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Dear Editor:
Jose Latour's article "Foreign Visitors Overloading US Hospitals" points to a tough balancing act for consuls: facilitating the entry of a critically ill person seeking American medical treatment vs. protecting America's taxpayers from foreign visitors lacking adequate means to pay for their medical treatment. Under the Emergency Medical Treatment and Active Labor Act (EMTALA), US hospitals are generally required to receive and treat patients with emergency medical conditions, regardless of the patient's ability to pay or lack of insurance coverage. This treatment must also be given regardless of the patient's immigration status. One of the results: the more than $40 million which Mr. Latour mentions was spent by Florida taxpayers in 2002 on medical treatment given to uninsured foreign nationals. In recognition of this problem, the State Department has urged consuls to be "alert for medical travel which might result in unexpected high costs for US hospitals" and to be "judicious in granting nonimmigrant visas for US medical treatment" (See ALDAC 199998, http://travel.state.gov/state199998.html). One way in which Consuls might be allowed to continue to issue visas to needy foreign medical patients, while keeping the financial burden off the shoulders of the American taxpayer, is through a more vigorous utilization of the affidavit of support. While use of the contract-style Affidavit of Support, Form I-864, would probably require legislative action, the Department of State could instruct posts to routinely use the older version of the Affidavit (Form I-134) to overcome public charge issues. Accordingly, one suggestion for assisting consuls to achieve the proper balance between competing interests could be to condition issuance of visas for medical treatment upon submission of Form I-134 by a US citizen or permanent resident to cover medical expenses in the event a given foreign national is unable to do so. In our context, this sponsorship might be extended to corporate citizens, such as charities or hospitals, which may be willing to undertake the cost of treatment for the visa applicant.

Liam Schwartz
Ramat-Gan, Israel



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