Thread: Taxpayers Should/Should Not Have to Pay for I.A. Healthcare

U.S. Taxpayers Should Not Have to Pay for Illegal Immigrants' Healthcare

Compassion aside, the nation cannot afford to include the undocumented

By Daniel Stein
Posted November 10, 2009

Daniel Stein is president of the Federation for American Immigration Reform.

As the long and complex national debate about healthcare policy has unfolded, there is still a good deal of disagreement among Americans about many aspects of the bills that are making their way through Congress. On one matter, however, there is overwhelming consensus: Eighty percent of Americans are opposed to including illegal aliens under a taxpayer-subsidized national healthcare plan, according to a June 2009 Rasmussen poll.


Americans recognize that extending the full range of benefits to people who have no legal right to be in the country is unjustified and would add billions of dollars to the cost of a healthcare overhaul. Taxpayers—at the federal and state level—already spend about $11 billion a year on unreimbursed care for illegal aliens.

When analyzing a previous version of a House healthcare reform bill, the Congressional Budget Office estimated that the average government subsidy per person would cost $4,600 a year, growing to $6,000 a year by 2019. According to estimates, covering illegal aliens would increase the amount American taxpayers are spending for healthcare for illegal aliens from $11 billion per year to $30 billion. That would rise to $40 billion per year by the end of the next decade. Moreover, these costs fail to take into account any increase in the illegal alien population during that time.

While federal law and basic human decency require that emergency care be provided to anyone in a life-threatening situation, there is no compelling legal or humanitarian reason to offer every medical service to persons in the country illegally. Doing so would either drive up costs for everyone else or add to the already staggering deficit—both of which President Obama and congressional leaders have vowed will not happen.

The Pew Hispanic Center estimated that in 2007, 59 percent of illegal aliens lacked basic health insurance. Assuming that percentage has not increased as a result of the recession, and using conservative estimates of the population, that would mean some 6.6 million illegal aliens are medically uninsured. These uninsured illegal aliens are far more likely to have incomes below 400 percent of the official poverty level, making them income eligible for the government affordability credits included in the healthcare reform bill approved by the House.

For many of the reasons expressed by advocates for illegal aliens, continuing to have millions in our country who lack health insurance and are unable to pay for care poses its own set of problems. Those issues can and must be addressed by enforcement of our immigration laws, not by forcing American taxpayers to absorb billions of dollars in additional costs.

Advocates for covering illegal aliens begin from the false premise that the presence of 11 million to 15 million illegal aliens in our society is an immutable fact. It isn't. Through the elimination of nonessential public services and benefits, greater cooperation on the part of state and local police, and a rational enforcement strategy that makes it difficult for employers to get away with hiring illegal aliens, the number living in the United States can be reduced dramatically.

Recent history has demonstrated that enforcement works. Even before the onset of the recession, stepped-up worksite enforcement, begun in 2007, resulted in the first declines in the illegal population in decades. Moreover, in states that have implemented their own immigration enforcement strategies, the results were even more dramatic. Arizona, which requires employers to use a federal employment eligibility program known as E-Verify and bars illegal aliens from receiving most state benefits, has reduced its illegal alien population by about one third.

Unfortunately, the Obama administration has moved in precisely the opposite direction. Rather than continuing strategies proved to reduce the illegal population, it has pursued policies designed to create pressure for a massive amnesty. On several occasions, Obama has acknowledged that providing healthcare benefits to illegal aliens is politically untenable with the American public. Yet, he has openly assured ethnic advocacy groups of his commitment to granting amnesty to current illegal aliens and then bringing them under the umbrella of a national healthcare system.

Aside from being equally untenable with the American public, granting amnesty to illegal aliens would do nothing to reduce the cost burden for their healthcare. Because of education levels and limited jobs skills among the illegal population, the majority would not see their incomes rise appreciably and would therefore qualify for large taxpayer subsidies under the reform bills before Congress.

