Antonio Valenzuela Gomez, a retired factory worker who boasts 49 grandchildren, lifts his shirt to show the giant scar where American doctors cut into his chest a year ago.
Gomez, 79, was at his house in the dusty Mexican border town of Naco near here when his heart began to fail. There is no hospital in that part of Mexico, so family members loaded Gomez in a car and drove him a short distance to the U.S. checkpoint.
An ambulance arrived from the Arizona side and rushed Gomez 7 miles to Copper Queen Community Hospital here. Emergency room workers stabilized him and sent him 80 miles north to Tucson Medical Center, where heart surgery was performed.
Gomez, who spent three weeks in U.S. hospitals, thinks the bill was about $20,000 - likely a fraction of the actual cost. He offers gratitude along with small monthly payments that will never cover the expense. "They saved my life," he says. "They treated me well."
Along the border from Chula Vista, Calif., to Brownsville, Texas, U.S. hospitals serve as a medical safety net for undocumented immigrants and residents of northern Mexico. Each year, their care costs American medical centers, consumers and taxpayers hundreds of millions of dollars. During 2002, 38 Arizona medical centers surveyed by the Arizona Hospital and Healthcare Association reported losses on foreign-national patients of $153 million.
After years of pressure from the health care industry, the federal government last week announced a plan to repay hospitals across the USA for up to 30% of the unpaid bills they rack up for such patients from now through 2008. The payback could total $1 billion. Arizona hospitals stand to receive $45 million a year.
Hospitals are required by law to treat all emergency patients, regardless of nationality or legal status.
Jim Dickson, chief executive officer at Copper Queen hospital, says he is happy to care for anyone who is sick or injured. But about 15% of his patients are poor Mexican nationals, and financial losses have been excruciating for a little hospital in Bisbee (population 6,000).
"We had super-deficits the last two years," says Dickson, who solved his budget crisis by laying off about 35 of the hospital's 130 employees and eliminating medical services such as the long-term care center. "This has had a very negative impact on our hospital."
Arizona has been particularly burdened since the mid-1990s, when U.S. border crackdowns in Texas and California began funneling illegal immigrants and drug smugglers to the state's 350-mile border with Mexico. Last year, Arizona accounted for 52% of the 1.1 million illegals captured by Border Patrol agents in the Southwest.
Arizona's 5.7 million population includes an estimated 500,000 undocumented immigrants. The nationwide total is about 11 million, the Pew Hispanic Center estimates.
University Medical Center, a non-profit hospital in Tucson, will spend an estimated $12 million this year on unreimbursed emergency care for foreign nationals, hospital president Greg Pivirotto says. "It's a drain that hurts your ability to render care."
Because UMC has the only trauma center near the southern Arizona border, it treats severely injured patients who require expensive care. The hospital counted about 5,000 emergency patients in April, including 100 foreigners.
"It's a fairly small percentage, but it's a huge cost," Pivirotto says.
Hospitals use international collection companies to pursue payments. Some patients such as Gomez pay as much as they can. But most costs go uncollected.
Although public attention has focused on unpaid medical care for illegal immigrants, Pivirotto says four-fifths of the foreign nationals in his hospital entered the USA with legitimate paperwork - visas, 72-hour passes or "compassionate entry" permits granted in medical emergencies.
The percentage is likely higher at places like Copper Queen hospital, located in this hillside mining town. To the south, Naco overflows with would-be immigrants, smugglers and others clogged at the border. Dickson, the hospital administrator, says Naco's true population is triple the official count of 7,500. Four Border Patrol agents guarded the border here a decade ago. Today, there are 550.
But Naco still has no hospital, and local clinics lack radiology labs, emergency rooms and basic equipment.
"Even the federale who gets shot, he comes here," Dickson says. "The mayor, el presidente, will tell you that they count on us for care, because we're their local hospital."
Francisco Murrieta, an aide to Naco Mayor Vicente Torres, confirms that townsfolk rely on the Bisbee hospital when serious injuries or illnesses strike.
"If somebody has a big medical need, they want the best attention," he says.
Dickson says he sympathizes with his southern neighbors and tries to help by contributing medical gear to Naco's health clinics.
"I smuggled a defibrillator across the border in an ambulance because they had no way of measuring your heart," he says. "We gave them an ambulance because they were transporting patients in the backs of cars."
Dickson says some pregnant women from Naco used to cross the border after going into labor, obtaining the best medical care plus citizenship for a newborn child.
That's no longer a problem because financial losses forced Copper Queen to close its maternity ward.
