increase from 2001 when 
the State paid $43.4 million for the care of 12,000 people.
  Mr. Speaker, I will have to say, if we do not pass this bill, it is 
absolutely going to break our hospitals. We do have a billion dollars 
that was put into the Medicare bill for reimbursement to our hospitals 
for illegal alien care. That means, to obtain those dollars, and all 
hospitals, particularly rural, desperately need those dollars, 
hospitals have to ask the question: Are you or are you not a citizen? 
It is that simple.
  I do not happen to think that we have a pot full of money that is so 
big that everybody can get everything that they want. We do not. I see 
it in Medicaid today for U.S. citizens. There is not enough money in 
there now. We have to be particular about how we spend that money. And 
first and foremost, it must be spent on the American citizen, not 
someone who started out the day breaking Federal law.
  Mr. Speaker, we ought to be talking about that more than anything 
else. This Congress is responsible for that. We passed a law saying 
that people cannot sneak across our borders. If Members do not believe 
that ought to be the law, if they think that is not important, then 
stand up and repeal that and we will look at this whole scenario, 
including health care, in a different vein.
  Ms. SOLIS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I submit for the Record letters from various hospitals 
and organizations in opposition to this bill.

                                                     May 13, 2004.

                  RE: H.R. 3722 (Rohrabacher)--Oppose

       Dear Congresswoman Solis: On behalf of Private Essential 
     Access Community Hospitals, Inc. (PEACH, Inc.), representing 
     37 private safety net hospitals across California, I am 
     writing to express our strong opposition to H.R. 3722 
     (Rohrabacher), which would require hospitals to document the 
     immigration status of those seeking emergency care. We ask 
     for your NO vote when this measure comes before the House 
     this month.
       In California and throughout the nation, private safety net 
     hospitals are a vital segment of the safety net, providing 
     critical health care services to diverse populations within 
     their communities, including undocumented immigrants. PEACH 
     hospitals consider it part of their mission to provide 
     essential services to all who seek care regardless of any 
     barrier, including ability to pay or immigration status.
       We have two primary concerns about H.R. 3722. First and 
     foremost, our hospitals are in the business, socially, 
     morally and economically, of saving lives and protecting the 
     health care of their communities. They are not in the 
     business of serving as immigration officers. This is neither 
     the role of hospitals nor an effective use of extremely 
     limited hospital funds and staff time--particularly in an 
     emergency department setting.
       Second, we believe that H.R. 3722, rather than discouraging 
     the tide of illegal immigration, would instead have a 
     negative impact on public health care. Individuals who are in 
     need of emergency care, including those with contagious 
     conditions and/or who are seriously ill, would be forced to 
     avoid treatment in order to avoid the threat of deportation. 
     This would likely result in the spread of serious and 
     contagious conditions to the greater community creating a 
     health care epidemic as well as a secondary wave of patients 
     needing costly emergency care.
       PEACH appreciates the desire to stem illegal immigration, 
     but H.R. 3722 sets a very dangerous precedent by using health 
     care providers as adjunct Border Patrol. We urge you to 
     defeat this ill-advised measure, and appreciate your 
     consideration of the views of those who are on the front 
     lines of health care every day.
           Sincerely,
                                             Catherine K. Douglas,
                                    President and CEO, PEACH, Inc.
       On behalf of:
         California Hospital Medical Center, Central Valley 
           General Hospital, Citrus Valley Medical Center--Inter-
           Community Campus, City of Hope National Medical Center, 
           College Hospital Cerritos, College Hospital Costa Mesa, 
           Community Hospital of San Bernardino, Community and 
           Mission Hospitals of Huntington Park, Daniel Freeman 
           Memorial Hospital, Fountain Valley Regional Hospital 
           and Medical Center.
                                  ____

