Leticia Van de Putte “voted to give illegal immigrants in this country free health care–not emergency health care but total free health care.”

In the only debate between major-party candidates for Texas lieutenant governor, Republican nominee Dan Patrick stood by his objections to a Texas law authored by his Democratic opponent that enables some children living in the state without legal authorization to qualify for in-state college tuition.

Patrick, a Houston state senator, went on to say Sept. 29, 2014, that after the tuition proposal passed into law in 2001, state Sen. Leticia Van de Putte of San Antonio, the Democratic nominee, supported another questionable move.

“She voted to give illegal immigrants in this country free health care — not emergency health care but total free health care,” Patrick said. “That was about seven years ago and that bill didn’t pass.”

We were curious about the described vote.

By email, Patrick spokesman Alejandro Garcia said Patrick was referring to Van de Putte’s vote for a proposal that cleared the Senate in 2003, Senate Bill 309. Garcia said the legislation required “local hospitals to provide emergency care to patients regardless of immigration status. Opponents claimed the bill would drive up the costs of health care and increase taxes to provide care to illegal immigrants. Van de Putte supported this measure knowing that it would benefit illegal immigrants at a cost to taxpayers,” Garcia wrote.

We’d been down this path with Patrick before. In May 2014, we rated False his claim that the Senate had earlier approved free health care for illegal immigrants.

Let’s unspool afresh.

Senators including Van de Putte on May 5, 2003, gave voice-vote approval to the proposal, which a May 5, 2003, Senate Journal entry summarized as “providing health care services without regard to a person’s immigration status.” At the time, Patrick, a talk-radio host, wasn’t yet a senator.

The legislation said a city, county or public hospital “may use money from local sources to provide health care services to a person without regard to the person’s immigration status and shall establish a cost-share system for persons receiving health care services.”

At an April 2003 committee hearing, authoring Sen. Mario Gallegos, D-Houston, said it permitted hospitals to draw on local revenue to provide preventive services to residents regardless of a patient’s immigration standing. Sylvia Garcia, then a Harris County commissioner, testified the proposal would hasten outpatient services, heading off health problems early and saving money thanks to fewer emergency-room visits.

Proponents described the legislation as vital after the then-Texas attorney general (and future U.S. senator), John Cornyn, issued an advisory opinion in July 2001 stating that unless lawmakers allowed the Harris County Hospital District (and others, presumably) to deliver preventive services to patients regardless of immigration status, the district couldn’t give such care without violating the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which required state legislatures to intervene if states wanted hospitals to go ahead and do so.

Notably, Cornyn’s letter made it clear some health services already were provided to patients regardless of immigration status–as mandated by federal law. Cornyn’s letter said the district was required by law to provide emergency care to residents regardless of their legal status.

Lance Lunsford, spokesman for the Texas Hospital Association, which describes itself as the political and educational advocate for more than 430 hospitals and health systems statewide, told us a federal law from the 1980s, the Emergency Medical Treatment & Labor Act, made free emergency care available to illegal immigrants. According to a federal website, that act required Medicare-participating hospitals that offer emergency services to provide a medical exam when a request is made for an emergency condition, including active labor, regardless of an individual’s ability to pay.

Cornyn’s letter also said federal law permitted public health services including immunizations and testing and treatment of symptoms of communicable diseases. Still, he wrote, the 1996 law specified that any other state or local health benefit could be provided only if a state law “affirmatively provides for such eligibility.”

Mike Stafford, the Harris County attorney, reacted to Cornyn’s letter by advising the local hospital district to stop giving discounted preventive care because it violates federal law, according to a July 12, 2001, Associated Press news story. “It’s up to the Texas Legislature to step in now and, if they want to create an exception for this, it’s allowable,” Stafford said.

In 2003, Senate Bill 309 died in the House, though advocates including Lunsford said the permission to provide such services ended up in House Bill 2292, a major 2003 overhaul of health care agencies. Section 285.201 of the Texas Health and Safety code “affirmatively establishes” the eligibility of undocumented residents to receive non-emergency public health benefits funded locally by public hospital districts.

And in the end, did the legislation expand free health care for illegal immigrants?

When we inquired, King Hillier, a vice president of the Harris County Hospital District, said by phone that “basically” the district had already been providing non-emergency services when the issue reached lawmakers. Hillier stressed the permissive quality of the proposal; funding and delivery of services was left up to local governments. Finally, Hillier noted the Senate version of the law envisioned a system of patients sharing costs, which has resulted, he said.

Our ruling

Patrick said Van de Putte “voted to give illegal immigrants in this country free health care—not emergency health care but total free health care.”

The 2003 proposal in question didn’t provide immigrants free across-the-board health care. Rather, the measure permitted (and didn’t require) local governing bodies to provide (or, it appears, resume providing) non-emergency services to residents regardless of immigration status, an action that was predicted to improve outcomes and head off costly emergency care to which all residents were already entitled per federal law. Significantly, too, the proposal envisioned patients sharing costs.

Diagnosis: False.

FALSE – The statement is not accurate.