Senate Majority Leader Harry Reid (D., Nev.) has insisted the Senate will deal with immigration and health reform separately. And Senate Finance Committee Chairman Max Baucus (D., Mont.) told the Dallas Morning News in May, “We’re not going to cover undocumented aliens, undocumented workers. That’s too politically explosive.”
But it’s hard to envision how health reform can avoid tripping the immigration booby trap. Approximately 15–22 percent of the 46 million residents of the United States without health coverage are illegal aliens. That’s about 9 or 10 million people. More generally, a third of the foreign-born are uninsured, Census data analyzed by the Center for Immigration Studies show. That means something like 12.6 million people, or more than a fourth of the total uninsured, are immigrants, both legal and illegal. Since 1989, immigration is responsible for 71 percent of the rise in those without health insurance. The fact is, the problem of the uninsured would be a more manageable one if the U.S. were not admitting millions of uninsured immigrants.
#ad#Two health-care plans working their way through Congress — the bill from the Committee on Health, Education, Labor, and Pensions (HELP), and a draft outline put together by Baucus’s Finance Committee — could suffer because of this interaction between immigration and medicine.
For example, the HELP bill’s proponents hope to expand Medicaid so that everyone earning up to 50 percent above the federal poverty level can enroll (currently, Medicaid income requirements vary by state, with the poverty level being the usual limit). Since immigration law only requires relatives who sponsor someone for an immigrant visa to earn 25 percent above the poverty level, the end result would be that someone poor enough to qualify for Medicaid would be able to sponsor new immigrants to the U.S. What are the chances that these newcomers sponsored by Medicaid recipients would be able to afford health insurance when their sponsors can’t?
And under the Finance Committee’s plan, tax credits for buying insurance would be available to individuals who earn up to three times the poverty level. (That’s $32,490 for individuals and $66,150 for families of four.) Like other refundable tax credits — meaning that if your tax credit is worth more than you pay in taxes, the government sends you a check for the difference — this health-coverage tax credit would amount to a welfare-type subsidy funded by those Americans who pay taxes.
No health legislation on the table requires federal, state, or local agencies — or private institutions receiving federal funds — to check the immigration status of health-program applicants, so some of the money distributed via Medicaid and tax credits inevitably would go to illegal aliens.
Also, the HELP bill makes citizens and lawful aliens eligible for a new Right Choices program — an advocacy program providing Democrats jobs spending taxpayer money. And another part of the Finance Committee plan would exempt illegal immigrants from a mandate to buy insurance. Uninsured Americans would have to pay a fine, but uninsured illegal aliens would be off the hook — thus, they would have no reason to buy their own coverage or to stop receiving taxpayer-funded health services at clinics, emergency rooms, etc.
If the children’s health reauthorization early this Congress is any indication, liberals intend to redistribute income even to aliens. The Pelosi Congress dropped requirements that SCHIP applicants document their legal status, dumbed down standards so stolen Social Security numbers can be accepted, and allowed illegal aliens onto SCHIP for up to 90 days.
A recent Rasmussen poll found 80 percent of American voters oppose covering illegal immigrants in any health-reform bill, while just 11 percent support it. And 70 percent oppose universal health care if illegal aliens are included.
The American people may soon realize how much health reform will benefit immigrants and cost the native-born. When that happens, the volatile politics of immigration could derail universal health care.
– James R. Edwards Jr. is coauthor of The Congressional Politics of Immigration Reform.