Health reform could cost illegal immigrants in Cook County

May 1, 2011
Mike Yolpe

CHICAGO | Adapting the county's health care system to the to the sweeping federal health care reforms is a priority for Cook County Board President Toni Preckwinkle, but she recently said those reforms will come at the expense of those living illegally in the county.

"There was a devil's bargain made in the passage of health care, and that devil's bargain was the exclusion of the undocumented from coverage," she said last month when addressing her first 100 days in office. "We in the county have a large pool of undocumented."

According to the latest figures from the Illinois Coalition for Immigrant and Refugee Rights, Illinois has about 550,000 illegal aliens. Without access to health insurance, Preckwinkle said, the burden of paying for health care for the local illegal population will fall mostly on the county.

Douglas Rivlin, press secretary for U.S. Rep. Luis Gutierrez, a Chicago Democrat who led the fight to include illegal immigrants in the Patient Protection and Affordable Care Act of 2010, said he wouldn't characterize it as a "devil's bargain" since "everything that comes before the House of Representatives excludes undocumented immigrants when possible."

"It makes no economic sense to exclude undocumented immigrants and their families from the Affordable Care Act and specifically from the exchanges where costs are brought down by increasing the number of participants," Rivlin said in a statement. "Including the relatively young and healthy undocumented should help bring down costs for all. Excluding them undermines the savings and further marginalizes an already at-risk portion of the U.S. population."

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 contains exceptions that allow federally-funded community health centers to provide primary care services without needing to verify citizenship eligibility.

Jim Gilchrist, founder of the anti-illegal immigration group the Minutemen, sees other consequences of granting health insurance to the undocumented.

"Providing guaranteed health coverage to illegal aliens would only be another invitation for the world's population to migrate here," he said. "No one with any common sense would encourage such a thing."

The Cook County Health and Hospital System operates hospitals, clinics and other health care facilities throughout the county, and it serves about 500,000 people a year. The health system accounts for a little less than a third of Cook County's entire budget, Preckwinkle said.

"We're going to find ourselves in 2014 in a situation where lots more people will have insurance and where fewer people have fallen through the social safety net," she said. "Then, we're in competition with the nonprofits and for-profits providers of health care. The question is whether we can survive in that environment."

Preckwinkle believes this is a budgetary issue, and that the county will not be reimbursed for care given to illegal residents -- those that are undocumented. But Ben Domenech, health care expert for the Chicago-based Libertarian think tank the Heartland Institute, said that's a bit of a misnomer.

He explained that many illegal aliens would still be able to buy health insurance on the private market. It's up to each individual state, Domenech said, to set up enforcement processes to verify that all health insurance purchases are made only by those legally in the country.

Maricela Garcia, head of the Chicago office of La Raza, said Illinois has not yet begun to set its verification process for its health care exchanges.

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