Insuring immigrants could cut cost of care for all

08:20 AM CDT on Tuesday, May 26, 2009

Immigration and health care are political Everests. There's widespread agreement that our current approach to both is broken and that we can't sustain the path we're on. To fix either one requires a daunting, exhausting climb through the clouds in search of consensus.

The health care climbers are making progress. They hope to write legislation in the next few months that will insure nearly everyone while curbing the staggering costs of care. But it doesn't look like they'll extend health insurance to the millions of recent immigrants living here, and that's worth thinking about.

Offering health insurance to immigrants living illegally in the country sounds like a crazy idea. For most, U.S. health care is far better than what they might get back home. For immigrant women, giving birth in the United States grants their offspring citizenship. If they can use insurance to get prenatal as well as delivery care, gaining access to U.S. care becomes an incentive to come in violation of the law.

Yet nearly half of the recent immigrants (here for less than 10 years) with and without authorization already have insurance, said Leighton Ku, a George Washington University professor of public health policy.

An estimated 44 percent of recent immigrants are insured. That means they are working at companies that provide them with health insurance, whether they are authorized to be here or not. Although recent immigrants comprise 5 percent of the adult population, they account for only 1 percent of health expenditures.

"Typically, they are working fairly hard physical work, so they are the sort of people you would want to help get health insurance if they are injured on the job or can't necessarily work," Ku said. "I hope we are a compassionate enough society to do that. And from an economic standpoint, the medical expenses of immigrants are very cheap. They're not bankrupting the system."

The economic rationale is the same for the larger population of the uninsured. About 47 million Americans don't have health insurance. With unemployment the highest it's been in a generation, more are going without insurance every day.


Youth the ideal

Any insurance pool would want young, healthy workers because they use the least medical care but contribute premiums used for those with greater needs. (The vast majority of medical expense occurs in treating the 20 percent of Americans who have chronic diseases such as diabetes, cancer and cardiopulmonary illnesses.)

Many of the uninsured are young adults no longer covered by their parents' policies. They may not be able to get health care at work or school, and individual insurance policies are more money than they want to spend.

The legislation under discussion in Senate and House committees seems destined to require that all of these people get insurance. For people with pre-existing medical conditions, the insurance industry has volunteered to move off the current high-cost, discriminatory approaches to individual policies – but only if everyone has to get insurance.


Figures fuzzy

The U.S. Department of Homeland Security estimates there are 11.6 million immigrants in the country illegally, including 1.68 million in Texas. How many lack health insurance is not clear. The Center for Immigration Studies in Washington estimates 15 percent of the 47 million uninsured are illegal immigrants. The U.S. Census Bureau uses a higher estimate of 22 percent.

Those without health insurance are seen at many charity clinics across the Dallas area and other parts of the state, or at emergency rooms such as Parkland Memorial Hospital's. Parkland gets some compensation from the federal government for treating illegal immigrants who don't have insurance, but the program's spending ($221 million a year nationwide) seems well short of the need.

Offering immigrants health insurance would act as an incentive to come to the United States without a visa. Insuring them once they're here, however – either through employer or individual mandates – could lessen the cost of medical care for the population as a whole.

But that's a mountain too tall for the current health care reform debate.

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