Fact is, illegal immigrants are in 'health care purgatory'

Rita Hibbard's picture
Printer-friendly version

So Joe Wilson shouts crudely, "You Lie," at the president from the House floor. What's the truth about illegal immigrants and health care?

Karen E. Crummy of the Denver Post, takes a look at the language of the House bill, and determines that while illegal immigrants are not exempt from the requirements to buy insurances and not prohibited from enrolling in the "Health Insurance Exchange," which offers access to private plans and a public option (should it ever come to pass) they must be in the country lawfully to receive subsidies based on income. That's according to research by the the Congressional Research Service, a nonpartisan arm of Congress.

"While there are no spelled-out citizenship verification procedures, implementing proper mechanisms would fall to the health choices commissioner, a presidential appointee position, created by the legislation, who would oversee a new regulatory body, according to congressional services. There are citizenship checks already in place for federal programs such as Medicaid, which could be used for this purpose.

Additionally, Leighton Ku, a health policy analyst and professor at George Washington University, said that because the bill ties subsidies to substantiated income, there already exists a good method to weed out fraud through tax returns. Those require Social Security numbers, which illegal immigrants are barred from obtaining.

While some people - both noncitizens and citizens - may try to use false Social Security numbers, the numbers are likely small, Ku said.

Ku points out that while there is always some fraud, social security numbers are a "well-established way to determine whether someone is a citizen in this country."

Southern Methodist University Law School Prof Nathan Cortez, in his The Health Care Blog, also analyzes the issue, writing that both the House and Senate bills state "in pretty clear language" that they don't cover illegal immigrants. The bills would, however, allow illegals to purchase coverage without subsidy. And let's hope that even Joe Wilson wouldn't have a quarrel with that.

"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. 

-- Rita Hibbard