Healthcare and 12 Million Elephants in the Room: Undocumented Immigrants

During his recent speech before the joint session of Congress, President Obama set out to make the details of his health care blueprint more clear and correct the false points that Republicans and special interests have raised in their opposition to reform. One of those fallacies was the notion that the President's plan wouldn't allow undocumented immigrants to be qualified for federal funding to obtain insurance. This led to Rep. Joe Wilson (R-SC) to shout out "you lie!" at the president, making him thousands of friends and millions of foes.

As the media began covering the outrage that ensued following the event, they focused almost exclusively on the act itself rather than the subject that led to the bad behavior: undocumented immigrants. In fact, not only the media, but most politicians and citizens from across the political spectrum seem to have agreed that they don't want to talk about undocumented immigrants in the context of health care reform. But undocumented immigrants constitute a significant element that will directly affect the success of reform, so we can no longer close our eyes and pretend the issue is not there. We need to begin talking about it.

There are nearly twelve million undocumented immigrants in this country. They live in the shadows and most do not pay taxes while having to endure abuse from employers who don't have to uphold federal labor standards. But what makes illegal immigration relevant in the health care debate is that when an undocumented immigrant visits an emergency room, the hospitals are still obligated to provide them with service without asking for documentation. Such visitors--like documented American residents without insurance--often do not have the financial means to visit a doctor when the first signs of symptoms arise. When their health care problem forces them to finally visit a hospital, not only is there a much higher risk for action and lower chances of lasting improvement, but the medical services to address the same condition at such a late stage cost much more than if the patient had been able to address the problem earlier.

One of the aims of President Obama's health care reform plan is to help insure everyone (either through an insurance exchange or a public option to compete with private insurance companies), allowing people to visit their doctors in a timely manner, which could significantly bring costs down.

What makes the issue of illegal immigration a difficult one in the context of health care reform is that covering and not covering undocumented residents both lead to unfavorable outcomes. If they were not to be covered, then even if the reform leads to most legal residents obtaining some kind of insurance (either public or private), we will continue to have millions of immigrants without insurance who will continue to go to hospitals. This will impede the ability of reform to bring health care costs down while creating a system that channels public funding to cover the expenses for the treatment of conditions and problems that could have been taken care of long before they forced the patient to make the ER visit.

But unlike what many refuse to acknowledge, there are also legitimate problems with allowing federal funds for undocumented residents. As far as the larger issue of illegal immigration is concerned, it is first important to note that no sensible person would advocate throwing 12 million people out of the United States. But the fact of the matter is that this is a country of laws. What makes the United States one of the most prosperous countries in the world is not the color of its residents' skin, religion or genetic superiority, but its political system and constitution.

As a country, we have borders, and it is completely reasonable to expect our government to defend our borders and confront those who break our laws. Most undocumented immigrants come from poor countries to the U.S. to work and realize their own American dream. But that is no justification for breaking our laws, and it is reasonable for American tax-payers to not want to fund care for those who do not contribute to the system through taxes and other duties of a citizen. Yes, they work hard and do important work, but Americans do that too. Every person who breaks the laws of a democratic country makes that country a little worse off. There has to be a difference between those who go through the legal processes to have a chance to live in America and those who break its laws to get there. As for those who are already here, they most certainly should not be rewarded with free health care service that's paid for by the rest of the citizens.

These two bad options should lead us to thinking about a possible solution. One would be for us as a country to decide that we no longer want to be a country, because we will not be a country if we decide to not enforce the protection of our borders. We can then also allow anyone in the world who wants to vote in our elections to do so, because if anyone can walk into this country and take advantage of all the benefits that our legal residents enjoy, the notion of having certain rights solely because we are Americans, and in fact the very notion of being an "American", no longer make any sense.

Alternatively, if we decide that we do want to remain a country and understand that being a country entails, among other things, affording its legal residents special rights (which is this blogger's recommendation), our policy-makers should take up the issue of immigration reform as soon as they pass health care reform. The focus of an ideal immigration reform will allow those who are already here to get in line and make their case for becoming legal U.S. residents, make legal immigration more possible and faster, and make illegal immigration (or smuggling of narcotics) less possible through strong enforcement and punishment for those who break our laws. Those who then become legal residents should be afforded the same rights that current legal citizens enjoy.

