A poor illegal immigrant who goes to the John Peter Smith Hospital emergency room in Fort Worth gets the same care at the same price as any other indigent resident.

The Rev. Sergio Diaz is working to expand health care services available for illegal immigrants in Tarrant County.

But the same person who goes to a JPS clinic for nonemergency treatment is often faced with a hefty bill. Unlike other large urban public hospital systems in Texas, JPS excludes illegal immigrants from its charity program that provides preventive healthcare.

Trying to balance politics, medicine and money, the Tarrant County Hospital Board of Managers will debate and possibly decide Tuesday whether to spend millions to provide free or low-cost nonemergency medical care to thousands of illegal immigrants.

The Rev. Sergio Diaz of Iglesia San Miguel, an Episcopal church in Fort Worth, said he has been fighting for this issue because of the damage caused by inadequate health care. He said members of his church – many of them illegal immigrants – can’t get preventive health care and that some have died from complications from treatable diseases such as diabetes.

“This touches my heart because most of my people are immigrants,” said Mr. Diaz, a member of Allied Communities of Tarrant. “I’ve seen a lot of people suffering.”

Health care has become a major part of the national debate about illegal immigration, and the costs even led Dallas County officials to send bills to Mexico and other countries demanding payment for some of its expenses at Parkland Memorial Hospital.

The debate has also been simmering for more than a year in Tarrant County, where Allied Communities of Tarrant, a coalition of churches and social-justice activists, has pushed for the expansion of charity care. At the same time, a local conservative group favoring a crackdown on illegal immigration has been urging the board to retain the existing policy.

Dennis Killy, a member of the Tarrant Alliance for Responsible Government, said expanding cheap health care to illegal immigrants is an insult to citizens and to those who came to the United States legally. It simply rewards those who ignore federal law, he said.

“Where does it end?” Mr. Killy said. “When do we stop paying our tax money for something we’re getting nothing for?”

Mr. Killy said he believes a significant majority of board members support his group’s position and would not change the JPS policy. Officials with Allied Communities of Tarrant said they think it’s going to be a closer vote.

Three board members, Erma C. Johnson Hadley, Dan Serna and Ronnie W. Coulson, all declined to comment on how they might vote.

“It’s my obligation to leave my mind open,” Mr. Serna said.

Mrs. Johnson Hadley, board chairwoman, said this is a difficult decision that generates strong opinions and mixed emotions among many people. She said she met with Sen. John Cornyn and told him that this is something that needs to be addressed in Washington.

“We feel somewhat put out that we’re having to deal with a federal issue,” she said.

People supporting a tougher stance on illegal immigration see this as a critical financial issue. They worry that a change in policy will cost taxpayers dearly.

The cost of this possible expansion, however, depends on who’s adding the numbers.

The hospital district hired Phase 2 Consulting of Austin to conduct a study, which was released in July.

Estimating the number of illegal immigrants in Tarrant County at 107,000, the study calculated that expanding the charity program would cost the hospital district an additional $41.3 million right now. That number would increase to $114.4 million by 2017, according to the study.

Allied Communities of Tarrant conducted its own study in February that came to a dramatically different conclusion. Quoting 18th-century literary figure Samuel Johnson and a passage from the Bible’s book of Leviticus in the introduction, the alternative study estimated the cost to be between $2 million and $4.2 million added to the hospital district’s $600 million-plus budget.

Parkland officials estimated their cost for nonemergency care for illegal immigrants was $22.4 million in the past year – about halfway between the two Tarrant County estimates.

Patricia Gaffney, a member of Allied Communities of Tarrant who helped research and write the report, challenged some of the basic assumptions of the Phase 2 study. She said that study projects a 56 percent increase in Tarrant County’s illegal immigrant population in the next decade even though federal reports show that illegal immigration is decreasing.

Ms. Gaffney also said the Phase 2 study overestimates the number of illegal immigrants who would use the service. Many are wary of government programs because of their immigration status, she said.

Mr. Killy said he is more likely to believe an independent, third-party report than one created by a group advocating for one side of the issue.

Dave McElwee, another member of Tarrant Alliance for Responsible Government, said that aside from the immediate cost, he also worries about the message that expanded health care would send.

“I think there ought to be programs for the indigent but not for those in the country illegally,” he said. “All this does is act as a magnet for other illegals.” 

If the board votes Tuesday to expand health care, it’s not clear how quickly such a change would be implemented, JPS senior vice president Robert Earley said. He said the board and Tarrant County Commissioners have already approved the 2007-08 budget, and no funds are set aside for additional health care costs for illegal immigrants.

This is the second time this issue has come up for Tarrant County. For part of 2004, the board opened up all its programs to illegal immigrants. JPS officials were uncertain about whether a new state law allowed or mandated them to provide nonemergency charity services to illegal immigrants. Mr. Early said a ruling by the Texas attorney general and statements of intent from the sponsor clarified that the law didn’t require the expansion.

At the time, JPS officials said the expanded program cost them up to $4 million for six months. Mr. Earley said the participation was probably limited three years ago because the program wasn’t actively promoted by the hospital district and there were questions about how long it would last.

The board voted in August 2004 to make immigration status a factor for the JPS charity nonemergency care.

Officials with Allied Communities of Tarrant and the Texas Hospital Association also said most urban public hospitals in the state don’t limit health care service because of immigration status, but neither had conducted a comprehensive study.

Dr. Ron Anderson, chief executive of Parkland Memorial Hospital, which does not exempt illegal immigrants from its charity programs, said the decision by JPS did not affect his system.

But he said that it makes sense to get all low-income residents preventive health care in neighborhood clinics. When he came to Parkland in 1982, the system had no clinics and about 182,000 emergency-room visits annually.

Since then, the system opened neighborhood clinics countywide, and the emergency-room visits fell to 145,000 even though the population has nearly doubled.

“The truth is, if you don’t provide this care in the clinic, you’ll provide this service in the emergency room,” Dr. Anderson said.

Two studies were created this year estimating the cost of expanding nonemergency health care to illegal immigrants in the John Peter Smith Hospital system. One was created by Allied Communities of Tarrant, which supports the expansion, and the other by Phase 2 Consulting on behalf of JPS.
ACT study Phase 2 study
Current cost $2 million to $4.2 million $41.3 million
Estimated number of illegal immigrants 96,800 107,000
Percentage of illegal immigrants projected to use the new service 27 percent 7 percent
SOURCE: Dallas Morning News research