That's true, it's basically just shifting costs from one entity but not the other, neither of which is the entity getting the benefits of the services. But then who cares if it's the government or the hospitals absorbing these costs? Hospitals absorb them via charging us higher medical fees, and the government would absorb them via charging us higher taxes (and many illegal immigrants, although not all, don't pay taxes). Either way, its the law-abiding residents of the US who are footing the bill. And to address the last sentence, to illegals not paying for the ER visits matters even less than for citizens/residents, IMO, since citizens and residents have to worry about credit history and such as it is such a big part of day-to-day life in America. For example, I got some debt in the US due to circumstances beyond my control (homeless), and then I just took off for Canada and now I don't have to pay it unless I move back to the US for a long period of time, but someone who's permanent home is in the country can't do what I did. Similarly, someone who doesn't have to worry about the financial consequences can get away with abusing the services in the ER.