This includes hospitals that face the cost of uncompensated care.

Uncompensated care refers to services provided without payment, such as charity care and unanticipated bad debt. Federal law mandates hospitals provide emergency services to all patients, regardless of their ability to pay. But growing uncompensated care burdens can negatively affect hospitals’ operating margins. 

Rep. Ryan Mackenzie, R-Macungie, is the sponsor of House Bill 2591, which would require the reporting of costs associated with health care provided to undocumented migrants, similar to recent actions taken in Florida and Texas. 

Florida Gov. Ron DeSantis signed a law requiring hospitals accepting Medicaid to report patient citizenship status. From June to December 2023, care for undocumented immigrants cost over $566 million. Similarly, Texas Gov. Greg Abbott issued an order for state agencies to track healthcare costs for undocumented immigrants and seek federal reimbursement.

Andy Briggs, a House Republican spokesman, told The Center Square he’s unaware of any state laws explicitly prohibiting questioning individuals about the status of their citizenship.

“In fact, there is a federal precedent for this requirement as applicants for Medical Assistance must provide satisfactory documentation of citizenship,” he said.

“Due to the failed immigration policies of the Biden administration, the situation at our borders continues to pose significant challenges,” Mackenzie at a press conference announcing a package of bills aimed at addressing undocumented immigration in the state. 

Noting the record number of illegal border crossings over the past few years, he stated that Pennsylvania needs a better understanding of the community impact, particularly as it relates to sanctuary cities.

Currently, hospitals can report uncompensated care costs to the Department of Health for reimbursement through the Hospital Uncompensated Care Program. 

Mackenzie’s legislation will require Pennsylvania hospitals to submit an annual report to the department, detailing the number of admissions and emergency room visits made by undocumented immigrants, the costs associated with those visits, 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. 

For hospitals to remain viable, many are forced to cover the financial gap left by uncompensated care by cutting costs and increasing revenue from paying patients, insurance companies, and government programs. This ultimately results in higher costs being passed down to taxpayers, patients and insurance providers. 

Liam Migdail, vice president of strategic communications for the Hospital Association of Pennsylvania, declined to comment on the issue, citing an unfamiliarity with the proposed legislation. 

The Pennsylvania Health Care Cost Containment Council, or PHC4, which has reported on the financial health of the state’s hospitals since 1989, says “a high-quality, cost-effective healthcare system depends on financially stable hospitals and health systems.”

The council’s 2023 financial report found that 51% of the state’s general acute care hospitals posted a negative operating margin – 15% had margins between 0-4%, and 34% were above 4%. The statewide average operating margin decreased 2.11 percentage points, dropping from 4.37% in 2022 to 2.26% in 2023. 

The forgone dollar value for statewide uncompensated care increased 2.9% – from $752 million in 2022 to $774 million in 2023.

In 2022, Pennsylvania, with 12.5 million residents, had an immigrant population of 7.8%, including 3.3% noncitizens. An estimated 5.4% of the population, or 672,800 people, were uninsured, according to KFF, a nonprofit that conducts health policy research. 

The package of bills also includes requiring the use of E-Verify for state grant recipients, and employment in the meatpacking, food processing, and lodging industries; banning out-of-state driver’s licenses for undocumented immigrants; protecting unaccompanied immigrant children; and cracking down on human traffickers.