Medical personnel in hospital. (Photo by Don Murray/Getty Images)
Florida’s hospitals and emergency rooms last year treated nearly 94,000 patients who told health care providers they lacked legal permission to live in the United States, or fewer than 1% of hospital inpatient and emergency room admissions for the year.
The state Agency for Health Care Administration (AHCA) released those numbers this week, based on information reported to it by the hospital industry. AHCA, however, was unable to determine how much uncompensated health care those patients received.
Nevertheless, the report asserts that the costs associated with illegal immigration are passed on, either directly or indirectly, to taxpayers, patients, and insurers and that people residing illegally in the United States place who seek care place a strain placed on the health care system due to increased utilization of services.
“Operating costs will rise because more nurses, hospital beds, and equipment are needed,” the report says. “Therefore, the rise in care provided to illegal immigrants will have a considerable direct and indirect impact on health care costs, especially if the population of illegal immigrants continues to grow.”
Hospitals did receive $76 million in Medicaid payments for providing emergency health care to immigrants who aren’t legally residing in the United States, a figure that includes both state and federal dollars.
The report estimates that the total cost of care (paid or otherwise) provided to immigrants not legally residing in the state is nearly $660 million.
AHCA did not immediately respond to the Florida Phoenix’s request for statewide hospital operating revenue data that could help put the $660 million figure into context.
“The cost of care from illegal immigrants is a direct contributor to the strain on Florida’s health care system. Uncompensated care as a result of illegal immigration strains the state’s limited health care resources and drives up health care costs,” the report reads.
“In addition, regardless of ability to pay for services, increased numbers of illegal aliens in the health care system will continue to impact professional staffing needs, such as additional doctors and nurses, which remain in short supply. As the demand for services outpaces supply, costs will likely go up at a faster pace than inflation.”
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Uncompensated health care, incurred by rendering health services without receiving any payments to cover those costs, were a driving force behind the mandated report contained in a sweeping immigration bill (SB 1718) that the Legislature passed in 2023 as Gov. Ron DeSantis was poised to enter the Republican presidential primary.
The law required AHCA to submit a report to the Legislature by March 1 quantifying the costs of uncompensated care for “aliens who are not lawfully present in the United States, the impact of uncompensated care on the cost or ability of hospitals to provide services to the public, hospital funding needs, and other related information.”
Alexis Tsoukalas, senior policy analyst at the Florida Policy Institute, criticized the methdology the state used to determine the amount of uncompensated care, which multiplies the percentage of all ER visitors and hospital admissions who told hospitals they were undocumented by the total operating expenses of Florida’s hospitals.
“Although the intent of the dashboard under SB 1718 was to show the amount of uncompensated care, the state — just like last year — has chosen not to provide that estimate. The truth is that undocumented immigrants represent a nominal share of all hospital patients and ER visitors,” Tsoukalas said in a statement to the Florida Phoenix. “Moreover, it is important to consider the myriad contributions that immigrants — including those without a documented status — make to the Sunshine State.”
Answering is optional
While the law required the hospitals to ask patients to report whether they were in the United States legally, patients are not legally required to answer the question.
Thomas Kennedy, spokesman for the Florida Immigration Coalition, said his group continues its Decline to Answer campaign, which encourages patients not to answer the question.
“We don’t believe that it’s neither good for the patient or the provision of health care in the state for this question to be asked,” Kennedy told the Florida Phoenix Monday. “Therefore patients should not respond.”
According to the report, 233,903 inpatients admitted to hospitals in 2024 refused to answer whether they were legally residing in the United States and another 604,393 emergency room patients refused to answer the question. That’s 838,296 patients.
Confusing
Hospitals are required to report patient data quarterly to AHCA broken out by hospital inpatient data and emergency room visits.
The report contains conflicting data.
For instance, a summary of emergency room visits for 2024 shows that 8,357,273 people presenting at a hospital emergency room department reported residing legally in the United States and that 604,393 emergency patients refused to answer the question. The summary on page 2 also indicates that 67,699 self reported as not legally residing in the United States. But the figure on page 4 indicates that 67,857 patients self-reported as not legally residing here.
And on page 2, AHCA estimates the total number of emergency visits for 2024 is 9,041, 429 on page 2 and 9,029,523 on page 4, which is a discrepancy between the two numbers of 11,906 visits.
Similarly, the hospital inpatient admissions data included on pages 2 and 4 of the report list different figures.
Page 2 shows 3,155,826 hospital admissions by people who self-reported living legally in the United States and another 26,185 admissions from patients who self-reported not legally residing in the United States.
Add in another 233,903 patients who refused to answer the question and the total inpatient admissions for 2024 was 3,415,914. That number doesn’t match what’s listed on page 2 (3,415,629) or page 4 (3,411,492).
The administration had offered no accounting for the disparity in its numbers as of this publication.
Kennedy told the Florida Phoenix: “That math ain’t mathing.”
Late
AHCA was required to submit the report to the Legislature by March 1. The Florida Phoenix reported on Friday that the agency missed the deadline. DeSantis Communications Director Bryan Griffin attributed the missed deadline to delays by some hospitals in submitting data to the state.
The 2024 report is the second submitted to the Florida Legislature since the law passed.
The first edition of the annual report tracked hospital data from June 1, 2023, through Dec. 31, 2023, and 10 years of hospital audited financial data. It, too, found that fewer than 1% of all Florida hospital admissions and emergency room visits involved patients who self-reported as not legally residing in the United States.
The first report also was unable to pinpoint the amount of uncompensated care provided to people not legally residing in the United States. The report noted the agency was unable to find “any obvious correlation between the level of uncompensated care and the level of illegal aliens presenting at the hospital.”
The report for 2023 states that “high levels of uncompensated care are more associated with rural county status than illegal immigration percentages. There also did not appear to be a correlation between total profitability and illegal immigration percentages. All the counties that had negative profit margins had below average illegal immigration ratios.”
None of these findings are in the second iteration of the report.
Following the release of the first report and press coverage of the findings AHCA developed a second report that contained none of those findings and published it on its website.
This story has been updated to include comment from Alexis Tsoukalas, senior policy analyst at the Florida Policy Institute.
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