A Matter of Life
Two years ago, in August, 2004, the board of the John Peter Smith Hospital system took a step that set it apart from public hospitals in all other metropolitan Texas counties. Members of the League of Women Voters of Tarrant County believe this was an unfortunate step backward – and one we’re hoping the JPS board in coming months will erase.
The backward step was the hospital board’s decision – on a 6-4 vote – to no longer serve undocumented immigrants in its non-emergency clinics. JPS, like every other hospital, is required to serve anyone who walks through its doors with a medical emergency. But since 2004, the county’s only public hospital has refused to provide preventive healthcare on a charity basis to undocumented immigrants and their families – which translates to thousands of local residents who may have nowhere else to turn for routine medical help.
The League, along with the Allied Communities of Tarrant, Catholic Charities, LULAC, and other community groups, has been urging the JPS board for months now to rethink this position. The JPS board last week finally agreed to hire an outside group to study the size of the immigrant healthcare problem here.
That’s a fine step, although the board apparently won’t begin choosing the group to do the study until October. Our League realizes this is a complex and weighty issue, involving millions of taxpayer dollars. After all, one of the League’s basic activities is studying social policy issues and then educating the public about them.
In fact, the League has studied this issue, and we are convinced that the facts are already there to support a change in JPS policy. First, there is strong evidence that undocumented immigrants in Tarrant County are having trouble finding adequate healthcare. Most are not covered by employer health insurance, and they are far more likely to have little or no money to pay medical bills. It’s tough for many of them to get to a clinic, and once there many face language problems and the fear of being turned over to authorities. Beyond that, the application process at JPS is difficult for anyone, much less people who have limited understanding of English or the local hospital system.
Just as evident was the fact that JPS sometimes has found itself overwhelmed by the demands of serving the undocumented population along with its other clients. And the problem is only likely to grow, due to higher-than-average birth rates among Hispanic families, a rapidly expanding immigrant population, and increasing numbers of lower- and middle-class workers going uninsured or underinsured. JPS leaders must balance all that with the need to take in enough insured or paying patients to stay solvent.
However, JPS’ own reports show that, for the last four years, the hospital system has produced a healthy budget surplus – about $39 million in the 2004-05 budget year. We believe that is more than enough to allow JPS to improve and expand its services to the medically indigent in Tarrant County, including undocumented workers.
As for the effects on taxpayers: People who rent their homes pay property taxes indirectly through their landlords, and people who receive paychecks contribute to Social Security. Poor people also pay a higher percentage of their income to sales taxes than other groups. Moreover, denying preventive care may be just as costly to taxpayers as providing it, since emergency room costs routinely are several times that of preventive care.
Finally, the League believes there is a strong legal reason for providing healthcare to the undocumented: The U.S. Supreme Court, in its landmark 1982 decision in Plyler v. Doe, ruled that under the Fourteenth Amendment, schools in Texas could not deny education to undocumented children. In 2004, a Texas attorney general’s opinion advised that providing non-emergency medical care to undocumented immigrants was optional for a public hospital. We disagree. We think denying charitable healthcare to the undocumented should be held illegal under the Plyler decision.
Earlier this summer, the League’s board voted unanimously to support the three-point proposal put forward by the Allied Communities of Tarrant. ACT’s proposal calls for cooperation between JPS Hospital and ACT to open the charitable JPS Connection program to undocumented persons. Community task force listening sessions would be arranged as well as hospital screening care at churches and elsewhere. The proposal would improve JPS’ delivery of services, and basic health screening and education sessions would help residents understand when to go to clinics and when to the ER for medical care. The proposal is a call for action by the JPS Hospital Board and administration to treat all clients on an equal basis in its clinic system.
We believe JPS should adopt the ACT proposal, get the proposed study done, and then begin using its budget surplus to provide better services for all of Tarrant County’s medically needy people. We ask hospital board members to display the political will necessary to open JPS’ primary care clinics to all local residents. It’s a matter of life.
Jeane Grisham is president of the League of Women Voters of Tarrant County, which includes all areas of Tarrant County outside of Arlington, Pantego, Dalworthington Gardens, and Grand Prairie.