KMAX: News of the West

LOS ANGELES (AP) Proponents of stricter immigration controls are trying to use the courts to make public health officials collect medical fees from the sponsors of legal immigrants who can't pay their bills.

Years ago Los Angeles County reached the same conclusion as many other local governments nationwide: The cost of tracking down the people who sponsor immigrants, usually their family members, would exceed the money the county could recoup.

A lawsuit filed in state court here could change that by forcing public agencies to go after the money and in the process prompt local governments to tackle immigration law, which is usually federal domain.

The lawsuit, sponsored by the Friends of Immigration Law Enforcement in Washington, D.C., asserts that the county is violating federal law by not collecting from immigrant sponsors. The group estimates that policy means taxpayers foot as much as $20 million a year in unpaid bills, said Craig Nelsen, director of the group sponsoring the lawsuit.

The county says the money at stake is dramatically less than that and insists tracking down sponsors would cost more than what the county could recoup. Immigrant rights advocates who support the county's position say the lawsuit, if successful, would keep legal immigrants from seeking medical care for fear of burdening their sponsors.

A Los Angeles judge is expected to decide Thursday whether the case can proceed. Both sides of the immigration debate are watching closely.

Under a 1996 federal law, sponsors of legal immigrants must sign an ``affidavit of support'' promising to pay for public services before the immigrant can enter the country. The law was intended to prevent immigrants from moving to the United States solely to go on the dole.

The case follows several similar federal proposals that target undocumented immigrants. Yet those on both sides of the debate say this lawsuit could set a precedent by using the issue of sponsorship in the health care system to tighten immigration policy.

Los Angeles County isn't alone in its failure to track and bill immigrant sponsors but California counties are more vulnerable to litigation because state law lets residents sue the government if they feel their tax dollars are misappropriated.

Immigration advocates have attacked the lawsuit as a thinly veiled attempt to manipulate immigration law under cover of fiscal responsibility in health care. They say what the plaintiffs really want is to get at undocumented immigrants; by making legal immigrants name their sponsors, hospitals inevitably would identify some illegal immigrants.

``The plaintiffs are affiliated with an anti-immigrant organization, so they have an agenda,'' said Gabrielle Lessard, health policy attorney for the National Immigration Law Center. ``Collecting a few dollars from a few lawfully present immigrants is not going to solve the problems for the county.''

The lawsuit could discourage legal immigrants from seeking preventive health care because they don't want to burden their sponsors, said Barbara Frankel, supervising attorney at the Health Consumer Center of Los Angeles, which has filed a brief against the lawsuit. That would cost the county much more in expensive emergency room services, which it can't refuse anyone and which can't be billed to sponsors under federal law, she said.

Sharon Reichman, the lead county attorney defending the current policy, said the amount of money in question is negligible not the millions the plaintiffs estimate. Immigrants with billable sponsors represent a small portion of the approximately 28,000 inpatients the county treats each year who aren't covered by private insurance or a state or federal program, said John Wallace, spokesman for the county health department.

What's more, opponents of the lawsuit point out, sponsors may themselves be too poor to pay even part of the bill. A family member must only earn 125 percent above the federal poverty line to sponsor someone, Frankel said, a requirement they must meet without including government welfare programs.

``We're probably talking about a lot of effort to recoup very little money,'' Reichman said. ``And with the health care crisis in Los Angeles County we don't have the money to chase that right now.''

The county, which treats 600,000 uninsured patients annually, faces a shortfall of $265.1 million by fiscal year 2006-2007 and has been forced to close hospitals and consolidate services.

The plaintiffs counter that immigrants and their sponsors who don't pay are part of that budget crisis.

The lawsuit echoes previous attempts to manage immigration through the health care system, although those instances targeted undocumented immigrants.

A recent bill sponsored by Rep. Dana Rohrabacher, R-Calif., would have require hospitals to report a patient's immigration status before they could be reimbursed for treatment. Patients found to be in the United States illegally could be deported. The House overwhelmingly defeated Rohrabacher's proposal in May.

Regulations being written by the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Studies could require hospitals to ask emergency room patients their immigration status if they want reimbursement from a $1 billion package Congress set aside to defray the cost of treating undocumented immigrants.

Immigration rights advocates say that while the Los Angeles County lawsuit is milder than those examples and deals only with legal immigrants, it is still too invasive.

But officials at Friends of Immigration Law Enforcement, encouraged by overwhelming feedback from those who heard about the lawsuit on talk radio, say they plan to file similar lawsuits in other California counties. Nelsen said the group has received about 1,000 calls and e-mails from Californians willing to be listed as plaintiffs.

``I'm hoping that the court will order the county to do the public-minded,'' said Nelsen, ``responsible thing and begin asking people who they are and whether they're legally entitled to the services.''