Executive Summary

In October of 2006, the Allied Communities of Tarrant set out to determine whether enough academic and financial information exists to make an informed business decision on whether the Tarrant County Hospital District (the JPS Healthcare Network) should extend clinic treatments and preventive health care to low-income undocumented residents and to uninsured working citizen families who earn slightly more than the current federal guidelines. The answer has been a resounding YES. Here are our findings:

1. Fewer than 100,000 undocumented immigrants reside in Tarrant County.

2. Generally, these residents are younger, healthier and use health care less than their counterparts in the general population.

3. Using data from JPS and other counties we project an annual cost to include low income immigrants in the JPS Connection program to be $2 million to $4.2 million.

4. The cost to do nothing includes more costly chronic disease, higher overall costs and an impediment to student education.

5. With a $10 million appropriation, (approximately 2% of its operating budget) JPS could reinstate care for low-income immigrants and add significant clinic care for working families who earn slightly more than the federal guidelines for the JPS Connection program.

6. With over $160 million in profits in the last three years, JPS has the financial capacity to immediately expand its clinic system to (1) undocumented residents and (2) families earning slightly above the federal guidelines for assistance.

Population Size and Characteristics Using data from the Department of Homeland Security and the Census Bureau, we have determined that fewer than 100,000 (6%) of the 1.6 million residents of Tarrant County are undocumented immigrants. National and local health surveys and epidemiological studies show immigrants to be younger and in better health than the general population, since they are generally of working age and have families. For reasons of culture and fear of the system, undocumented residents tend to seek medical care and emergency care less than the general population, and are more likely to self-pay, even when subsidized care is available.

Unfortunately, when undocumented residents become ill or face chronic disease, the likelihood of serious illness is much more likely than in the general population. This includes routine contagious diseases common among school age children.

The only health category where undocumented residents require health care in greater amount than the general population is maternity care. This is attributable to the lower average age of immigrant families as well as family size (slightly more than two children per family). While these health costs are important to note, they should not affect any JPS decision on clinic and preventive care, since maternity care is already provided for all Tarrant County residents, regardless of federal residency status.

Cost of Care Using data provided to the JPS Board in 2004 and more recent data from Harris County’s programs to treat immigrants in its clinic system, we have determined the annual cost to treat low-income undocumented Tarrant County residents will be in the range of $2 million to $4.2 million. This amounts to less than 1% of JPS’s $500 million operating budget.

Effect on JPS Of the six Texas metropolitan counties (Bexar, Dallas, El Paso, Harris, Tarrant and Travis) only Tarrant County excludes low-income undocumented residents from clinic and preventive care. Examining the financial records of each system, we found five of the six county health systems to be financially sound (El Paso is the exception). We have provided detailed comparisons and ratios between the Tarrant, Harris, Bexar, and Dallas county systems. Our analysis shows no negative effect in treating undocumented residents. In fact, Harris County found it would have cost $23 million to $35 million more if it closed its clinic system.

JPS itself has an unprecedented capacity to fund this policy change. With accumulated operating surpluses (profits in the business world) of over $160 million in just three years, JPS had over $329 million in cash reserves (Aug. 2006). JPS surpluses come not only from paying customers but also from tax dollars dedicated for medical treatment. In the 2004-05 year, JPS made a $17 million profit from charity care—enough to provide 150,000 clinic visits to needy Tarrant County residents—without sacrificing its financial goals.

The Cost of Inaction Finally, heath studies and interviews with local health professionals and educators disclosed the costs of doing nothing. Restricted healthcare access exacerbates chronic disease, creates heavy financial burdens for serious illness and disrupts students’ learning opportunities.

Conclusion The two most serious holes in the Tarrant County health system are clinic and preventive care for undocumented residents and for working uninsured families earning slightly more than the federal limits. The relatively small (1%) cost of including low-income undocumented residents and the financial strength of the JPS system allow a policy change to accomplish both. We recommend using $10 million increased healthcare access for these two populations. This will allow immediate reinstatement of low-income immigrants in the JPS Connection program and allow a pilot sliding scale fee structure to provide clinic access to working uninsured residents.