Increase law enforcement efforts—and the influx of immigrants will increase.

Say what?

No, that wasn't a misprint – not when the law in question is the Emergency Medical Treatment and Active Labor Act of 1985.

EMTALA requires that every emergency room in the country treat the uninsured for free. And, naturally, that includes immigrants and illegal aliens.

An "emergency," as defined by this statute, is any complaint brought to the ER, from hangovers to hangnails, from gunshot wounds to AIDS.

The hottest ER diagnosis, according to medical lawyer Madeleine Cosman, is "permanent disability" – a vaguely defined condition that covers mental, social, and personality disorders. [Source: Madeleine Pelner Cosman, "Illegal Aliens and American Medicine," Journal of American Physicians and Surgeons, Spring 2005.]

Drug addiction and alcoholism (DA&A) are among the fastest growing "disabilities"

• In 1983 only 3,000 ER cases were classified as DA&A
• In 1994 DA&A cases exploded to 101,000
• In  2003 about 325,000 such cases were reported

And immigrants (legal and illegal) get more than medical treatment. A "disability" diagnosis automatically qualifies them for Supplemental Security Income, a federally funded cash transfer payment.

The numbers are staggering:

• 127,900 immigrants on SSI in 1982 (3.2 percent of recipients)
• 601,430 immigrants in 1992 (10.9 percent of recipients)
• 2 million in 2003 (about 25 percent of SSI recipients)

Unlike the other laws affecting illegal aliens, EMTALA is vigorously enforced. Hospital ERs must have physicians available to them at all times from every department and specialty covered by the hospital. The Feds impose fines of up to $50,000 on any physician or hospital refusing to treat an ER patient—even when the attending physician examines and declares the patient's illness or injury to be a non-emergency. Lawyers and special interest groups are granted more authority than doctors in these matters.

But even EMTALA can't stop ERs from closing their doors completely, however.  Uncompensated medical costs forced 84 California hospitals to close over the past decade.

EMTALA is not just for immigrants, of course. Uninsured U.S. natives receive the same ER privleges. Immigrants and their children, however, account for one-quarter of all uninsured—and more than half (59 percent) of the growth in the uninsured caseload. [Table 1: Who Are The Uninsured?]

Even Mexicans in Mexico regard EMTALA as their entitlement: Ambulances drive from Mexico to U.S. border hospitals, drop off indigent patients, and leave secure in the knowledge that their fares will be admitted.

The drivers apparently know that EMTALA requires hospitals to accept anyone who is within 250 yards of a hospital—no matter how they got there.

The moral: "It's just obvious that you can't have free immigration and a welfare state."—Milton Friedman, quoted in Forbes, December 27, 1997.

Edwin S. Rubenstein (email him) is President of ESR Research Economic Consultants in Indianapolis.