The following is the transcript of Mr. Aviles' remarks.
“As the largest municipal healthcare system in the nation, HHC annually serves 1.3 million predominately low-income New Yorkers, including nearly 450,000 patients who are uninsured. We are a true safety net system with a statutory mission to serve all New Yorkers without regard to insurance status, ability to pay or immigration status.
“And because NYC is a city of immigrants - where roughly 38% of the residents are foreign born -- the majority of our uninsured patients are immigrants and a very substantial percentage have undocumented status.
“Now I should be clear that we are strong proponents of healthcare reform to extend coverage to those who are currently uninsured. But the overarching goal should be to achieve a healthcare system that is more rational, more equitable and more cost-effective. The exclusion of legal immigrants - who have played by the rules -- from access to affordable coverage makes no practical sense and is needlessly punitive. Similarly, prohibiting undocumented immigrants from buying insurance coverage at whatever unsubsidized price the insurance exchange might charge also makes no practical sense.
“These exclusions do not eliminate the costs of care for these individuals and families; they merely transfer those costs to providers. And often the uncompensated care burden will be shouldered disproportionately by safety net systems like ours simply because we will not turn these uninsured immigrant patients away. In localities where no safety net providers exist, the hospital emergency room will become the provider of last resort, an extraordinarily inefficient and costly way to render care and one that will further burden already overcrowded emergency departments.
“And access to emergency care by itself does not constitute effective access to healthcare. Uninsured immigrants will, like other people, continue to be involved in car accidents, have strokes or heart attacks, become ill with chronic conditions or get cancer. What happens after the emergency treatment? Where will they go for post acute care, rehabilitation, or ongoing treatment?
“Beyond the fundamental issues of equity and compassion, I want to emphasize that the financial destabilizing effect of denying legal immigrants access to affordable coverage and barring undocumented immigrants from purchasing market priced coverage is not trivial. And its negative impact is not limited to the directly affected immigrant patients.
“Our system -like many public hospitals in the country - provides essential services to our entire community on a limited budget. We run six level one trauma centers, a burn center, and two highly specialized regional neonatal intensive care units, among other critical, high cost services that benefit the whole community. I remind everyone that that the pending healthcare reform proposals in Congress would divert funding dedicated to safety net providers like HHC to partially pay for expanded coverage. These funding reductions are proposed on the theory that with fewer uninsured patients, public hospitals will still be able to cover costs and will still have sufficient resources to fully serve their communities.
“But, if we need to absorb the cost of uncompensated care - either because legal immigrants are barred from accessing affordable insurance coverage made available to everyone else or because undocumented immigrants are barred from buying the insurance coverage that they are otherwise prepared to purchase, we will necessarily have to divert resources required to support many of the essential services we provide to the community at large.
“This approach is not the path to a reformed healthcare system that is more rational, more equitable and more cost-effective. On the contrary, it is punitive, short-sighted, and, in our view, antithetical to the principles that have made America a beacon and a refuge for generations of hard-working immigrants… immigrants whose children and grandchildren have become today's leaders across our nation.”