Don't Enshrine Discrimination in Health Care Reform

Finally, the country seems serious about reforming health care. But with discussions about a public option, cost control and competition raging, one aspect of achieving true universal coverage is being left out: what to do about immigrants who lack coverage?

All of the plans getting serious consideration in Congress would exclude undocumented immigrants. Many proposals would even bar access to community health centers and emergency rooms -- a historic shift from America's humanitarian tradition that in an emergency no one should be turned away. Some proposals would exclude legal resident immigrants who have been in the United States for less than five years. Unless the debate takes a different turn, millions of immigrants will be left out of the system.

We should not enshrine discriminatory principles into a new health care system. A "universal" health care program that leaves out millions of Americans is a fraud. Just as we stand up for other core principles in the health care debate -- quality, affordability, a strong public plan -- we need to stand up for immigrant coverage as an essential component of just and effective health care reform.

Without immigrant inclusion, people like Ockwhan Her, a 48 year-old Korean-American mother of two from Los Angeles, will continue being relegated to second class status. Ockwhan, uninsured, couldn't afford to visit the doctor when the pains in her stomach became too great to ignore. It wasn't until a personal emergency forced her to return to Korea that she was able to afford seeing a doctor, and learn that the pain in her stomach was cancer. Even though a legal permanent resident in the United States, our laws bar her from receiving health care benefits that could save her life.

It's worth reminding ourselves of why it's so important for immigrants to be included in our national health care system. Here are some common sense reasons:

• Contrary to right-wing myth, almost all immigrants pay taxes. Excluding immigrants from a tax-funded health care system is simply unfair.
• If immigrants are excluded from coverage, they will continue to go to emergency rooms for medical services, services that we ultimately pay for through public programs or higher insurance premiums. Rather than subsidize inadequate, short-term care, let's provide real preventative care that will actually keep families healthy.
• Health is, by nature, a public good. We all benefit when every family in our community is

healthy. Leaving out millions of Americans hurts all of us, not just those who are excluded.

There is no reasonable basis for excluding immigrants from access to health care. It's all about bigotry and fear, including the fears of our political leadership. Even many progressive members of Congress are reluctant to take a stand because they don't want to get in the way of health care "reform."

But until we include everyone, universal coverage will continue to be a myth, and tax payers like Ockwhan will continue to suffer needlessly.

Comments

[mtbmtb]

Thanks for a good article - do you know if today's house bill includes such restrictions?

[Elias Feghali]

This is a question of values. Thanks for this article, as it's easy to forget the millions that continue to be shut out by a failed immigration system. A health care system that does not account for such a large percentage of our community is not only ineffective, but delusional. Undocumented people are very much a part of this country, this economy, and our collective future. I agree that providing them free health care is costly - but I would counter that the costs are worth it. Coupled with sensible and fair immigration reform, we can move forward towards a better and more inclusive republic.

Oh, and the amendments about excluding recently naturalized citizens is an upfront to any democratic sensibility. Segregation of this kind should never be an option, let alone a consideration.

[sixyfivepercentwater]

There is obviously a lot of emotion in response to this position, and it's sometimes hard to think about this issue logically. Americans have a huge fear of the brown man taking what is theirs, whether we're talking about illegal immigrants from the south or faceless extremists from the middle east. This fear has been built up over the last few years to justify atrocities committed by the last administration.

The fear that illegal immigrants are going to overwhelm our health care system is baseless. Illegals do not visit hospitals unless they absolutely have to, due to justified fears of being deported. I hope none of us is inhuman enough to maintain that we are going to turn away a human being in pain, with a broken leg, a high fever, etc. Does our self-image as Americans include turning away children simply because their parents don't have the right paperwork?

We need to look at models from other developed countries, such as the UK. There, anyone presenting with an emergency - tourist, illegal immigrant, whoever - is given basic medical treatment to at least stabilize their condition, without being charged. Sure, it's a little bit of a drain on the system, but what is the humane alternative?

It's a question of who we want to be.

[surya24]

Thank you for this important article. It is about time we bring humanity back into this debate. We are one of the only Western/Developed nations that does ensure health coverage for all residents, regardless of status. If we want to be a leader in the world, we must put human dignity first.

[EdCoughlin]

So your argument is that people who are in a country illegally and don't pay taxes deserve access to something bought by those who do pay taxes free and clear?