Coming at a time of high unemployment and soaring government deficits, the debate about whether to provide these healthcare benefits serves to illustrate the enormous costs of our failed immigration policies. Immigration, legal and illegal, has been a driving force behind the growth of the medically uninsured population in the United States. Until we bring our immigration policies in line with economic and fiscal realities, we will continue to face Hobson's choices on this and many other key issues.

Four out of five Americans are opposed to including illegal aliens under a national healthcare system not because they lack compassion but because they understand we cannot maintain a system that invites millions to use services that must be financed by taxpayers or through increased government borrowing. If our national goal is to provide a high standard of care without breaking the bank, then we must limit access to citizens and long-term legal residents and enforce laws against illegal immigration.

http://www.usnews.com/articles/opinion/ ... healthcare


The Immigration Debate Can Wait; Healthcare for All Cannot

Coverage for the undocumented is the best policy in the long run

By Eric Rodriguez
Posted November 10, 2009

Eric Rodriguez is vice president of the National Council of La Raza, where he heads the Office of Research, Advocacy, and Legislation.

The fight over legal and undocumented immigrant inclusion in a reformed healthcare system has been brewing for months but has recently intensified. Anti-immigrant politicians have called the president a "liar" over the question of whether or not his plan would give benefits to "illegal aliens." But rather than expose these politicians for fearmongering, honest health-reform negotiators have inadvertently legitimized the claims. Efforts by Senate negotiators to tighten health proposals and prevent unauthorized residents from accessing new benefits now border on the ridiculous. Reformers have overreacted, and desperation for political cover may well take us down a perilous path.


Anti-immigrant politicians argue that undocumented people should be excluded from the proposed taxpayer-subsidized health insurance exchange. The president agrees, and Senate legislation does exactly this. But the health exchange is a structure, more akin to the Internet and our road systems, not a government benefit. Who would argue we should erect barriers to our roadways for unauthorized workers? Should we also prohibit undocumented immigrants from buying food in a grocery store or medicine at a pharmacy? In both cases, taxpayer dollars are used to support regulation of products sold in these markets. More workers in the health exchange will help control healthcare costs and ensure that Americans are not exploited when purchasing health insurance.

And what about the more than 1.5 million undocumented children in the United States? Under the Senate healthcare plans, a child who was involuntarily brought to the country at the age of 2, for example, and is now 14, loves the Jonas Brothers, and gets straight A's in school would be prohibited from participating in the exchange.

Unauthorized workers and children are already barred from Medicaid, and health reform continues the ban. But under current law, if the parents of an undocumented child can afford to buy private insurance with their own money, they can. If the Senate restriction becomes the law of the land, 650,000 undocumented children without health insurance will be effectively barred from the most affordable private health insurance plans available. Health reform would make these children less secure.

Anti-immigrant politicians further argue that U.S.-born children of immigrants should not be given citizenship. Do you wonder what they believe about providing these American children healthcare? These politicians would punish citizen children and families with a working parent who is unauthorized. Negotiators seem to agree. Reformers would go overboard in crafting a complex web of rules to guarantee that the unauthorized parent of a family of four U.S. citizens cannot possibly benefit from health reform. In effect, the rules could mean that the entire family cannot afford health insurance because of a drastically reduced affordability credit.

Side by side, the new rules could mean that the government will treat a U.S.-born child of an unauthorized parent as less than a U.S.-born child of U.S. citizen parents. This unequal treatment among U.S.-born children might even be unconstitutional. One can make an argument that those in the country unlawfully should not receive direct government assistance. But no one can reasonably argue that Congress ought to institute laws that directly harm U.S.-born spouses and children of unauthorized workers in order to punish the workers. The cost of this overreaction is that American children and spouses in this boat—some 4 million children are in mixed-status families—could find themselves capsized without affordable healthcare options.

Politicians—including some who should know better—further argue that some categories of legal immigrants should not have access to Medicaid. Current law prohibits all legal immigrant adults from gaining access to Medicaid during their first five years in the country. To effectuate this, lawmakers have put in place bureaucratic red tape, verification, and citizen documentation rules that have been incontrovertibly proved to be costly and to harm eligible U.S. citizens.

