Immigrants, Health Reform, and “Lies”
Filed under: Global Health Care, Health Reform, Hospital Finances, Medicaid, Obama Administration, Proposed Legislation, The Uninsured, Undocumented Aliens
In a much-anticipated prime time address to Congress, President Obama made the case for health care reform. One ostensible goal of the speech was to correct misinformation about the bills proposed by Congress. As a scholar who studies both health care and immigration (and sometimes the intersection between the two), I’ve grown increasingly frustrated with the misconceptions surrounding this issue — and I very much hoped the President would deflate the myth that health reform would provide federal benefits to undocumented immigrants.
Of course, when President Obama made this very point (”The reforms I’m proposing would not apply to those who are here illegally”), he was greeted with a heckle from South Carolina Representative Joe Wilson, who shouted “You lie!” Although Rep. Wilson later apologized for his “lack of civility,” he didn’t recant the basic factual assertion, making clear that he still disagreed with the President’s statement that health reform doesn’t cover undocumented immigrants. Of course, the media has jumped on this story, but perhaps unsurprisingly, few bothered to clarify the underlying factual dispute.
Neither bill published by the House or Senate covers undocumented immigrants. In fact, both bills state in pretty plain terms that they don’t do it. The House bill, titled America’s Affordable Health Choices Act of 2009, states in Section 242 that those not lawfully present in the United States are not eligible for insurance subsidies or tax credits. To make it even more clear, Section 246 is titled “No Federal Payment for Undocumented Aliens,” and states “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”
Likewise, the Senate Health, Education, Labor, and Pension Committee’s bill, titled the Affordable Health Choices Act, states in Section 3111(h) that “Nothing in this Act shall allow Federal payments for individuals who are not lawfully present in the United States.” The Senate Finance Committee has yet to release its bill, but it’s a good bet that undocumented immigrants similarly will be excluded.
Although nothing in the bills apparently would prohibit undocumented immigrants from purchasing health insurance in the new national marketplace (called an “exchange” and a “gateway” in the House and Senate bills), it’s not clear why anyone would take issue with immigrants purchasing insurance on their own, without federal subsidies. Moreover, although nothing in the bills seems to alter federal funding for emergency care provided to immigrants, nothing creates such a benefit either — thus undercutting Rep. Wilson’s contention with the President.
This controversy should remind us that immigrants remain in a sort of health care purgatory, caught in our two most dysfunctional systems — immigration and health care. In the mid-1990s, Congress severely limited immigrant access to programs like Medicaid as part of welfare reform, making it difficult for even lawful immigrants to enroll. In fact, even lawful immigrants aren’t eligible for Medicaid for five years after entering the United States — and various peculiarities of immigration law often push this waiting period to ten years. At the same time, immigrants do receive indirect federal funding for health care through the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals with emergency departments to screen and at least stabilize patients presenting with emergent conditions. Thus, hospitals must provide emergency care regardless of the patient’s immigration status.
Unfortunately, most immigrants are ineligible for means-tested public insurance programs like Medicaid. This regulatory framework has led to “medical repatriation,” in which hospitals effectively deport immigrant patients to unload expensive long-term care burdens. Of course, hospitals — most of which are run by state and local governments — complain about unfunded federal mandates like EMTALA. Hospitals can be “stuck” treating immigrants whose medical needs have shifted from acute to long-term (as with the car accident victim who needs neurological rehabilitation and nursing care). As Prof. Boozang discussed, a growing number have begun “repatriating” immigrant patients by sending them back to their country of origin — without consulting immigration officials — sometimes by purchasing commercial plane tickets or even hiring air ambulances.
Certainly, there are more humane ways to handle health care for immigrants. California, for example, legalized cross-border health insurance, thus allowing immigrants living in the state to purchase insurance with lower premiums and deductibles that covers care provided in Mexico. Arizona and Texas have considered similar legislation, to no avail. Recently, UCLA researchers estimated that over 950,000 people travel from California to Mexico for medical care every year. For a population being left out of health care reform, traveling to Mexico for care may be the future — whether voluntary or not.
