The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

Immigration Reform and Health Reform


One of the main ways Sen. Marco Rubio has tried to build support among conservatives for immigration reform is by establishing that immigrants receiving provisional status will not be eligible for subsidized health benefits under the Affordable Care Act. As Jed Graham of Investor’s Business Daily explains, however, this introduces a serious complication:

While the outlook for immigration reform is uncertain, the hurdle to passage could be significantly higher if the employer mandate remains unchanged. As IBD first reported, the interaction of the Gang of Eight’s immigration reform with ObamaCare would give some employers a $3,000 incentive (after taxes) to hire a newly legalized immigrant over an American citizen

This perverse outcome, which isn’t desired by anyone, and the growing realization — even among Democrats — that the employer mandate risks hurting working-class wage-earners whom ObamaCare is intended to help have created a window of opportunity.

And Los Angeles County is concerned about this provision as well, as Kitty Felde of Southern California Public Radio reports:

Tucked away in the 844-page Senate immigration bill is a provision that forbids undocumented immigrants from getting health insurance through the exchanges set up by the Affordable Care Act — until they complete their provisional status. L.A. County Supervisor Don Knabe says that’s 15 years of no federal dollars.

Knabe says the county currently gets about $600 million annually from the federal government to partially reimburse hospitals for treating the uninsured. Because the immigration bill also forbids any entitlement dollars from being spent on the undocumented, the county would lose the money.

“While we all we all may support immigration reform to a certain degree or a path to citizenship, ” says Knabe, “it can’t be at any cost. They have to be sensitive to the costs to local governments.”

I think it is far more likely that Los Angeles County and similarly-situated local governments will receive a carve-out of some kind, now or later, than that hospitals won’t be reimbursed by the federal government. And if the Gang of Eight immigration reform is passed in its current form, there is good reason to believe that W visa holders — less-skilled “temporary” workers who will be permitted to bring their spouses and children with them — will eventually join the ranks of the unauthorized immigrant population rather than return home to their native countries. This will create a new population of mixed-status households led by unauthorized immigrant parents, as some nontrivial number W visa holders will inevitably have children while living and working in the United States. Medical providers in metropolitan areas with large immigrant populations will have a strong incentive to advocate expanding federally-subsidized medical coverage to this population, the more comprehensive the better, as the federal government is in a better position to use debt finance to meet its obligations than state and local governments. All this is to say that the toughest provisions of the immigration reform bill will likely prove unsustainable.  


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