Confusion over these rules also helps explain why more than 45 percent of all legal, taxpaying immigrants have no health coverage. Rather than fix this problem, health reform could make matters worse. The Senate bill maintains the bar on Medicaid for legal immigrants. True, families may be eligible for the new healthcare exchange, but negotiators are threatening to extend ineffective and burdensome verification and citizen documentation rules to the exchange.

If Congress caves to these anti-immigrant voices and makes it harder for U.S.-citizen or lawfully present children of immigrants to get health insurance, we ought to know what will happen. Children in these families will not have a regular doctor. Most will not have access to preventive care, diabetes screenings, or flu shots. When a child gets sick or hurt—which will happen—parents will first attempt to administer aid themselves, and when the condition has become unbearable and potentially life-threatening, the parents will have no choice but to take their child to an emergency room for costly care. Is this the health reform we seek for our children?

There are legitimate policy questions about how we should treat undocumented immigrants in the country. The debate over how to fix our broken immigration system is forthcoming, and those questions will be answered there. The healthcare reform debate is about how we get all workers, families, and children access to affordable, high-quality care.

Anti-immigrant politicians do have a perspective about immigrants and healthcare that should be heard. But health reformers who adopt their proposals should beware. Anti-immigrant lawmakers seek punishment at any cost, even if it harms the health status of American children and other U.S. citizens. That's a clear path down a treacherous road we should wisely avoid and an ambition the Congress ought not to satisfy.

http://www.usnews.com/articles/opinion/ ... all-cannot

Undocumented immigrants--at least Rodriguez did not go far enough to call them undocumented citizens as some have done.
The horror of any socialized medicine, like I experienced in Germany in the 1970s, was that any worker was covered after only six hours on the job. In those days, all workers were legal, and no one dared to be illegally in that country.

There five basic reasons for the high cost of Health Insurance and Health Care in the US:

1. The government systematically underpays doctors and facilities providing care to Medicare and Medicaid patients. This forces these providers to pass the additional costs onto their other paying customers and their insurance companies.

2. Emergency rooms are required by law to provide care to anyone who shows up regardless of the ability to pay. They are typically not reimbursed for non-paying patients, and as in number 1 above, pass the additional costs to other paying patients and their insurance companies.

3. Illegal aliens account for a significant number of the patients who use emergency rooms for free care even in non-emergency situations.

4. Government overhead for administering Medicare and Medicaid accounts for a significant portion of the government costs for those programs, especially when the costs of the federal employees' own Cadillac health insurance program and retirement program are factored in. Note that Medicare and Medicaid costs account for approximately 57% of the Health Care costs in the US.

5. High cost of liability insurance for providers because of law suits and often unrealistically high awards (of which about half goes to the lawyers). Corollary to this are costs associated with providers practicing "defensive" medicine, i.e., performing tests and diagnoses that would not normally be called for, but doing so anyway to protect against suits that claim the provider did not do enough to cure/heal the patient.


Given the above, some straight forward tactics that would reduce health care costs are:

1. Pay the going rates. This would tend to keep private health insurance costs lower, while reflecting the true costs of the Medicare and Medicaid programs. Once Americans appreciated that, they would be even less inclined to have the government run ANY health care programs.

2. Reimburse emergency rooms at the going rate. Same rationale as number 1 above.

3. Ban illegal aliens from receiving non-emergency care in emergency rooms. If not, then identify their employers and charge them for the emergency room costs. If no employer can be identified, identify the country of origin and bill it.

4. Reduce the government overhead in Medicare and Medicaid.

5. Pass tort reform. Mississippi, Texas, and California have done so. Other states may have. Mississippi and Texas say tort reform has lowered costs by reigning in high awards, and by keeping tort lawyers from selecting 'friendly counties' to press their cases in. It was not unusual, for example, for a suit with thousands of plaintiffs to be tried in a county with only one plaintiff because of the county's record of high awards for punitive damages. This 'gaming' of the judicial system invariably led to higher awards with a correspondingly elevated increase in liability insurance premiums

I wonder if this healthcare bill would pass if the public servants themselves were required to use it. I really think then it would tank faster than the Titanic.