We cannot have this rigorous debate about health care reform in a bubble. If we truly want to address the issue of high health care costs and lack of access, we must address the impact that illegal immigration has on the system, whether we like it or not. And when we do decide to talk about illegal immigration, we are not going to go anywhere if we don't recognize that we can neither systematically throw out 12 million undocumented immigrants, nor completely ignore the fact that they have broken our laws and immediately provide them with all the benefits of living in the United States without expecting them to recognize their duties to this country. Doing so will only create incentive for more illegal immigration and transform the problem from bad to worse and perpetually doom health care reform in the long run.

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Comments

[edayres]

I wish we would stop playing nice with words and calling them, "Undocumented Immigrants or Undocumented Workers." It may be politically correct but it is not an accurate description. They have broken the law and there is nothing wrong with describing them as such. Even calling them Illegal Immigrants is a compromise that affords them an appropriate amount of respect.

[CelticMajic]

How can we possibly, realistically do a mass deportation of illegals. We can however send them back one at a time. EG, you show up at an ER, are undocumented, then you get care and a free trip home, all the way HOME.

[greyhound2]

If the Feds had enforced the immigration laws which have been on the books for years, we wouldn't have this problem. The article states 12 million, but that's only the half who have applied for welfare, food stamps, aid to dependent children, housing assistance and don't forget HUD. The other half are waiting for amnesty so they can make a trip to the welfare office to sign up for their free bennies. Morally, they should all be deported at their own expense as they broke our laws and knew so when they skipped the border to claim squatters rights. To cave in to lawlessness only encourages more lawlessness. To say you can't deport 12 or 24 million, Yes We Can!

[nee]

ILLEGAL ALIENS need to get in the back of the line in their own countries. Those who have waited to LEGALLY enter our country need to be rewarded. All ILLEGALS no matter where they come from or who they are related to need to go back to their own countries and see about getting health care there.

[chinshihtang]

Illegals do not generally pay taxes or pay medical bills. These are both problems that need to change.

I would recommend that illegals who enter emergency rooms without an emergency be required to pay something upon being released. Those who do not should be subject to vagrancy laws.

Those who have an emergency need to be treated--no question about that. Those whose illnesses pose a public health threat should be treated, then subject to deportation. Those whose illnesses can be successfully treated should be required to make some payments or find some sponsors who will make some payments, or be subject to vagrancy laws. Hospitals should be able to establish some credit for treating illegals and accepting only partial payment, as they should also be able to do for visiting foreigners who do not have US health insurance.

I do not agree that illegal immigrants should not be allowed to purchase health insurance.

There is one great flaw in all my statements, though--the assumption that hospitals will be able to determine who is an illegal immigrant. I don't think it's true. For example, are they expected to demand proof of citizenship, or examine the validity of visa stamps in passports? The best I can say is that they should generally expect some proof of identity before discharging patients, and then submit that proof for reimbursement or credit.

[cynara]

What evidence do you have that illegal immigrants do not pay taxes? Most do, since on top of having immigration on them, failure to pay income taxes would bring the attention of the IRS.

Check out this article from the liberal bastion "Real Clear Politics" that examines illegal immigrants contributions to the US social security and tax base:
http://www.realclearpolitics.com/articles/2007/06/lead_weight_or_gold_mine_what.html

[makeck]

Its called working under the table? Working for cash? The underground economy? The IRS would be after them ONLY if they had REPORTED income that they failed to pay taxes on. They get paid cash at the end of the day. Guys and girls who get handed a pile of cash at the end of the day/week do not get W4s or 1099s with which to file their taxes. The only tax they pay is sales tax.

By the way, there not just illegal immigrants. Theres more than a few people who stand in welfare/un­enployment lines that leave there and go to a job that is paying them cash.

[makeck]

OK, checked out the article. It is NOT about ILLEGAL IMMIGRANTS. It is about IMMIGRANTS in general. There is a distinct difference. Immigrants with degress who arrive here are generally not working as busboys or day laborers. Using the gross numbers from total immigrion and economic benefit statistics from the legal immigrants is deceptive and misleading.