They do have an option available to them that will give them this access to all the services of this country. It's called legal immigration. Yes there is a line, but it can be shortened by, for example, pursuing education in your home country or developing an in demand skill. There are many, many nurses coming here from all kinds of third world countries and they're coming here legally because they have a skill that we need. If someone is coming here illegally because they have no skill that is needed in the marketplace (meaning they'll just push a low skill American out of the job and depress wages) sorry if they don't have my sympathy.

As to the families of illegal immigrants just scraping by I can't help but say what everyone HAS to be thinking on that topic. If you were in your home country doing so badly you had to immigrate illegally to another one, and are doing so badly in this country that you're living on the edge of abject poverty with no benefits and no real job skills....­why in the world are you having kids? Now its the community at larges responsibility to educate those kids and give them free food and medicine? How is that fair to anyone, especially more responsible adults.

[readwithcare]

Thank you for this important comment. We can only have a successful health reform when everyone is included. Leaving out groups of our population will make us all more sick, and increase costs on health care. It's disappointing that the current proposals before Congress will divide families, giving coverage to some but not others.

The example Mr. Bhargava offers is shows an important and oft unnoticed injustice in our health care laws: we deny lawful immigrants access to care for five years. The tragedy of this injustice is that studies repeatedly show that immigrants are often in greatest needs during their first few years as they adjust to life in their new home. In many cases, these immigrants will have found higher paying jobs - and often with employer-sponsored health coverage, after these initial years. That is, if they are lucky enough not to catch a cold. These newest Americans are playing by the rules, paying taxes, and shouldn't have to wait 5 years to see a doctor.

The commentators who are trying to distort what Mr. Bhargava is saying with allegations about "illegals" should read carefully - he's talking about discrimination against LAWFULLY residing immigrants.

As to those whose papers aren't in order, my view is that if someone is going to end up in the emergency room anyway, why not include them in the system: preventive care is cheaper, and by having more people pay in, the rest of us won't get stuck with the bill later.

[LeLoup]

"Excluding immigrants from a tax-funded health care system is simply unfair."

It is already done. I've been in the US for 13 years, legal and all, and we were denied access to Medical Access in PA. We needed that help for our autistic son, since treatments for this condition can easily reach 100K a year. HC insurance companies routinely denied coverage for autism.

For the record, he was diagnosed way after we came here.

The stated reason why we were denied was that in the PA law, non permanent residents are automatically excluded from the program except political refugees. Why? Since we chose to come to the US, we couldn't get help. Never mine that we're paying the same amount of taxes like any other state resident. We got shafted not only based on discrimination based on national origin, but also based on our motives of immigration.

Let me repeat that: we pay the same amount of taxes as anyone else, yet, we were denied access to a state program.

The inequities do not stop there: my daughter's college tuition is 2.5 TIMES of what parents of PA kids pay for State College education. (Penn State, no to name them) yet, we own a home in PA, we work in PA, and, at the risk of repeating myself again, WE PAY THE SAME AMOUNT OF TAXES IN PA (and Federal) like any other resident.

I challenge anyone to tell me this is anything else than discrimination.

[EdCoughlin]

Well that choice argument does kind of work there. I mean you did choose to come here, choose to live in PA and choose to go to that school at that cost. You could have chosen a more generous country (or your own country where you had citizenship free and clear) or at least a more generous state that has more lenient residency requirements.
Yes it is somewhat unfair to get less benefits, but its also unfair that millions of Americans born here don't have coverage for medicine and the means to pursue higher education. If we were going to invest I would greatly prefer that native born Americans go to the front of that line, since they were given no choice but to be Americans, while you came over here by choice and could reasonably have pursued these benefits in your home country where you would be in the front of the line.
You also have not received citizenship, and given 13 years and legal immigration you almost certainly could have if you tried. That someone who doesn't care enough to become a citizen complains about not getting all the rights of citizenship also doesn't make a whole lot of sense.

[pj100]

As much as I would like to agree with Mr. B. I respectfully say NO. I don't mind paying extra in taxes if it means more people will be able to afford health care (maybe my premuiums will be reduced) but I'm sorry I don't believe we should be paying for people who don't belong here legally ,may be heartless but part of our helath care problem is illegal immigrants and other people going to the emergency rooms and can't pay ,because in the long run the cost of that is past on to people with health insurance.

[NedroidPrime]

Wait, you call excluding people that are breaking the law discrimination? Seriously?!