                                                      May 7, 2004.
       Dear Member of Congress: We understand that the House of 
     Representatives is expected to soon consider legislation 
     (H.R. 3722) proposed by Representative Rohrabacher (R-CA). 
     The undersigned organizations, representing America's 
     hospitals and health systems, health care providers, and 
     safety net systems, are united in our opposition to H.R. 
     3722, the ``Undocumented Alien Emergency Medical Assistance 
     Amendments of 2004,'' and urge you to oppose this 
     legislation. We believe it will severely undermine Section 
     1011 of the Medicare Prescription Drug, Improvement, and 
     Modernization Act of 2003 (MMA) and create unnecessary 
     barriers to life saving treatments at hospitals nationwide.
       After months of careful deliberation by the Medicare 
     conferees, the Congress and Administration included essential 
     resources for hospitals providing life saving emergency care 
     to undocumented aliens. The undersigned organizations deeply 
     appreciated the inclusion of Section 1011 in MMA.
       We are deeply concerned that H.R. 3722 would weaken Section 
     1011 by imposing new burdensome requirements on hospitals in 
     order to receive any of the resources from Section 1011. In 
     addition, H.R. 3722 would virtually ensure that illegal 
     immigrants will avoid getting the appropriate and timely life 
     saving health care they need, when they need it. H.R. 3722 
     could pose a significant public health threat for entire 
     communities because the fear of deportation would inevitably 
     preclude undocumented immigrants from seeking care for 
     communicable diseases until these individuals are extremely 
     ill.
       Hospitals provide care to anyone who walks through their 
     doors, regardless of race, ethnicity or citizenship status--
     twenty-four hours each day, seven days a week. That is the 
     role of community hospitals. Rep. Rohrabacher's legislation, 
     however, seeks to create a new role for hospitals in their 
     communities--that of border patrol agents. In order to 
     qualify for Section 1011 funding, the Rohrabacher legislation 
     would require that hospitals demand and upload personal 
     data--including such ``identifiers'' as fingerprints and 
     digital photographs--on undocumented aliens to an electronic 
     database set up by the Department of Homeland Security (DHS) 
     and the Department of Heath and Human Services (HHS) for 
     deportation purposes. Furthermore, the bill requires 
     hospitals to retain original documents and data for a period 
     of at least 5 years, thus imposing additional paperwork on an 
     already overwhelmed system.
       We do not believe this is in the best interest of the 
     patients we serve and the nurses and physicians that provide 
     emergency care. Today's health care delivery system is very 
     fast-paced and in an emergency situation, the urgency of 
     providing life-saving care take precedence over anything 
     else. Requiring hospitals to collect these data diverts us 
     from doing our job of caring for patients. Hospitals do not 
     have the expertise or the resources to interrogate and 
     investigate patients in the pressured environment of an 
     emergency.
       We respectfully ask that you oppose this legislation should 
     it come up for a vote.
           Sincerely,
       Federation of American Hospitals.
       American Hospital Association.
       National Association of Public Hospitals and Health 
     Systems.
       Association of American Medical Colleges.
       Catholic Health Association of the United States.
       National Association of Children's Hospitals.
       VHA Inc.

  Ms. SOLIS. Mr. Speaker, I yield 1\1/3\ minutes to the gentlewoman 
from Guam (Ms. Bordallo).
  Ms. BORDALLO. Mr. Speaker, I rise today in strong opposition to H.R. 
3722, a bill that presents more questions than answers about providing 
efficient and effective health care treatment to undocumented 
immigrants.
  I share the concern about lapses in our country's immigration 
program, and I support measures such as biometric visas and other 
advanced technologies to more accurately control who enters our 
country. However, I am very concerned about this particular 
legislation, as I fear that it will serve only to undermine the 
efficiency and effectiveness of our public health system with little 
benefit to our Border Protection Services.
  Mr. Speaker, we are talking about health here. The reason that I 
hesitate to support H.R. 3722 is twofold. First, funding was included 
in last year's Medicare reform act for the simple purpose of assisting 
State and local health authorities to cover the cost of providing 
health services to illegal immigrants.
  This provision demonstrates both our Nation's compassion by ensuring 
public health to all walks of life and also its commitment to providing 
our medical community with the necessary resources to do their jobs. 
Adding more regulatory and financial burdens, such as those outlined in 
H.R. 3722, will increase costs.

[[Page 9695]]

  Secondly, I am concerned that immigration paperwork will either 
prevent or delay critical health care services to immigrants in 
general. Documentation can be dealt with after immediate medical 
procedures are rendered. Because of these concerns, I urge my 
colleagues not to support H.R. 3722.
  Ms. SOLIS. Mr. Speaker, I yield 1 minute to the gentlewoman from 
Illinois (Ms. Schakowsky).
  Ms. SCHAKOWSKY. Mr. Speaker, we have been asked to vote on a lot of 
really bad ideas presented by the majority, but I have to say this is 
clearly one of the worst.
  This bill, regardless what the gentleman says, would require doctors 
and nurses to be part of enforcing Federal immigration laws while 
threatening the health and well-being of our communities.
  But do not take my word for it. The American Medical Association says 
``This bill would effectively turn physicians and other health care 
providers into Border Patrol agents. By requiring physicians to report 
patients and perhaps withhold necessary care, this bill would, in 
effect, require physicians to violate the Hippocratic Oath. Finally, by 
discouraging undocumented individuals from seeking medical care for 
problems that might cause harm to others, such as communicable 
diseases, this bill would have very negative effects on existing public 
health efforts.''
  I know the gentleman goes to great lengths to say what is not in his 
bill is not in his bill, but these are the experts that are required to 
actually carry out this law. This bill is so ill-advised, it could 
allow for a woman in active labor to be deported. That is not America.
  We should vote ``no'' on the legislation.

