State leaders and policy experts are at odds about the cost of undocumented immigrants using Florida health care facilities.
The disagreement stems from new data released by the Florida Agency for Health Care Administration showing the number of undocumented people who went to Florida hospitals and responded to a state-mandated survey.
The legislation (SB 1718, also known as the Immigration Law) was signed into law in May by Gov. Ron DeSantis. It requires Medicaid-accepting hospitals to ask admitted and emergency patients about their immigration status. Critics of the law have suggested it does more harm than good creating a culture of fear in a health care environment.
The state’s report lists $566 million in expenses incurred by undocumented immigrants.
Republican Sen. Blaise Ingoglia of Hernando County is the sponsor of the Immigration Law. His office did not respond for comment. However, co-sponsor of the bill, Republican Rep. Randy Fine of Brevard County, said the report successfully showed that Florida is unfairly supporting undocumented people.
“The fact of the matter is, we're spending a half a billion dollars to provide health care and hospitals to people who should not be in the United States. That's half a billion dollars stolen from real Floridians,” Fine said.
But policy analysts argue that’s not what the report details.
“Looking more closely reveals the opposite is true,” said Alexis Tsoukalas, a policy analyst with the Florida Policy Institute. “Not only are undocumented people not as significant of a strain on the cost of health care as the state is purporting, but the share that is responding to the question and saying that they're undocumented and the share that is seeking care is much lower than I think the state originally intended to prove.”
According to AHCA, the report “includes county-level data information relating to the costs of uncompensated care for patients who are not lawfully present in the United States.”
In its cost analysis, AHCA states that the “cost of care provided to illegal immigrants is greater than $566 million.” However a closer look at the report shows the $566 million is not the cost of care, it is an “expense incurred,” Tsoukalas said.
“The difference there is you have expenses, but then you get a certain amount of that reimbursed based on whether people have their own insurance, or they're paying for the services or Medicaid or Medicare coverage,” Tsoukalas said.
When asked what “expenses incurred” meant, Fine said it referred to “uncompensated care,” or health care services that have not been reimbursed.
“Generally. it gets paid back in one of two ways, either higher prices on Americans or reimbursement from the state,” Fine said.
The AHCA report states that there were nearly 5 million emergency department visits. Less than 1% of those patients identified as an undocumented immigrant (0.82%). It should be noted that patients had the option of whether or not to respond to the citizenship question.
As far as the expenses incurred, the report doesn’t detail how hospital reimbursements occurred, whether it was through Medicaid or Medicare covering the expenses, or if the patient used insurance. The latter is possible. An undocumented immigrant could have coverage through a family member’s job-provided insurance.
“People can self-pay, and also there is federal Medicaid,” Tsoukalas said. “The funding that comes down specifically for people to access emergency care, regardless of citizenship status. The dashboard doesn't break any of that detail out.”
There’s also the issue of the report’s methodology.
“It's not precise,” Tsoukalas said.
The report doesn’t break down which services were provided nor the actual costs of those services. Instead, AHCA took the overall “costs” (in this case expenses) reported from each Florida county and multiplied it by the percent of listed undocumented immigrants to determine the $566 million figure.
“This methodology is not very sound, or very clear,” Tsoukalas said. “It’s still likely to overestimate the cost because county cost can vary in the actual procedures that people get in the treatments. They can vary widely.”
Despite any issues observed in the report’s first year, Fine said it accomplished its goal.
“I think the purpose of this whole exercise is to show that Biden's open border policy isn't free. It has real consequences for everyday Floridians in terms of funding that is not available for all of the other things that we want to do,” he said.
As for what’s next, the law remains in effect, and hospitals will continue to ask patients’ citizenship status. As for what that information will be used for in the future, Fine said he’s not sure.
“I don't know what we can do, but what we can do is we can get angry. And we can say this is what happens when Joe Biden has a border where if you're just willing to swim across the Rio Grande, you're welcomed into America,” he said. “When you have an open border, as we do in this country, this is what happens. And this is just a fraction of the cost of illegal immigration.”
According to the 2024-2025 fiscal year budget, Gov. Ron DeSantis recommended nearly $558,000 for AHCA’s budget for the continued collection of hospital immigration data.
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