The Real Health Care and Immigration Questions

As we predicted, the politics of immigration have been dragged into the politics of health insurance reform. It is now crystal clear that no issue of importance can be determined smoothly and comprehensively as long as 12,000,000 people live, work and raise children in the U.S. but float in limbo because of our broken immigration system.

The anti-immigration side, most of whom would oppose the president's approach to health care reform anyway, has lied to the public. Their claims that undocumented immigrants and their families would somehow benefit or even participate in a reformed health insurance system are patently false. Our current systems of public health insurance (Medicare and Medicaid) already do a very, very good job of excluding ineligible immigrants.

Adding additional documentation requirements would be repeating a mistake we made when documentation checks on Medicaid in 2006 prevented eligible citizens and especially children from accessing care. Rearranging already effective methods for screening out ineligible immigrants from government programs will cause additional problems for citizens and legal residents; such as those 11-13 million Americans with no driver's license, birth certificate, or passport who could be excluded from access to affordable health insurance under various proposals under consideration.

Reality is not the strong suit of anti-immigration advocates and Members of Congress whose approach to immigration is based on driving out or deporting 12,000,000 people and their families.

The real questions on immigrants and health insurance reform relate to citizens, legal immigrants, and children.

Tax-paying legal permanent residents and other legal immigrants are also in jeopardy because of existing rules that bar them from coverage for five years and because of new restrictions being considered as part of health insurance reform. Five years is a long time to have to rely on the emergency room for expensive coverage (that we all pay for) and it is a lifetime for a child. It is fiscally and socially wise to include all tax-payers equally in a reformed health insurance system.

Finally, every child in America, regardless of the immigration status of their parents, is extremely likely to work and raise children in this country and live out the rest of their lives here. Therefore, it is a wise investment to ensure that affordable health insurance coverage is available to children.

If our goal is to make sure as many people living and working in America are covered by affordable health insurance so that the cost to tax-payers of expensive uninsured medical expenses is reduced, then ignoring immigration status makes sense. However, at a minimum, we should make sure that all tax-payers who are legal residents or citizens have access to affordable insurance coverage and we should not bar anyone who can afford it on their own from purchasing it.

Health insurance reform and immigration reform are two separate but interrelated matters. The goal of health insurance reform should be making sure every tax-payer in the system has access to affordable coverage. Immigration reform should be about making sure that everyone who is living, working, and raising families in the U.S. is in the system and paying the full compliment of taxes. We need solutions on both fronts.

Comments

[Norski]

Emercency Room Data, Pew Center Data, and Census Data Referneces that shows those who suffer most in the health care mess are Citizen Black Americans rather than Illegal Immigrants:

http://www.cdc.gov/nchs/data/ad/ad372.pdf
http://pewhispanic.org/files/reports/61.pdf
http://www.census.gov/Press-Release/www/2006/nationalracetable3.pdf

[Norski]

What does emergency room data really say? The most recent year of complete Center for Disease Control statistics regarding Emergency Room (ER) Admittances is 2004.

Using contemporary USA Census and Pew Center Illegal Immigration data from 2005 sets the base line. One finds that 78% of the 11.1 million Illegal Immigrants living in the USA in March 2005 were classified as coming from Mexico & Latin America (Hispanic) per Pew Center data and 42.7 million or 14.4% of all people living in the USA were classified by the Census Bureau as Hispanic. That means 20.3% of the people classified by the Census Bureau as Hispanic were in the USA illegally.

One would expect from the data that people classified as Hispanic would have a much greater share of ER visits than their 14.4% share of the population, if Illegal Immigrants really had no access to health care coverage. But in fact people classified as Hispanic made up only 12.8% of all ER visits. So it seems Hispanic Illegal Immigrants are not being forced into the ER for treatment en masse.

It is Black Americans who have twice the rate of ER visits as their percentage of the USA population with 22.6% of the ER admittances versus 12.8% of our population. Yet Black Americans make up the lowest percentage of Illegal Immigrants at less that 3%. It seems Citizens out of work thanks to illegal immigration is where the real problem lies.

[marmara33]

Finally, someone cares to think reasonably: Two different problems that need fixing...Not two different problems used to cancel each other out!

[Kathecita]

Really?? so-called "Edgar Martinez", your solution is worsen the recession, so the economy is at such low point that immigrants will "self deport"?? You call that a solution? I call that a fantasy. Isn't it better to get them into the system, paying their full boat of taxes and upholding public safety by ensuring that people have access to affordable healthcare?