                              {time}  1530

  Mr. ROHRABACHER. Mr. Speaker, I yield myself 1 minute.
  We keep hearing the bogus arguments. This requires the doctors to ask 
so many questions; we know now that is not true. Only the people who 
are trying to get reimbursed from that billion-dollar fund are going to 
ask the questions. This bill has minimal added questions. Two. Who is 
your employer and then taking a picture or getting a fingerprint which 
might be required in order to get reimbursed in the first place.
  Do my colleagues on the other side of the aisle really believe in 
unlimited treatment for illegal immigrants without asking any 
questions? Is that what we are going to do? Who benefits from that? 
Certainly the illegal immigrant does and the tens of millions of other 
illegal immigrants who come into our country seeking health care, yes, 
they are going to benefit.
  Who else benefits? The employer who does not want to offer health 
care to his employees. That is who benefits. That is who is being 
subsidized here. Behind the scenes when you get to the Chamber of 
Commerce and these other people opposing this, that is what their 
motive is. They do not want to offer health care to their employees. 
This gives the government the subsidy to subsidize them hiring people 
at below minimum wage level and, in fact, off the books at times. If 
you want to combat illegal immigration, this is the way to start; and 
it does not add any new paperwork or any new questions for the doctors.
  Ms. SOLIS. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from California (Ms. Linda T. Sanchez).
  Ms. LINDA T. SANCHEZ of California. Mr. Speaker, envision this: an 
undocumented immigrant or a legal permanent resident or even a U.S. 
citizen suffers severe abdominal pain and finds himself in the 
emergency room of a nearby hospital. The first order of business for 
the emergency physician, nurse, or whoever is attending the patient is 
not to ask them where it hurts and do a physical exam to see if their 
life is in imminent danger, but to ask their immigration status and get 
a sworn statement to that effect.
  If that patient at that particular moment cannot prove their legal 
status, that same doctor must make the choice not to provide care to 
this person, or they must at least report them to the immigration 
officials before providing lifesaving treatment. I ask you, what kind 
of choice is that? What happens if that same immigrant decides not to 
seek care because of the potential consequences and what could become a 
burst appendix leads to infection, more expensive care or possibly even 
death? There is no humanity in the choice you are asking health care 
workers to make in this circumstance. They are no longer healers, but 
immigration law enforcers.
  What is even more appalling is that the Republican leadership chooses 
to pursue this course of action to deal with this country's immigration 
problem rather than look at the comprehensive immigration reform 
measures that have been introduced in the House. If the Republicans are 
serious about reforming immigration, then take a look at the bill the 
Democrats introduced which would bring a sense of order and reason to 
the influx of immigrants into this country.
  Let us not jeopardize our entire public health system in this 
misguided attempt to bring down health care costs and deport 
undocumented workers. This bill is an affront to our health care 
professionals and to the immigrant community in this country which 
would no longer be able to get care without presenting their green card 
first.
  I urge a ``no'' vote on this legislation.
  Mr. ROHRABACHER. Mr. Speaker, I yield myself 30 seconds. This bill 
does not require the first order of business to ask questions. This 
bill says if you want to be reimbursed from that billion dollar fund, 
yes, you are going to have to ask some questions, anyway, and adds one 
other question: Who is your employer? It does not require the doctors 
to turn anybody into the INS, although we have heard that over and over 
again in this debate. It does not require that. It requires their files 
to be available to the INS and to the Department of Homeland Security. 
It is those agencies that then follow through. The doctors do not have 
to report anything. It just has to be available on a computer.
  Communicable diseases, we keep talking about that, that also is 
wrong. The bill exempts communicable diseases. Let us talk about the 
real issue, illegal immigration. How many services are we going to give 
people until we get tens of millions of more immigrating into our 
country?
  Ms. SOLIS. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Texas (Mr. Hinojosa).
  Mr. HINOJOSA. Mr. Speaker, I rise in strong opposition to H.R. 3722. 
I am appalled that the Republican majority would bring such a mean-
spirited and discriminatory bill to the floor of this House for a vote. 
Under current law, hospitals can receive reimbursement for emergency 
services they provide to uninsured people, including immigrants. Our 
current law is a responsible public health and safety policy. It is 
humane. In this country, we do not deny emergency medical treatment 
because someone is poor, uninsured, or born in another country.
  The proposed H.R. 3722 would turn hospital emergency rooms into 
immigration processing facilities or, worse, detention facilities. 
Hospitals would be required to collect sworn statements of citizenship 
from individuals suffering medical emergencies. Hospitals would have to 
collect fingerprints or other biometric identifiers of all emergency 
patients. Under this proposed H.R. 3722, they would have to submit the 
information to the Department of Homeland Security and store it for a 
minimum of 5 years.
  It seems to me there are a few Republicans who want to make people 
afraid to go to the hospital. This legislation will have deadly results 
in many of our congressional districts, especially in my district, a 
border district. We have daily trade and commerce across the border. 
Businesses depend on it. Fear will keep people from seeking lifesaving 
medical treatment. I urge all my colleagues on both sides of the aisle 
to send a message to those who would sow fear and hate, by strongly 
opposing H.R. 3722.
  Mr. ROHRABACHER. Mr. Speaker, I yield 1 minute to the gentleman from 
Texas (Mr. Culberson).
  Mr. CULBERSON. Mr. Speaker, we face a record national budget deficit 
in

[[Page 9696]]

