As the Senate prepares for a floor vote on their bipartisan immigration bill and members of the House continue working diligently to craft their own language, the hotly contested issue of access to health care has again come into the spotlight.
If some members have it their way, the tradeoff for immigration reform will be steep, coming with new restrictions on health care and further cementing existing ones; effectively limiting the options that immigrants will have to purchase affordable health insurance.
The concern here is more than just a matter of basic fairness; it's about making short-sighted compromises that we will all pay for through worse health outcomes and increased costs for years to come. If immigration reform provides a pathway to legalization for up to 11 million people without options for affordable health insurance, we could see the health care gap between the haves and have-nots widen.
Federal law already effectively bars many immigrants from health programs, like Medicaid, that citizens can qualify for. The Senate immigration bill unfortunately maintains these restrictions for many of the newly legalized and would have the effect of locking them out of the very programs they pay into for a decade or more.
The restrictions on health care access in the Senate bill even extend to health reform. While individuals who eventually legalize will be able to purchase coverage in the new health insurance marketplaces, they will not have access to the tools that would actually make coverage affordable, such as the tax credits and subsidies, until they get a green card -- a wait of at least ten years for adults. That's a huge problem because health reform rests on the assumption that the majority of people who enter the new marketplaces will qualify for subsidized coverage through the credits or subsidies. Without these tools, premiums could run upwards of hundreds of dollars a month, putting many of the newly legalized in a difficult position of having to go without insurance.
In a bizarre twist, some Republicans in the House are demanding that the 11 million newly legalized be required to purchase coverage -- akin to health reform's individual mandate, a requirement that the same members have opposed -- without access to tax credits and subsidies.
This compromise is ill conceived and economically risky. Being uninsured means delaying needed health care services, and oftentimes only seeking medical attention in emergency situations. The uninsured receive less preventive health care, have worse physical and mental health outcomes and are diagnosed at later stages for treatable conditions.
Health costs eventually become due. The economic toll that uninsurance takes is staggering: shorter lifespans and bad health result in a loss of $65-130 billion annually. These costs consist of lost wages, absenteeism, family leave to deal with avoidable sickness and lower quality of life.
In short, uninsurance translates into lost economic productivity and economic insecurity. A minimum wage worker without coverage who gets sick could be economically devastated by a hospital bill. It is no wonder individuals and families across the country live in fear of what might happen if they get sick.
Offering everyone -- immigrants and native-born Americans alike -- the same opportunity to get affordable health insurance is not a "benefit" for a deserving few, it is the sound and conservative solution for a nation with staggering rates of uninsurance.
Everyone needs health care at some point and everyone should pay their fair share. Making health insurance more affordable and accessible for everyone would help people take responsibility for their health, stay healthy, have better access to preventive care and lessen the physical and economic effects that uninsurance takes on the nation, including the billions that federal, state and local governments pay in uncompensated care.
Congress needs to make the intelligent, fiscally-prudent decision here and protect America's health for the long term and give immigrants the same access to affordable health insurance coverage as all Americans.