Critical Condition

Health Politics Could Trump Immigration

The Washington Post had a front page story on the politics of immigration this morning, claiming that immigration is clearly a winning issue for the Democrats. I’m not sure I buy the article’s premise, which is based mainly on the growing size of the Hispanic vote. As the chart that accompanied the article showed, smart Republicans can and will win Hispanic votes, as both Ronald Reagan and George W. Bush did — both won over 35 percent of the Hispanic vote, with Bush securing 44 percent in 2004.  

Furthermore, one area in which the politics of immigration could actively hurt the Democrats is with respect to health policy. This point is illuminated in a recent report by Sens. Tom Coburn and John Barrasso, both M.D.s, on the first hundred days since the health-care bill has become law. The report, which Carrie Lukas summarized on Critical Condition when it came out, is a useful compilation of many of the familiar concerns with the health-care law, but it also highlights some of the new law’s disturbing treatments of immigrants, both legal and illegal, versus native-born citizens. 

For example, according to the report, “American citizens will be forced to purchase costlier health care or pay a tax; illegal immigrants will continue to get free care and those costs will be shifted onto Americans.” This is a significant cost, the report states, as the expense of providing uncompensated care was $43 billion in 2008. If the CBO estimates of more than 20 million people remaining uninsured in 2019 are accurate, this means that the cost of uncompensated care, much of it going to illegal immigrants, could remain over $20 billion in 2019, five years after the health-care law is fully implemented.

Another oddity in the law applies to low-income legal immigrants, who will be eligible for subsidies and participation in the insurance exchange, while similarly situated low-income American citizens will only be eligible for Medicaid. This provision, which appears to favor immigrants over native-born citizens, is a fat target for political attack. 

These two examples indicate the extent to which, contrary to Democratic hopes, the politics of health care will only get worse for the Democrats once the bill is fully implemented. In addition, policies like these could also upset Democratic plans for making immigration a political winner for them.

Tevi Troy is a presidential historian and former White House aide.

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