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Undocumented Alien Emergency Medical Asistance Amendments of 2004

Location: Washington, DC


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,


This Act may be cited as the "Undocumented Alien Emergency Medical Assistance Amendments of 2004".

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.


(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 ©(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 ©(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:


"(1) IN GENERAL.-No payment may be made under subsection © to a hospital with respect to the provision of eligible services to an undocumented alien described in subsection ©(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 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.


"(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.


"(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.


(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.


(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.


(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.


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.


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