this country. We face a record national debt of over $7 trillion, which 
we cannot leave to our children. We face in Harris County, Texas, 
spending over $100 million a year providing health care to illegal 
aliens.
  This bill that the gentleman from California has filed, which I 
strongly support, only requires hospitals that are seeking 
reimbursement from that billion dollars to identify whether the 
individual in question is a citizen or not. A hospital is not eligible 
to be reimbursed unless they are already treating somebody who is an 
alien.
  The gentleman from California's bill, and I have read it very 
carefully, requires that this question be asked of everybody who is 
presented to a hospital for medical treatment if they are an alien. The 
gentleman from California's legislation is based on common sense. We 
must make sure that we balance the budget in this country. The budget 
deficit is now over $500 billion. Uncontrolled immigration is a 
national security issue. We must control our borders. It is a financial 
security issue for the sake of our kids and our grandchildren.
  I think the gentleman from California has come forward with a 
commonsense proposal that we can move forward on to the Senate and that 
we could deal with in conference committee. If opponents of this bill 
have better ideas, let them offer them as amendments. I strongly 
support the legislation and encourage my colleagues to vote for this 
bill in the interest of national security and the financial security of 
the future of this Nation.
  Ms. SOLIS. Mr. Speaker, I yield 2 minutes to the gentleman from Texas 
(Mr. Doggett).
  Mr. DOGGETT. Mr. Speaker, our border communities face some tremendous 
health care challenges. This bill would simply add to their burdens. It 
seems to confuse TV shows, trying to merge ``ER'' with ``NYPD Blue.'' 
It would involve our health care workers, our physicians, and instead 
of being physicians, it would turn them into Homeland Security 
deputies. When a doctor asks the nurse for a patient's vital signs, it 
ought not to mean fingerprints and a visa entry number.
  Think of it. A parent who is rushing a child to the emergency room 
with an excessively high fever, with a rattlesnake bite, with an 
accidental-fall injury is thinking, ``can I get my child to the doctor 
on time?'', not ``did I bring my employment history, my immigration 
status, my financial status?'' Some of our border physicians face such 
immense burdens. That physician is thinking, ``how can I take care and 
save the life and the future of this young person?'' Involving doctors 
and nurses in the red tape of the federal bureaucracy jeopardizes all 
of us, because these viruses and bacteria are equal opportunity 
pathogens. Tuberculosis, typhus and hepatitis do not ask for your 
immigration status. All of us could be adversely affected if fear 
forces people not to seek treatment at a medical facility.
  It is also important to consider that, finally, there is a small 
amount of relief for our border communities. Starr County, one of the 
poorest counties in the entire country, ought not to have to bear all 
of the cost of our federal immigration policy, nor should physicians in 
Mission or McAllen bear the entire cost of a policy that is federal in 
nature. Finally, there is some assistance on the way under legislation 
approved last year. Let us not destroy it with this bill. The Border 
Health Caucus has been leading the way in trying to find solutions to 
address the care of all the people in the border region.
  As we discuss immigrants, some here see numbers, but these are real 
live human beings that face crisis every bit as real as that of someone 
like myself who has lived here forever. This is a chance for groups to 
come together to stop bad legislation and start us on the way to 
solving our health care problems along the border.
  Ms. SOLIS. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
New York (Mr. Crowley).
  Mr. CROWLEY. I thank the gentlewoman for yielding me this time.
  Mr. Speaker, I rise in strong opposition to H.R. 3722. Hospitals, 
doctors, and nurses ought to be free to do the incredibly important 
jobs we all depend on them to do, that is, to save human life. Sadly, 
this bill would help prevent that. In turn, this bill will hurt 
patients.
  On a recent New Year's Eve in a hospital in my district, an 
undocumented woman gave birth to a girl. That girl, by birth, is a U.S. 
citizen but her mother remains not. If this bill had been law, that 
mother would have likely faced deportation. If that mother were 
deported, in all likelihood her baby girl, a U.S. citizen, would have 
gone with her. In essence that baby girl, a U.S. citizen, would have 
been deported.
  If this bill had been law when this mother went into labor, there is 
also a good chance that she would not have sought care at all. I ask 
you, if a pregnant woman is afraid to seek out care to help herself and 
her baby who, when born, will become a U.S. citizen, who suffers? If a 
person with a communicable disease does not seek treatment, who 
suffers? A communicable disease does not ask whether you are a U.S. 
citizen or not. If a person with a chronic ailment does not seek 
treatment until the condition worsens, requiring emergency care and 
taking up a scarce bed in the ER, who suffers?
  The reality is that this bill endangers the health of the 
undocumented, and this bill endangers the health of the documented as 
well. I would have thought that the sponsor of this bill would have 
learned from the ill-fated proposition 187 in his home State of 
California that led to scares and communicable disease outbreaks 
throughout the entire population, especially school children, because 
some people were denied care.
  I urge my colleagues to vote ``no'' on this bill.
  Ms. SOLIS. Mr. Speaker, I yield 1 minute to the gentlewoman from 
California (Ms. Waters).
  Ms. WATERS. Mr. Speaker, this is not the way to deal with immigration 
problems. I rise in strong opposition to H.R. 3722. As a matter of 
fact, I am surprised at the gentleman from California. Does he not 
understand that this would transform our health care personnel into the 
border patrol? This bill will have a disastrous impact on emergency 
care and community hospitals throughout America.
  Mr. Speaker, hospitals, doctors, nurses, and health care personnel 
are trained to be caregivers, not adjuncts of immigration law 
enforcement. Do our health care personnel not have enough to do already 
without imposing this huge reporting burden on an already overextended 
health care system?
  Mr. Speaker, forcing health care personnel to start taking 
fingerprints and snapping pictures of patients suspected of being 
undocumented when perhaps they need a blood transfusion or something to 
save their lives will cause people who urgently need medical care to 
refrain from seeking such care because they fear that they may die 
trying to get service or they will be deported. We all know that in 
health care an ounce of prevention is worth a pound of cure. When any 
persons delay their access to health care, their medical condition is 
much worse.
  I would urge a ``no'' vote on this bill. It is unsound public policy. 
I am ashamed of it. Do not do it.
  Ms. SOLIS. Mr. Speaker, I yield myself the balance of my time.
  In closing, I urge all my colleagues to join the hospitals, doctors, 
nurses, business owners, women's groups, children advocates, civil 
rights organizations, and, yes, the U.S. Chamber of Commerce to stand 
strongly against this bill. We cannot let this bill be the message to 
send to the American people about what the U.S. Congress thinks about 
the role of hospitals. We cannot let this bill be the message we send 
to the American people about what we think about immigrants, 
hardworking, tax-paying immigrants who come to this country for a 
better life, just as my parents did some 50 years ago. In fact, the 
average immigrant contributes about $1,800 more in taxes annually than 
he or she receives in any form of benefit, because they do not collect. 
We can do better than this bill. I urge my colleagues to vote against 
H.R. 3722.

