President Obama’s push to overhaul the nation’s health-care system has stalled in recent weeks. Applying the drag is a combination of Congressional Budget Office findings, which indicate that the leading health-care proposals would increase costs, and public opinion, which is increasingly alarmed that they would diminish the quality and availability of care. Those are valid concerns, but one aspect of Obamacare has not yet received sufficient scrutiny: its impact on illegal immigration, and vice versa.
If the administration and its Democratic allies in Congress are to be believed, illegal immigration is a non-issue when it comes to health care. In a recent interview with CBS News, President Obama insisted that any health care plan that becomes law will not provide insurance coverage for illegal immigrants, though he added that an exception would be made for their children. Similarly, Nancy Pelosi said last week that “illegal immigrants are not covered” in the America’s Affordable Health Choices Act of 2009, the health care legislation currently under discussion in the House.
Not everyone is impressed by these assurances. In a forthcoming study, Jack Martin, the director of special projects at the Federation for American Immigration Reform (FAIR), estimates that illegal immigrants cost federal and state governments some $10.7 billion in health care expenses annually – and that this number may well rise if some version of Obamacare is passed.
The problem, Martin figures, is in the fine print. Take the House bill. Although it does not explicitly cover illegal immigrants, Martin points out that neither does it “close loopholes for health insurance coverage.” Indeed, Democrats on the House Ways and Means Committee last month rejected an amendment by Nevada Republican Dean Heller that would have required the federal government to use the same database used to determine eligibility for welfare benefits to screen for citizenship as part of a government-run insurance plan. As a result, Martin told Front Page, “there is no system for the verification of identity, and the entitlement to receive those benefits. If that’s how the legislation ends up passing, we expect it to increase the outlays for health care services to illegal aliens.”
Martin is not alone in speculating that Congress is on a path to create insurance coverage for illegal immigrants. Hospitals and hospital groups across the country, already burdened by the costs of caring for illegal immigrants, share a similar concern.
“Congress has been on the fence on this one,” observes Linda Quick, president of the South Florida Hospital and Healthcare Association. “On the one hand, the legislation says that you have to be legal to be covered under the public program. On the other hand, there is language that precludes asking for documentation of legal status. So they can wink [at illegal immigrants] and say, ‘We didn’t really leave you out.’”
For states like Florida, home to a disproportionate share of the country’s 10 to 20-million-strong illegal immigrant population, that could add a costly new chapter to an old story. Because illegal immigrants currently receive emergency care through Medicaid, the federal and state program aimed primarily at the poor, hospitals are forced to absorb the cost of their treatment – a tab that can run into the millions of dollars a year. In 2007, for instance, the Florida Hospital Association estimated that treatment for illegal immigrant patients cost the state $100 million.
The debt load is heavier still in border states like Texas and California. FAIR’s Martin calculates that of the $10.7 billion spent annually on illegal immigrants, some $6.9 billion is borne by the states, with border states shouldering the largest share. According to FAIR, California alone spends approximately $1.6 billion a year on health care for illegals, a deep drain on resources that prompted California’s State Association of Hospitals to announce in 2005 that the state’s public health system is “on the brink of collapse.”
Even fiscally conservative Texas, last or next to last in any number of public spending categories, has incurred a heavy toll from health care for illegal immigrants. In 2006, the state’s comptroller estimated that illegal immigrants cost state hospitals as much as $1.3 billion. Such was the outstanding debt that the University of Texas Medical Branch in Galveston was forced to consider denying cancer care to illegal immigrants.
Just as there is no free lunch, though, there is no free health care. Runway hospital costs are ultimately paid by the very group that, according to the Obama administration, has nothing to fear from its health care plans: the insured. But as unscreened illegal immigrants become eligible for more care under a government-administered plan, insured Americans could see their costs rise. Hospitals, already beset by debt amassed from caring for the country’s 47 million uninsured, between 7 and 10 million of whom are illegal immigrants, will be forced to pass on additional losses to those who can afford to pay for medical care – that is to say, those with insurance.
If illegal immigration is likely to increase the costs of a government-run insurance program, the reverse is also true. Making illegal immigrants eligible for health care, in effect even if not in stated intent, creates de facto “amnesty,” argues Mark Krikorian, the executive director of the Center for Immigration Studies in Washington D.C. “The issue is, Do we want to incorporate illegal immigrants into the institutions of our society? Because that is what covering them for health care would do: It would create a de facto legal status.” After all, Krikorian notes, “How illegal can an immigrant be if he has an identification card from the Department of Health and Human Services or wherever?”
The twin attractions of amnesty and insurance coverage, in turn,
could fuel a new flood across the border. “It’s certainly an enticement,” says James Edwards, co-author of Congressional Politics of Immigration Reform. “Whenever word spreads in these communities that there is a crackdown on illegal immigration, you see drops in the number of immigrants who come.” By the same token, creating more favorable conditions for entry – such as taxpayer-subsidized insurance coverage – encourages the opposite response. “Maybe it will be 100,000 or maybe a million, but it will have an impact on a sizable portion of people who come to this country,” Edwards says.
There is still a chance it may not come to that. Support for President Obama’s health care plan has fallen to an all-time low, according to last week’s Wall Street Journal/NBC News poll, with just 36 percent of Americans viewing it favorably. Meanwhile, the failure of the Democratic leadership to bring a health care bill to a vote before Congress’s August recess is being seen by some, including some Democrats, as a telltale defeat that could complicate a health-care deal down the line.
Political setbacks notwithstanding, neither the president nor Congress is ready to abandon plans for health-care reform. But it hardly augurs well for Obamacare that that those who stand to benefit most from its passage are not even American citizens.