Feds leave im­mi­grant emer­gency bills un­paid

The Washington Times Weekly - - National - BY STEPHEN DINAN

NO­GALES, ARIZ. | Many com­mu­ni­ties across the U.S. have prob­lems get­ting re­im­bursed for send­ing am­bu­lances to pick up pa­tients, but for one com­mu­nity along the U.S.-Mex­ico bor­der, the delin­quent party is the fed­eral gov­ern­ment, which the city of No­gales says owes it hun­dreds of thou­sands of dol­lars for pick­ing up im­mi­grants.

The Ari­zona city billed the fed­eral gov­ern­ment for hun­dreds of am­bu­lance sor­ties dis­patched to calls from fed­eral agents when they find some­one in­jured, but the gov­ern­ment has paid less than 20 cents on the dol­lar — leav­ing No­gales to bear the bur­den of more than $250,000 in the past fis­cal year alone.

“We would love to be re­im­bursed 100 per­cent. If we were to be re­im­bursed 100 per­cent, we could pro­vide a higher level of ser­vice to our res­i­dents in No­gales,” said Aaron White, the city’s act­ing fi­nance di­rec­tor.

No­gales, with a pop­u­la­tion of about 20,000 about 60 miles south of Tuc­son, of­fers a vi­brant shop­ping dis­trict that fans out from the of­fi­cial ve­hi­cle and pedes­trian bor­der cross­ings. The stores, with their cloth­ing, home goods and cheap chil­dren’s toys, cater to the 200,000 Mex­i­cans who live a few feet away in No­gales, part of the Mex­i­can state of Sonora.

That prox­im­ity also makes it a nat­u­ral point for bor­der-jumpers, which means fed­eral cus­toms, im­mi­gra­tion and drug agents have a heavy pres­ence as well. When in­juries oc­cur, it’s the city’s res­cue ser­vice that re­sponds.

Dur­ing the 2012-13 fis­cal year, the city says, it re­sponded to 248 calls and billed the fed­eral gov­ern­ment $300,058 but re­couped just $47,740, ac­cord­ing to fig­ures ob­tained by the No­gales In­ter­na­tional news­pa­per and con­firmed by city of­fi­cials.

The pre­vi­ous year, the city billed $277,382 for 230 calls and was re­im­bursed just $29,919.

It isn’t clear why No­gales isn’t be­ing fully re­im­bursed.

Part of the 2003 law that added a pre­scrip­tion drug pro­gram into Medi­care also cre­ated a pot of money to re­im­burse mu­nic­i­pal­i­ties for un­com­pen­sated care of il­le­gal im­mi­grants, in­clud­ing am­bu­lance calls.

The money — $250 mil­lion a year from 2005 through 2008 — was di­vided among states, to re­main avail­able un­til it was ex­pended. Some states have ex­hausted all of their des­ig­nated fund­ing, but Ari­zona still had more than $13 mil­lion at the be­gin­ning of 2013.

U.S. Im­mi­gra­tion and Cus­toms En­force­ment didn’t re­turn mes­sages seek­ing com­ment about the pro­gram.

The Cen­ters for Medi­care and Med­i­caid Ser­vices, which main­tains the spend­ing data, wouldn’t speak on the record and said it couldn’t speak specif­i­cally to why No­gales was be­ing re­im­bursed only 20 cents on the dol­lar.

CMS said any move to re­plen­ish the fund for all the states would have to be made by Congress.

No­gales’ fire depart­ment doesn’t keep track of whether the calls stem from in­juries from some­one try­ing to jump the bor­der fence, from a car ac­ci­dent or from some other cause. The No­gales In­ter­na­tional re­ported that af­ter the fed­eral gov­ern­ment dou­bled the height of the bor­der fence in the city, am­bu­lance calls spiked — though they even­tu­ally dropped to near their orig­i­nal level.

David Austin, an aide to the Bor­der County Coali­tion, a group of of­fi­cials from ju­ris­dic­tions along the U.S.-Mex­ico bor­der, said un­re­im­bursed care “re­mains a sig­nif­i­cant prob­lem.” The coali­tion helped push the orig­i­nal money, which was cham­pi­oned by Jon Kyl, an Ari­zona Repub­li­can serv­ing in the Se­nate at the time.

“How­ever, the pro­gram au­tho­riza­tion ex­pired and most states have ex­hausted their avail­able funds. To date, no one has cham­pi­oned a reau­tho­riza­tion,” Mr. Austin said.

No­gales of­fi­cials took um­brage to hav­ing this kind of at­ten­tion called to their city.

“One of our main con­cerns is that na­tional me­dia picks up on No­gales and all of a sud­den it turns neg­a­tive, rather than the pos­i­tives of life liv­ing here,” Mr. White said.

Deputy City Man­ager John E. Kissinger said the city sim­ply con­sid­ers the un­com­pen­sated funds to be bad debt, just like if any other pa­tient didn’t pay the bill from an am­bu­lance call.

“If you strip it down to its ba­sic and its logic, you can prob­a­bly an­tic­i­pate this type of debt. Now, if you want to make a big­ger im­mi­gra­tion story, you’re speak­ing to the wrong per­son,” he said.

“Some­times you read some of th­ese sto­ries, what we’re talk­ing is, ‘Well, if the un­doc­u­mented im­mi­grants weren’t in the U.S., we wouldn’t have that cost,’” he said. “But that’s not what we’re here about. The city of No­gales is here to pro­vide the best emer­gency re­sponse as we can.”

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