[[Page 9697]]

  Mr. Speaker, I yield back the balance of my time.

                              {time}  1545

  Mr. ROHRABACHER. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I would ask my colleagues to seriously consider this 
vote, and I would remind them that there are people all over the United 
States, especially their constituents, who are looking at this vote as 
a determinant as to whether or not we believe that illegal immigration 
is something that should remain uncontrolled and should continue in the 
years ahead, or whether we should start doing something about it.
  There is a seething among the American people, among the working 
class and middle-class people. They know that illegal immigration has 
had a horrible impact on their lives. It has brought down wages. We 
actually had a policy that permitted unlimited illegal immigration into 
our country, and because of that, working class people do not make as 
much money as they did before.
  Now we have a situation where illegal immigrants who go for emergency 
treatment, we are being told that we have to give them unrestricted and 
unlimited treatment, health treatment, and it is going to be paid for 
by the Federal Government. But that is not true of U.S. citizens. What 
about those middle-class, working-class people? They are out of work; 
they do not have insurance.
  In this situation today, we have created the perverse priority that 
our government is reimbursing hospitals and helping illegals, but we 
will not do it for our own citizens.
  We have a horrible problem in this country with illegal immigration. 
It is hurting many people's lives. Yes, rich corporations in the 
Chamber of Commerce, they get to hire people who are not even paying 
taxes half the time. They do not have to provide health insurance 
anymore because there are all these illegals willing to work anyway. 
That is very damaging to the American people.
  Also we are spending billions of dollars here already on cancer 
treatments, organ transplants and genetic problems. We are spending 
about $10 billion on this every year.
  This legislation says the only free treatment that somebody gets at 
an emergency center, illegal or not illegal, is if their life is under 
a threatening situation. I think even that is very generous of us in 
the United States. Interestingly enough, if someone goes through the 
process of being a legal immigrant, they do not get their health care 
covered, they do not get it reimbursed by the Federal Government.
  Mr. Speaker, unless H.R. 3722 passes, we have set up the priority of 
helping illegal immigrants. Do not think that will not attract tens of 
millions more illegal immigrants to this country who have diseases that 
need to be treated. That makes sense. Think about it. This is common 
sense.
  The American people are waiting to see whether or not we are going to 
use our scarce health dollars to take care of our senior citizens, to 
take care of our own people, to take care of our own little kids, or 
whether we are going to attract tens of millions of new people here and 
give that money away to strangers.
  This is not mean-spirited. This is down-in-your-heart. We love 
everyone in this country. We have a diverse country, every race and 
religion. It is that love for each other that keeps us together. We 
have to care more about our own people, and that is not mean spirited, 
than we do about people that come here illegally.
  Mr. Speaker, I would ask my friends and colleagues to support H.R. 
3722.
  Mr. BACA. Mr. Speaker, I rise in strong opposition to H.R. 3722, the 
Undocumented Alien Medical Assistance Amendments of 2004.
  The Medicare Prescription Drug Act that this Congress passed last 
year includes $1 billion to reimburse hospitals for their uncompensated 
care of undocumented immigrants. We included that funding because we 
recognized the strain hospitals experience in providing uncompensated 
emergency medical care to the uninsured. H.R. 3722 undoes this goodwill 
by requiring hospitals to enforce immigration law, refuse emergency 
medical treatment to immigrants, and have them deported.
  Many American citizen and immigrant families who are living, working 
and paying taxes in the United States are unable to obtain health care 
coverage for themselves or their families. At a time when health care 
has become a national crisis due to the large number of uninsured, we 
need to take steps to heal more, not less.
  Undocumented immigrants are not covered by employer health care 
plans, and they are systemically excluded from public health insurance 
programs such as Medicaid and SCHIP. We cannot encourage immigrants to 
refuse to seek medical care due to fear of deportation. It makes no 
sense. Do we want outbreaks of tuberculosis and other diseases and 
epidemics common in the developing world right here in America? That is 
likely to happen if immigrants are refused emergency medical care. This 
is why hospitals nationwide, the American Medical Association, and 
physicians of all types are urging this Congress to reject this attempt 
to inject an anti-immigrant agenda into the field of medicine. Besides 
public health, H.R. 3722 fails on a number of fronts.
  For instance, it would force hospitals to choose which law they will 
violate--the one that requires them to provide medical assistance to 
anyone that requires it, or H.R. 3722 and its requirement that we even 
deport women while in labor.
  The Emergency Medical Treatment and Active Labor Act requires that 
any patient, without regard to race, sex, creed, immigration status, or 
ability to pay, be given appropriate emergency care to stabilize his or 
her condition. This law is consistent with the Hipprocratic Oath, and 
is meant to ensure that no person in our country will be denied 
emergency medical care.
  I cannot support legislation that could punish employers that 
unknowingly hire immigrants with fraudulent green cards by forcing them 
to pay the medical bills. There is no precedent for holding employers 
liable for injuries and illnesses that are not work-related. Also, I 
fear that employers will discourage their employees from seeking 
treatment for any illness.
  Are we prepared to possibly read stories of immigrant laborers found 
injured or dead on sidewalks? It is not difficult to imagine immigrants 
being left behind by fearful employers trying to avoid the scrutiny of 
federal immigration enforcement officials.
  Mr. Speaker, H.R. 3722 is a Pandora's box that our Nation cannot 
open. H.R. 3722 will endanger the health of everyone in America. It 
will force doctors to violate their oaths and the law, require 
hospitals to enforce immigration law, and it will encourage employers 
to force their immigrant laborers to never seek medical treatment.
  I urge my colleagues to please oppose this misguided proposal.
  Mr. STARK. Mr. Speaker, I rise in opposition to H.R. 3722, the 
Undocumented Alien Emergency Medical Assistance Amendments Act. This 
draconian bill would convert our nation's hospitals from health care 
providers to border patrol officers.
  If enacted, it would seriously endanger the health and lives of 
immigrants who need emergency care--and jeopardize our nation's entire 
public health system in the process. This bill would deny critical 
federal reimbursement to hospitals for the emergency care of 
undocumented immigrants unless the hospital determined patients' 
immigration status and obtained employer information for transmission 
to the Department of Homeland Security for purposes of beginning 
deportation procedures for undocumented workers.
  Today, the House Republicans are proving that President George Bush's 
promise to reform America's immigration system is not real and is 
nothing more than an election year ploy to gain votes from immigrants. 
If President Bush were concerned about the well-being of immigrants, he 
would publicly denounce this bill and would have made clear to the 
House Republican leadership that it did not deserve to see the light of 
day. He's done no such thing.
  This bill also clearly demonstrates the Republican Leadership's 
willingness to sacrifice the health needs and safety of America's 
immigrants to ensure their large donors--the pharmaceutical companies 
and health insurance industry--get their billions of dollars in 
subsidies from the Medicare bill. HR 3722 is on the floor today because 
of a commitment the House Republican leadership made to the bill's 
author in exchange for his vote for the Republican Medicare bill when 
it narrowly passed the House last November. Its yet another example of 
the dirty dealing it took to get their Medicare bill through Congress.