Additionally, there are a number of bilateral agreements between the US and other countries (Mexico is one of them) where LEGAL IMMIGRANTS Social Security payments get credited to accounts in Mexicos version of Social Security. I am sure the money follows the credits. Not sure of the entire process, but it exists.

By and large, illegal immigrants pay only one tax directly, sales tax. Propertry and other taxes are probably collected indirectly. But by and large,they are not paying income tax at the state or federal level.

[mikefina]

Why have a border? Why call ourselves a nation?

Your suggestion just incentivizes millions more people to transgress the already porous fiction that is our southern border.

I agree that there is too much bigotry in this conversation. But there is too little honesty, too. If we are to have an integrous country, we must define the country somehow. And we do so two ways:

1. Geographically--via a demarcated land area
2. Politicall­y--through the franchise of citizenship

Treat illegal immigrants when the arrive at an emergency room--it is the humane duty of this nation. But, follow-up with the deportation of the individual once they are triaged--it is the moral course to retain our soverignty.

And send the Emergency Room bill to the Illegal immigrants' employer.

[jsgaetano]

If we leave Iraq and Afghanistan, we can easily afford to insure everyone. In the world.

It's far cheaper than a year of "staying the course".

[Tyler-Durden]

the hate projected at illegal aliens is simply disgusting. it's bigotry, plain and simple.

the people are here. they contribute to the economy when they purchase or rent; when they provide manual labor. they pay taxes if they use a ssn to get a paycheck.

the guilty party in this scenario is company that hires illegals to avoid paying minimum wage and adhering to federal workplace laws. if you have a problem with illegals, you really have a problem with the companies who hire them. it is THEIR GREED that motivates them to hire illegals rather than pay Americans a fair wage.

there are only two solutions to this:
1. remove the illegals. that would be pretty costly. and keeping them out would be even more so.
2. make them legal. once they're legal, they can be taxed like all other citizens and pay their share. also, the incentive to hire illegals would be removed.

the people are already here. so what is the problem with making them all citizens so they can contribute their share?

[Atcha]

"the people are already here. so what is the problem with making them all citizens so they can contribute their share?"

It won't settle the issue, it will just motivate more illegals to come, employers' control seems to be the most effective action, but it's costly

[makeck]

Am not necessarily a fan of your solution, but you make a point that is not said enough. The only people that benefit from employing illegal immigrants are the well to do. They get labor at a cheaper rate than they would have to pay Americans. That allows them to undercut the competition that is employing Americans. Then the American workers who DO pay taxes pay for the social programs that make it possible for the illegals to stay here without going bankrupt. Emergency room services are merely one set of those benefits.

I don't blame the illegals for trying to better their lives. I do blame the employers for screwing all of us for their own benefit.

[Chloe33]

If the elephant in the room is here illegally ----- NO HEALTHCARE. Easy.

[BadBob420]

You just don't get it do you? If an illegal, who had TB, or some other contagious illness, was walking around, infecting people because he can't go to the doctor, is that ok with you? Here he is, infecting everybody, until he gets so bad, he collapses, and is taken to the ER (most expensive health care). I guess you prefer that, to allowing him to get cheaper, immediate help, thereby not having him infect so many others and costing the taxpayer ER rates. Explane your answer to this in your SIMPLE terms!

[lletaa]

They dont get it, the status quo is fine with them. Pennywise and pound foolish with a dose of hate Hispanics thrown in. Let the insurance companies rack up record profits then blame illegals, good one.

[Chloe33]

Again, in simple terms : CLOSE the borders; and/or BETTER border security - then they woudn't be "walking around infecting people".

[bannorhill]

Give them ER care until stabilized. Then send them home to their own country.

[jsgaetano]

I say we not give health care to conservatives, and give the health care they don't want (For Freedumb!!!) to the immigrants.

[Chloe33]

Most conservatives already have health insurance, thank you.

Tax breaks and subsidies the 10 million or so that don't.

[WorkingClass]

The U.S. Chamber of Commerce wants unlimited "illegal" immigration so it will have cheap labor that can be cheated and abused with impunity. The Chamber pays bribes to our crooked politicians to perpetuate this non-immigration policy. In the process of taking back our country we will utterly and finally destroy the U.S. Chamber of Commerce.

