The New York Times on Tuesday examined how "uninsured Hispanic immigrants with uncertain immigration status -- have flocked in recent years to public hospital emergency rooms and maternity wards in Texas, California and other border states." As a result, many hospitals in border states have had to make an "uneasy decision: demand immigration documents from patients and deny subsidized care to those who lack them, or follow the public health principle of providing basic care to anyone who needs it," the Times reports. Parkland Health and Hospital System in Dallas, treats all patients regardless of immigration status. "We decided that these are folks living in our community, and we needed to render the care," Ron Anderson, president of Parkland, said, adding, "I don't want my doctors and nurses to be immigration agents." JPS Health Network in Fort Worth, Texas, requires patients to provide proof of citizenship to receive financial assistance in nonemergency cases. JPS officials said that their first responsibility is to legal residents, although they are "uncomfortable about having to make such distinctions," the Times reports. The federal government provides about $250 million annually to reimburse states for care provided to undocumented immigrants, and states such as Texas and California -- which have the largest populations of undocumented immigrants -- receive the largest share of those funds. However, the $66 million that California received last year for care provided to undocumented immigrants was "not even a down payment" on the total cost, C. Duane Dauner, president of the California Hospital Association, said. He added, "Emergency rooms and hospital doctors are forced to subsidize the lack of immigration enforcement by the federal government" (Preston, New York Times, 7/18).

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