Like it or not, these people are here illegally. The more steps that are taken to legitimize their actions, the less protections we will have as citizens. I'm sure there are plenty of europeans that would love to come here, but they have no choice but to do it legally.

If you want to call it discrimination, feel free to. I personally agree with this being in the final product, as it will be expensive enough as it is. We are not the world's caretaker, get over it!

[mtnyogini]

How very humane of you.

[NedroidPrime]

It's called breaking the law. Yeah, their home country may be horrible, but there are legal methods of entering the country and emigrating.

I mean, if we are going to stop prosecuting crimes I have a few I would like to add to the list:

Drugs
Smoking in public places (indoors)
Traffic laws
Robbery
Theft

There are a few more I could list, but I will refrain.

Yes, it sounds cold, but if we don't maintain the laws, we are nothing. We decry that politicians aren't apparently beholden to the law, yet you advocate to ignore the law for these other people.

To call it discrimination is just ignorant though. I have no problem with extending benefits to a person working on citizenship legitimately, but to offer it to a person who is here illegally.­.. Why not get rid of all immigration laws and security?

[aftershock]

"Like it or not, these people are here illegally.­"

And like it or not, as the article points out, "If immigrants are excluded from coverage, they will continue to go to emergency rooms for medical services, services that we ultimately pay for through public programs or higher insurance premiums."

So you pay for it one way or another...

[Derelict outlaw]

This is a very important post. Thank you. Like Senator Bernie Sanders I believe that the money conversation is a red herring and not the most important element of this national debate.

"In my view, the fight for universal and comprehensive health care is the civil rights battle of our time. Like the other great struggles in our history that have made us a more democratic and just society, victory will require a strong and united grassroots movement that is prepared to take on the very powerful and wealthy special interests that benefit from this failing health care system."

Universal healthvare will end the discrimination and end the enslavement of the American workers staying in punishing and terrible jobs so they lose their pitiful health care insurance.

[NedroidPrime]

That isn't what the post is about mainly. It is about extending benefits to people that are here illegally.

[huffposer]

"visiting another country"

Visiting? Is that what we're calling it? Squatting is more like it. They aren't tourists or visitors in our country. If an intruders breaks into your home, will you call him a visitor? Will you be a good Samaritan and tell him where to find your wallet and your house safe? Will you cook him dinner and pour him something to drink while he's robbing you? And don't be naive. We ARE being ROBBED -- of jobs (they aren't all picking fruit, you know), of resources, of tax dollars.

We're not the world's welfare system. We can't even afford to take care of our own people.

If illegals get sick while they're squatting here, they can get help with their health care -- back in their home countries.

[mat3]

Thanks for calling me a bigot because I believe lawbreakers should not receive health care benefits. I keep hearing supporters of illegal immigration say you can't deport 12 million people and you are correct. However, you can make it so uncomfortable here by denying them drivers licenses, health care, schooling, etc that they will leave on their own, no need to deport. The government is good at creating databases. You start taking care of your own family before you start taking care of the neighbors.

[propitiousmoment]

I fully agree with everything you have written here, Mr. Bhargava.

[RedDogBear]

"But with discussions about a public option, cost control and competition raging, one aspect of achieving true universal coverage is being left out: what to do about immigrants who lack coverage?"
If you aren't getting paid by the RNC or Kaiser you should be. Its going to be hard enough to get a public option through. As it is we are already hearing that public healthcare is socialism, communism, and nazism. Including healthcare for illegal immigrants is just insane.

[Lynwood Walker]

When you get sick visiting another country they don't turn you away from treatment. You get the treatment that their own citizens get because its part of an expectation that when you go to another country, legally, illegally, vacation or permanetly, that for your stay you are afforded basic human rights and dignities.

The fact that we feel we are above providing this basic service to the world's population, the fact that we feel we do not have to abide by then god-Samaritan practice, makes us a very selfish, racist, country.

Dont try to make this about RNC and Kaiser. The fact that we are discussing those options and limiting teh scope of debate to weak public insurance company means the DNC is no stranger to the hehalth insurance coffers.

[pj100]

You can say what you want Lynwood I am an african american same as you but I don't want to be responsible for people who come here illegally and expect to be taken care of by the US. I would also say the same for anyone whether a citizen or a legal resident if your looking to benefit from the system. My paycheck can only go so far before I'm bankrupt ... Are you a citizen? here illegally, what. No offense just trying to understand