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With all due respect, your article is misleading. Although HR3200 states that it does not cover illegal immigrants, the Congressional Research Service states – “For federal tax purposes, alien individuals are classified as resident or nonresident aliens. In general, an individual is a nonresident alien unless he or she meets the qualifications under a residency test. Thus, legal permanent residents, and noncitizens and unauthorized aliens who qualify as resident aliens (i.e., meet the substantial presence test), would be required under H.R. 3200 to have health insurance. H.R. 3200 does not contain any restrictions on noncitzens participating in the Exchange whether the noncitizens are legally or illegally present, or in the United States temporarily or permanently. Nonetheless, only aliens who could be classified as resident aliens would be required under the bill to have health insurance.” (This is from CRS)
Joe Wilson was actually correct. Nothing prevents illegals from being covered. An amendment was proposed by Republican (Sam Johnson) and defeated by Democrats that would have required enforcement. So the bill has words that have no meaning and cannot be enforced in this case.
This is a one party bill that is being forced upon the American people. They tried to pass this bill without review just like the “Stimulus” package. The more people find out about this bill, the less they like it. I am neither a lawyer nor an expert on Healthcare or the law, but I do have enough common sense to see this is a disaster in the making. They have destroyed Social Security, Medicare and Medicaid by mismanagement. And you would give them another Trillion dollars to destroy the best health care system in the world? I have relatives in Canada; I know what social medicine can do. It is rationing at best. My aunt was flown from Sudbury, Ontario to San Diego, CA for heart surgery because if she had waited for the Canadian Health system, she would have died. That is a fact.
So yes Obama is a liar. Please do more research before you call out Joe Wilson.
By the way, you also forget to mention how many Canadians come to this country for health care that is denied by there own system. Just check out the hospitals along the border. Canada and Great Briton both have said their respective systems are bankrupt. Why do you think we could do better here? It has failed in those countries. Great Briton’s NHS is the second largest employer in the world after the Chinese Military. How big and expensive do you think our Bureaucracy will be?
Again I am not an expert by any means, just very concerned about they path our government is taking headlong into socialism. To destroy the whole system that needs changes is wrong and irresponsible. We should first start with TORT reform and go from there. At least with a private system you still have some recourse if you are denied care, once the government takes over you have no recourse. I have been reading the bill and it scares me. This is very invasive and is destructive to our privacy. Not to mention once you change, there is no going back.
Respectfully,
Chuck Leone
So, let me get this straight. The argument you layout above suggests that if you are here without papers (illegally) you are going to go to the IRS or some other government agency and attempt to meet the “substantial presence test” in order to get government subsidized health care? Right! Get real. The only “insurance” the illegal would get is a one way ticket to jail while awaiting deportation. This is a foolish argument at best. People here illegally pretty much have zero rights, and federal, state and local governments are closing loopholes all the time.
I may be wrong, but I didn’t hear Obama refer to any specific piece of proposed legislation in his speech to Congress so when he says, ” The reforms I’m proposing would not apply to anyone here illegally” you must take him at his word since there is no way of proving he is lying. This is where Rep. Wilson looks the fool.
Nathan, the idea near the end concerning cross-border Insurance is one I haven’t considered, now I admit that I do not follow this issue so closely, but at first blush the idea does sound reasonable. I am with everyone on the side of stopping Free trips to the Emergency Room.
Typical miscommunication and defunct system. The hospitals are not allowed to request proof of citizenship. In fact, we don’t have a system to prove citizenship. So all those illegals currently receiving medical care will continue to receive medical care. Thus, the presidents assurance that illegals would not receive healthcare… is a lie.
Seems Nancy Pelosi is gung ho for the public option, payed for by taxpayers. How many migrants work at her vineyard? Does she offer health insurance?
I see Martha’s Vineyards is also pushing for public healthcare. How many migrants work there? Can someone explain how a multimillion dollar vineyard can claim nonprofit status and avoid paying taxes?