[[Page 9698]]

  If enacted, this policy would create a chilling effect in which both 
documented and undocumented workers would fear coming into hospitals 
for critical medical services. The result would be immigrants suffering 
from more serious health complications and eventually leading to the 
unnecessary deaths of many immigrants.
  This bill would also threaten the public health of this nation. Since 
this bill would surely drive a significant proportion of this country's 
population away from seeking needed medical care, it would undermine 
our public health system's ability to track and prevent the spread of 
contagious disease. Clearly, such a change would impact health care 
beyond the immigrant community.
  Instead of limiting health care, this Congress should be finding ways 
to expand health care to the 44 million Americans without health 
insurance. This bill would take us in the exact opposite direction. I 
urge my colleagues to vote against this bill and to protect our 
hospitals' abilities to continue to provide medical care to those who 
need it. To do otherwise is to endanger the health of us all.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise in opposition to H.R. 
3722, the ``Undocumented Alien Emergency Medical Assistance Amendments 
of 2004.'' This bill would amend Section 1011 of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 MMA. The 
purpose of Section 1011 of the MMA is to provide funds for reimbursing 
physicians and hospitals for treating undocumented individuals who 
cannot afford to pay their medical bills. H.R. 3722 would impose 
conditions on the Federal reimbursement of emergency health services 
furnished to these individuals, and it would require physicians and 
other health care providers to report the undocumented patients to the 
Department of Homeland Security so that they could be deported.
  H.R. 3722 would require physicians and other health care providers to 
be part time border patrol agents. According to the American Medical 
Association AMA, by requiring physicians to report patients and perhaps 
withhold necessary care, this bill would in effect require physicians 
to violate their Hippocratic Oath. The AMA also has expressed concern 
over the fact that by discouraging undocumented individuals from 
seeking medical care for problems that might cause harm to others, such 
as communicable diseases, H.R. 3722 could have very negative effects on 
existing public health efforts.
  I share the concerns of the AMA. The fear of deportation inevitably 
would preclude undocumented immigrants from seeking care for 
communicable diseases until they are extremely ill.
  It is important to remember that community hospitals must provide 
care to anyone who walks through their doors, regardless of race, 
ethnicity or citizenship status, and they must do this twenty-four 
hours each day, seven days a week. In order to qualify for Section 1011 
funding, the Rohrabacher legislation would require the hospitals also 
to demand and upload personal data. This would include the uploading of 
fingerprints and digital photographs for undocumented aliens to an 
electronic database set up by the Department of Homeland Security DHS 
for deportation purposes. Furthermore, the bill would require hospitals 
to retain original documents and data for a period of at least 5 years, 
thus imposing additional paperwork on an already overburdened system.
  Today's health care delivery system is very fast-paced, and, in an 
emergency situation, the urgency of providing life-saving care takes 
precedence over anything else. Requiring hospitals to collect 
immigration data would divert time and attention from caring for 
patients. Hospitals do not have the expertise or the resources to 
interrogate and investigate patients in the pressured environment of an 
emergency room.
  It also would divert funds that could be used to provide health care 
services for some of America's estimated 44 million uninsured patients. 
A substantial portion of these funds would have to be used to establish 
and implement an expensive new immigration enforcement program for our 
already underfunded, overburdened community hospitals.
  More than 200 organizations are opposed to this bill, including the 
American Hospital Association, Federation of American Hospitals, 
National Association of Children's Hospitals, National Association of 
Public Hospitals and Health Systems, Catholic Health Association, 
Association of American Medical Colleges, National Immigration Forum, 
National Immigration Law Center, Leadership Conference on Civil Rights, 
National Council of La Raza, League of United Latin American Citizens, 
MALDEF, National Asian Pacific American Legal Consortium, Asian and 
