Should Hospitals Snitch?

Republican House Leaders scrambled in the wee hours of Nov. 22 in an effort to get last-minute G.O.P. holdouts to pass President Bush's Medicare-reform bill. They succeeded, but now even some allies of the bill are upset at the dealmaking that enabled it to happen. The American Hospital Association (A.H.A.), an important supporter of the bill, is furious about a last-minute agreement Speaker Dennis Hastert struck to get California Congressman Dana Rohrabacher's yes vote. Hastert promised a vote next year on a bill Rohrabacher plans to introduce that would require hospitals treating illegal aliens to report them to authorities for deportation. The Medicare legislation reimburses hospitals for the $1.45 billion they spend annually caring for illegal immigrants who can't pay. That's "a huge drain of our resources," complains Rohrabacher, whose Southern California district has a high number of illegals. Diverting money from "the American people and legal residents in order to provide a health-care system for people who come here illegally is the most stupid thing I can think of."

But Rohrabacher's solution is "a really bad idea," complains A.H.A. executive vice president Richard Pollack. "The mission of hospitals is to take care of people, not to patrol borders." Under current law, doctors and nurses would not violate patient confidentiality by reporting illegal aliens. But such a policy would scare off those patients, says Pollack, and that could have "devastating public-health implications." If a disease such as SARS or AIDS were to go "untreated in any individual, regardless of immigration status, that can affect everybody." The bill could also alienate Hispanic Americans, a group Republicans will be courting for next year's elections. The Congressional Hispanic Caucus last week sent an angry letter to Hastert, demanding that he "rescind" his promise to Rohrabacher.

Hastert, who hasn't taken a position on Rohrabacher's bill, won't do that. "Promising people a vote on other legislation is not unusual," his spokesman, John Feehery, insists. The measure faces uphill battles in the House and Senate. And "we'll fight it," says Pollack.