Set aside Joe Wilson’s bad manners — what about the substance of his accusation?
Mr. Wilson claims that various Democratic proposals wending their way through Congress will use U.S. taxpayer dollars to further subsidize health care for illegal immigrants. Democrats say this is not true, and the back-and-forth continues like this: Democrats say that there is nothing in pending legislation that explicitly covers illegal aliens. Republicans say, “Aha! But we offered amendments that would have specifically required more robust measures to keep illegals out of the system and you voted them down, leaving the back door open!” And Democrats respond, “No, we didn’t. We don’t need that, because Medicare and Medicaid and such already require documentation of legal status.” And then the Democrats will point to this report from that solomonic arbiter of fact, the CNN Truth Squad, which concludes: “A new report finds the bill could require illegal immigrants to buy coverage, but it clearly restricts subsidies to U.S. citizens and legal residents.”
As Sarah Palin, critics of Van Jones, and those who seek to exclude Cass Sunstein from the collective czardom of the Obama administration have pointed out, there’s what the law says and there’s what the administrative apparatus does. When it comes to the question of whether government-run health-care programs will be used to subsidize illegal aliens, we need not confine ourselves to the realm of the hypothetical and the speculative. Helpfully, the government itself has taken a look at the issue from time to time.
One illustrative example, and there are many, is a 1994 report from the Department of Health and Human Services inspector general, documenting the fact that some states — California and Illinois among them — were improperly using Medicaid funds to provide routine medical care to illegal immigrants. If you have any familiarity with the workings of government bureaucracies, you will not need much imagination to figure out how that happened. The law empowers states to use Medicaid funds to cover “emergency” services for illegals. One of the emergency services covered is the delivery of babies. It is hard to imagine denying care to a woman being wheeled into an emergency room in labor. But, of course, providing care to women being wheeled into emergency rooms in labor was not the end of it. Bureaucracies like to grow, government bureaucracies are home to lots of Democrats, and illegal aliens provide a nice source of supplementary voters for Democrats in states such as — and let’s just pick two — California and Illinois.
So, rather than emergency deliveries being covered, pregnancy itself becomes an “emergency” condition, and Medicaid funds ended up getting used to pay for routine prenatal care and other services related to same. And then they began to be used for post-partum care, as well. The government’s own reportage documents lots of episodes in which federal funds have been used to subsidize illegals in contravention of existing statutes. On what grounds might we suppose that Obamacare would be any different? Especially if we consider that Republican efforts to help ensure that Obamacare might prove different were rejected? And might we be justified in asking the Democrats why, exactly, they voted against those measures? After all, if they are superfluous, they will have no real effect: If existing controls are sufficient, the illegals will be weeded out of the system well before they came up against these putative restrictions, no?
The results of this were entirely predictable. A GAO report finds that illegal immigrants constitute more than one-third of all Medicaid-funded pregnancies in California. Elsewhere in the country, the GAO found: “From 1992 to 1995 in Texas, the number of Medicaid-funded births to undocumented alien mothers more than doubled, while the total number of births remained fairly stable.” People respond to economic incentives. Even when the people and the incentives are illegal.
Missouri attorney general Chris Koster has estimated that one in ten Medicaid claims is fraudulent. How much of that fraud diverts money to illegal immigrants? Nobody knows for sure — and don’t ask the state bureaucrats for help in finding out: When the federal government passed new rules demanding better documentation of legal residency for Medicaid recipients, the states resisted. In California, officials representing the state’s Medicaid program, Medi-Cal, wanted to use such lamentably inadequate documentation as insurance records and school report cards in place of passports and birth certificates. We are entitled to question their motives, and their prudence.
So, Representative Wilson could use a visit from Miss Manners. But he is telling the truth, and President Obama is not.
– Kevin Williamson is a deputy managing editor of National Review.