Pacific Islander American Health Forum, Families USA, AFL-CIO and 
Catholic Charities.
  This legislation would weaken federal Emergency Medical Treatment and 
Active Labor Act EMTALA obligations by redefining the circumstances 
under which hospitals are required to treat patients who are 
undocumented immigrants. Such a policy would create a dangerous 
situation for all patients because physicians would be required to 
impose differing standards of care based on whether they determine a 
patient to be in the country legally or not. By necessity, emergency 
department professionals must be afforded the latitude necessary to 
provide treatment based solely on which treatment is medically 
appropriate for the patient and without regard for immigration status.
  It is in the best interests of all patients, documented and 
undocumented alike, that medical staff be permitted to focus their 
attention on caring for patients and providing necessary medical 
treatment rather than on assisting the federal government in enforcing 
the immigration laws of this country. I urge you therefore to vote 
against H.R. 3722, the ``Undocumented Alien Emergency Medical 
Assistance Amendments of 2004.''
  Mr. ISSA. Mr. Speaker, I rise today to oppose H.R. 3722, the 
``Undocumented Alien Emergency Medical Assistance Amendments of 2004.''
  I commend the gentleman from California for his intent in introducing 
this legislation. It attempts to address legitimate concerns that exist 
about widespread illegal immigration and the cost of providing services 
to those aliens. This legislation requires hospital emergency rooms to 
collect citizenship, immigration status, financial data, and employer 
information from aliens seeking emergency care and transmit that 
information to the Department of Homeland Security in order to receive 
reimbursement for services. H.R. 3722 also requires an employer who 
knowingly employs an illegal alien to pay the cost of providing 
emergency care to the alien. As a representative of the same state as 
the gentleman from California, I understand the factors that led to him 
draft this legislation.
  However, I am disturbed that this legislation has come to the floor 
of the House without proper consideration, that it has not been fully 
vetted through the Committee process. I am a member of the committee of 
jurisdiction, the Committee on Energy and Commerce, and this 
legislation has not had a hearing or a mark up before our committee. 
Before we make a change in the law, before we enact legislation that 
will impact the operation of every emergency room in America, I think 
we ought to have a thorough debate on the issue, hear from the doctors 
and hospital administrators and others who will be impacted by this 
legislation, and who will bear the burden of implementation.
  I am opposing this legislation today, with the hopes that the 
gentleman will continue to pursue solutions to a serious problem, and 
that we would have an opportunity to hold hearings on this issue in the 
committees of jurisdiction and address it through the normal committee 
process. This will give us the opportunity to perfect legislation in 
order to make it fair and practical for hospital emergency rooms and 
the patients they serve.
  I thank you for the opportunity to speak, applaud the good intentions 
of the gentleman from California, and respectfully urge my colleagues 
to vote ``no'' on this bill at this time.
  Mr. FILNER. Mr. Speaker, our Nation is not healthy unless everyone 
is. I rise in strong opposition to the Undocumented Alien Emergency 
Medical Assistance Amendments.
  It is true that hospitals in San Diego, Imperial County and 
throughout the border region need Federal assistance to pay for the 
uncompensated care they provide. Instead of debating H.R. 3722, 
however, I would prefer to debate and vote on my Pay Up! Act, H.R. 
2848, aimed at offering full Federal reimbursement to hospitals for the 
service they provide to undocumented patents. My bill would not force 
nurses and doctors and other medical professionals to suddenly become 
de facto immigration officials.
  Unfortunately, the dangerous legislation that we are considering 
today would do exactly that: it would deny Federal reimbursement to 
emergency health service providers unless they agree to also serve as 
immigration agents.
  As California's Border Congressman, I can tell you this legislation 
would be a disaster for border communities. It would put an extra 
burden on our already overworked health care professionals, as they 
scramble to find the resources to collect and process patients' 
immigration information, biometric identifiers and financial data. This 
legislation will lead to fear and confusion among both documented and

