Hospitals that service poor communities are sweating over a looming cut in the funds they use to care for the uninsured—particularly illegal immigrants. The government currently spends $20 billion annually to reimburse hospitals for covering the uninsured or poorly insured, who can't be turned away from emergency rooms. The Affordable Care Act will slice that in half, the New York Times points out, on the theory that more people will have insurance.
But illegal immigrants aren't covered by the reform law, and "safety net" hospitals say they suspect many of their patients are undocumented. "That's the 800-pound gorilla in the room," says one hospital CEO. "I was told in Washington that they understand that this is a problem, but immigration is just too hot to touch." The act did include a provision bolstering community health centers providing primary care to the poor and undocumented, but it was axed in last year's budget cuts.