[Atcha]

Europe has also an unknown amount of illegal immigrants who have access to emergency health care and it's never mentioned as a cause of deficit like it is in the US. This blog forgets to mention that there are billions of unclaimed benefits in the US due to the undocumented migrants working with a false Social Security number who contribute to the system and never receive benefits, they are also not the elderly who need the most care and only receive emergency treatments...Isn't there a tendency to lump all the uninsured hispanics using the emergency services in the illegal category?

[fallingsky]

and now the Democrats are pushing through provisions for Illegal immigrants,,,,,

[katheyquilts]

Every one should be able to BUY insurance, Also I want every driver to be licensed and insured. Un Insured people increase costs, to the whole pool of people.
TAKE THEIR MONEY DAMMIT!

[jsgaetano]

It's always funny when Goopers whine about the "Free Market", yet they want to deny people the ability to BUY health insurance, with their own money.

I say the Goopers should keep their damn gubment hands off our health insurance, and that goes double for those Goopers who want to deny people coverage for abortions, which are currently covered by insurance.

The problem was never government. The problem always has been, and always will be, allowing conservatives to participate in government. Get them out, and keep them out.

[BadBob420]

It is very inportant that this country discuss the realities of the situation, rather than retreat into the name calling, blame game.

I would like to point out one incorrect statement made in the piece. Illegal immigrants, do, in fact, pay taxes. If they use a false SS # at their employment, then money is deducted from their wages and sent to the government. Or, the employer often deducts taxes and then pockets it. Illegals also pay sales taxes and property taxes. This is a reality that no one wants to accept. The standard argument is that they pay absolutely nothing. That is totally false. In general, the illegal pays the same amount in taxes that the legal citizen pays who is at the same income level.

[billhodges]

If we stopped providing health care through he ER, and cut off ALL State and Federal aid to the illegal immigrants they would leave and far fewer would enter illegally. We offer them more than they get in their own country. Stop it and the flow will dwindle.

It may sound cruel but why treat criminals, and they are criminals.

[lletaa]

Yes it sounds cruel cause it is cruel. There is a bigger factor here then money. Its called humanity. Why is it that the poorest most vulnerable people get the blame instead of big fat rich insurance companies? So you would want untreated contagious people walking our streets and dying including children? There must be a better way and there is but no, the ceo of cigna must retain his 2 mill a month salary.

[bannorhill]

"So you would want untreated contagious people walking our streets and dying including children? "

No I would not.

Treat them and send them back to their home country like the law says.

[myvoice09]

Totally agree! To give illegal immigrants amnesty or access to medical services, food stamps, etc., is to reward bad/illegal behavior. They "cut in line." It is completely unfair to all who wish to immigrate to the U.S. and are following the rules, and it delays their entry. I truly sympathize with their plights - but we have to do the we can with the "cards we're dealt." I would have preferred to be born royal and rich - I can't move to Britain or Monaco and receive all the benefits that the royal families' enjoy. Illegals immigrants shouldn't be able to enjoy the benefits of American citizenship - at least, not until they follow the rules of the process and stop "cutting in line."

[lletaa]

If someone cut in line in front of me then had a heart attack I would give him medical care immediately. After, I would ask him to go to the back of the line. Cutting in line is not a capital offense. "Reward bad/illegal behavior, do you know that prison inmates are entitled to healthcare according to our laws.

[Liberal2]

Cruelty aside, the truth is America no longer can afford free medical for 12+ million illegals whose input to GDP does not cover the cost of their medical requirements.

As I explained before, there is no need for draconian police actions to handle the illegal alien problem. All we need is a $25,000 reward,payable to anyone turning in the employer of one or more illegals, payable even to the illegal who turns in his/her own employer. The employer will also pay for first class transportation back to their home country for every illegal in their employ and their family members.

One or two such awards and the illegal immigrant problem goes away.

[3rdpartypatriot]

This is a good idea, but with 12 million illegals, it would cost the government more than universal healthcare would to give 25k for each illegal.

By the way... Joe Wilson was right, the most recent position by those drafting the HC legislation is that people will not have to show federal or state ID before receiving benefits, thus allowing illegal/un­documented immigrants to claim benefits.