[MdeG]

Actually, quite a lot of them are already paying the full charge of taxes. I refer especially Legal Permanent Residents in their first 5 years of presence here. They pay all the taxes that a citizen does, but are not entitled to most public benefits. There are also a good number of undocumented people who pay income taxes, whether on ITINs or otherwise. And everybody pays sales taxes.

Ali Noorani is absolutely right that the bars on new LPRs should be lifted.

Bars on segments of the population (such as the undocumented) receiving affordable health care are really dumb public health policy, and in the long run more expensive. If you prevent people from getting checkups, vaccinations, and preventive care, you're increasing the risk of their being forced into the ER -- at high public expense. You're also setting up a situation where scapegoating and stereotyping is encouraged. We've got too much of both.

Undocumented folks do a lot of our food service and agricultural work. Most workers in these jobs -- regardless of status -- don't get sick pay or health insurance. That's a problem right there. Raising the bar on access to health care for people who handle food is a terrible idea for *all* of us. We're cutting off our noses to spite our faces, and we're very likely to regret it in the long term.

[americanalien]

God bless you Mr. Noorani. This is a well reasoned post. I couldn't agree more with your thesis that Health insurance reform and immigration reform are two separate but interrelated matters. Indeed they are and I hope that pragmatic policies like the ones you advocate become enacted into any reform effort instead of the dogmatic ideas out there that cater to people's worst fears and instincts. Sometimes the best ideas aren't the most expedient politically. I applaud you for highlighting the connection between these two very divisive issues and for basing your argument on reason as opposed to sentimentalism. If only those in power would take heed.

[DelawareBob]

Illegal aliens get FREE healthcare now! Imagine that! You are in this Country ILLEGALLY and get FREE medical care paid for by the American taxpayers.

Illegal aliens have made America the dumping ground for all their illegal alien children, then we have to school them and give them free medical care.

http://www.youtube.com/watch?v=mSe3C5vMafM&NR=1

http://www.youtube.com/watch?v=U_ZnX9JRo5M&NR=1

I for one, am sick and tired of these ILLEGAL ALIENS snubbing their nose at our immigration laws and the many other laws of this Country. If our Federal Government can not ENFORCE our immigration laws, and get these ILLEGAL ALIENS out of this Country, then let the States do it! One way or another, an end has to come to this illegal immigration, and not with AMNESTY! Amnesty will only encourage more ILLEGAL ALIENS to invade our Country and reward those who broke our laws and raped the American taxpayer in many ways...depressing our wages, taking our jobs, overwhelming our schools with their ILLEGAL ALIEN children, driving without a license or car insurance, all the crime from stolen identities to rape, drugs and everything else.

It's time for ZERO TOLERENCE with these ILLEGAL ALIENS. It's time for them get out of this Country and back in their own Country where they belong. When we get rid of the ILLEGAL ALIENS, we will get rid of all the problems that go with them. THAT IS A FACT!

[Nezua]

I, for one, am sick of lowlives filled with patriotic hate benefiting from the work of my people or sharing my air. Can you please accomodate by picking your own produce and walking around with an oxygen tank and a glass bubble over your face? I'd appreciate it. And that is a fact.

[Edgar Martinez]

Ali Noorani, how can you claim that illegal immigrants won't take part in Obama's health care plan, when you and Frank Sharry are lobbying for the legalization of 12 million illegal aliens? Are you stupid or just lying?

There is no need to deport 12 million illegal immigrants. Just enforce laws on the books and illegal aliens will deport themselves. They will leave the same way they came in. The current economic recession bares truth to this phenomenon. When there are no jobs, illegal immigrants will leave. Thus, take away the job magnet and illegal immigrants will self deport.

Pres. Obama will not bare illegal immigrants from buying private health insurance. He is baring them from taking part in the subsidezed program. Like all open border activists, you fudge the facts. Or better stated, you LIE.

Immigration and Health care are not separate issues. They both go together, just like taxes and mandates goes together with health care. If we allow millions of people to become part of the health care system through amnesty, the system will collapse.

[Trotski99]

I think you missed the central point of the article. The 12 million "illegal immigrants" simply by their virtue of being here in the U.S. are already part of our medical system. There is no excluding them short of letting them die on the steps of our hospitals or on the street.

The promise of health insurance reform should be to make sure that we pay for everyone's health care in the most efficient way possible. The more rules you put in place, the more you are going to put people in the emergency rooms instead of a cheaper alternative.

There are almost 300 million people in the U.S. with an estimated 12 - 20 "undocumented" individuals. To say that health care and immigration reform are inextricably linked is to give the so-called "illegals" much more say in the way our country is run than you yourself would probably want.