The federal government's unwillingness to stem the tide of illegal immigrants has created billions in healthcare expenses. Yet it is state and local governments that bear the cost. Not only is this profoundly unfair; it partly explains Washington's failure to fully address the problem. To allow states to recoup what they have lost and to force Washington to move on border control, states should insist that the federal government pay for its failure to secure the borders.

According to the Pew Hispanic Center, illegal immigration grew 23 percent over the past four years. This increase came despite of the creation of the Department of Homeland Security and increased funding for border control. Totaling nearly 11 million, illegal immigrants often seek healthcare services in the one place where Congress has mandated that no one can be denied care: the hospital emergency room.

As Americans, we accept that we have a moral obligation to provide emergency care to anyone who needs it, regardless of their citizenship. However, designed for acute and traumatic care, the emergency room is the most expensive place to receive care. Yet under the law, ERs must accept and treat patients without regard to the severity of a patient's condition.

Hospitals go uncompensated for providing much of this care, and the cost for providing care to illegal aliens is large and growing.

• In Los Angeles County, where the department of health is running a deficit of $1.2 billion, nearly two million illegal immigrants crowd its emergency rooms, creating long waits for patients, forcing closure of many facilities.
  
• The Florida Hospital Association reported that its members provide more than $40 million a year to care for illegal aliens.
  
• The U.S.-Mexico Border Counties Coalition reported that in just 24 counties on the southern border the cost of uncompensated care for illegal aliens totals more than $200 million every year.
  
• While the General Accountability Office recently said that it could not quantify the national total spent on care for illegal aliens, the Institute of Medicine noted that uncompensated care in general exceeds $35 billion a year.

Medicaid offers some resources for various reasons; the Balanced Budget Act of 1997 provided funds to 12 states for uncompensated care, as did the Medicare Reform Act of 2003. But these efforts to assist the states in their plight fall far short. While implicitly admitting through these appropriations that the federal government bears some--we would argue all-- of the responsibility for medical care for illegal aliens, the Medicare legislation sends only $1 billion over four years to the states for this care.

If the federal government continues to abdicate its responsibility to secure our borders, then it should pay for the costs of its failure. By not compensating the states, the federal government is forcing Sacramento, Tallahassee and other state capitals to pay for Washington's failure.

Why should taxpayers in the states most affected by the federal government's negligence--Florida, California, Texas, New York, Arizona, Illinois, New Jersey and North Carolina--pay billions every year for the federal government's failure? Legislatures in the affected states should pass resolutions calling on their members of Congress to pass legislation to allow them to be fully compensated for documented medical care for illegal aliens. Their House delegations would have enough votes and influence to dramatically change the debate about federal responsibility for the borders.

If the Congress had to face up to the costs of healthcare (and education and prisons could easily be added to this list) for illegal aliens the pressure to control the borders would increase substantially.

The purpose of these resolutions would be not only to recoup what has already been spent by the states but to force the federal government to move forcefully on border control. If Washington continues to shirk its responsibility at the border, state officials who represent the taxpayers footing the bill should force Washington to meet its responsibility at the Treasury.

Newt Gingrich is a senior fellow at AEI and founder of the Center for Health Transformation. David Merritt is a project director at the CHT.