[[Page 9699]]

undocumented immigrant families, discouraging them from getting 
necessary medical attention for children, pregnant women, the elderly 
and others. In fact, this legislation could put everyone's health at 
risk. The University of California at San Diego Medical Center has 
warned that this bill ``could undermine public health by deterring 
those with contagious diseases from seeking care.''
  This bill puts the lives of immigrants at risk. It puts our health 
care services at risk. It puts our public health at risk.
  On behalf of California's border communities, I urge my colleagues to 
not force doctors to spend their time figuring out which patients are 
in good standing with our complex immigration laws. I urge my 
colleagues to not force immigrant families to skip treatment for life-
threatening medical problems because they fear deportation. I urge my 
colleagues to vote ``no'' on the Undocumented Alien Emergency Medical 
Assistance Amendments.
  Mr. MORAN of Virginia. Mr. Speaker, I rise in strong opposition to 
the Undocumented Alien Emergency Medical Assistance Amendments of 2004, 
H.R. 3722, because it will place a new burden on already struggling 
emergency health care systems nationwide and will deter immigrants and 
their family members from seeking much needed health services.
  It is interesting to note that this month, at medical school 
graduations nationwide, a new community of physicians were called upon 
to take the Hippocratic Oath, which remains a sacredly held principle 
to the medical community today. Unfortunately H.R. 3722 would allow 
hospitals which receive federal funding to decide whether or not they 
would like to make emergency medical services available to certain 
immigrants, even if they are suffering from an emergency medical 
condition. This is a right that hospitals and other health care 
organizations do not want, as evidenced by the strong opposition of the 
American Hospital Association, the American Medical Association and 
countless other public health organizations. This seems to be in direct 
conflict of the Hippocratic Oath and will deny basic medical services 
to some of the most vulnerable of our society.
  In Northern Virginia, which encompasses my congressional district, 
the INOVA Health System serves nearly 400,000 residents a year and has 
about 240,000 visitors to its emergency rooms alone. The emergency room 
personnel at INOVA hospitals are some of the same nurses and doctors 
who serve as our First Responders and were certainly heroic on 
September 11th in aiding the victims of the Pentagon attack.
  Proponents of H.R. 3722 claim that this measure will help to lower 
the cost of health care in our country, but in reality, will do little 
to alleviate the growing cost of health care needs and will force 
hospitals to expand staff and technological resources to implement the 
reporting requirements such as obtaining signed statements relating to 
citizenship, immigration status, address, financial data and current 
employee status as well as purchase a digital electronic biometric 
identifier.
  I am greatly disappointed that the House Republican Leadership would 
bring to the floor for a vote, a measure which strives to deny even 
basic health services to some of the most vulnerable in our society, 
while our military is working hard to establish health services for 
citizens in some of the most war-torn and poverty-ridden countries in 
the world. H.R. 3722 will do little to address the important issue of 
rising health care costs and its intent seems to have been influenced 
more by political considerations than sound policy. I urge all my 
colleagues from both sides of the aisle to vote against the 
Undocumented Alien Emergency Medical Assistance Amendments of 2004.
  Mr. RUPPERSBERGER. Mr. Speaker, I rise in opposition to H.R. 3722 
because this bill places an undue burden on our hospitals to be the 
judge and law enforcement officer for our country's immigration 
policies. I agree with the sponsor of this legislation that we need to 
stop illegal immigration but we need to do that by giving immigration 
officers more resources to find, detain, and deport illegal immigrants. 
We need to redouble our efforts on our borders and aggressively prevent 
illegal immigration, but should not shift the responsibility of 
enforcing our immigration policy onto our health care professionals.
  The problem with this bill is that it targets the reimbursement of 
hospitals that provide care to injured or sick undocumented aliens. 
This legislation withholds reimbursements from hospitals that do not 
collect and share a person's immigration status, their citizenship, 
address, employment information, personal and financial data, health 
insurance information, and electronic version of their fingerprints 
that meet DHS standards. If they do not comply they do not get 
reimbursed. This means hospital personnel will have to spend time 
collecting information as opposed to treating the sick. More 
importantly, this places the burden on doctors to choose between 
treating a person and looking out for the financial security of the 
hospital. This is not a choice that a doctor should be forced to make.
  Many businesses do their due diligence in determining and screening 
workers but they do not have all the resources to fully verify 
immigration status. This legislation forces those businesses to 
reimburse hospitals for care if the company unknowingly employs a 
worker without full immigration documentation or offer health insurance 
to all of their workers. We should not punish businesses that have 
tried and do not have the resources to verify the immigration status of 
their workers. We also cannot require businesses to provide health 
insurance. That is a business decision and should be left to them. 
Government should not be forcing the hand of business.
  This legislation is opposed by the American Hospital Association, the 
American Medical Association, the U.S. Chamber of Commerce and the 
National Association for Manufacturing because this legislation does 
not address the real issue.
  This legislation penalizes hospitals and businesses and is not a way 
to stop illegal immigration. This is a law enforcement problem not a 
medical problem. We need to step up our efforts to reduce illegal 
immigration by increasing our resources in the law enforcement 
community.
  The SPEAKER pro tempore (Mr. Boozman). The question is on the motion 
offered by the gentleman from California (Mr. Rohrabacher) that the 
House suspend the rules and pass the bill, H.R. 3722.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of 
those present have voted in the affirmative.
  Ms. SOLIS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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