Illegal Immigrants Remain Uninsured
Illegal immigrants remain uninsured
Democratic health care overhaul did not address insurance for the country's 12 million illegal immigrants.
By Emma Dumain
Along with abortion, the hot-button issue of illegal immigration nearly scuttled the Democratic health care overhaul.
Though controversy flared when Rep. Joe Wilson (R-S.C.) called President Obama a liar during a joint session of Congress, Democratic leaders managed to tamp the issue down by barring illegal immigrants from many of the new programs and benefits in the bill.
As a result, some advocates say insuring the country's 12 million illegal immigrants will soon be one of the biggest unsolved health care problems.
Under the new law, undocumented immigrants are exempt from the individual mandate requiring most Americans to buy health insurance or pay a fine. But they are also barred from receiving Medicaid, the federal insurance program for the poor, or even buying their own insurance through statewide exchanges to be set up in 2014.
Pro-immigration advocates argue those provisions will leave many illegal immigrants uninsured without addressing the question of how to give them basic health services.
"Denying them doesn't prevent them from getting sick, and it doesn't prevent them from needing care," said Sonal Ambegaokar, a health policy attorney at the National Immigration Law Center, of undocumented immigrants. "They will still have to pay for care at unaffordable rates, and providers will be stuck figuring out how to care for them."
The Congressional Budget Office estimated in mid-March that, by 2019, 23 million non-elderly residents of the United States will still be uninsured. About one-third of this group, or close to 8 million people, will be illegal immigrants.
It's a bloc that a handful of health care analysts say will likely constitute the single biggest group of uninsured residents once the changes in the health care bill are in effect, though this claim is hard to quantify at this point.
For the near future, illegal immigrants will get health care coverage the same way they do now. They'll still be treated at community health centers, which were given 11 billion dollars in the new bill to serve 20 million additional patients, and they will also continue to be seen in emergency rooms, which are required by law to treat any patient who walks through the door regardless of financial or immigration status.
Some will receive insurance through their employers, or their spouses' employers, while others will buy insurance on their own through packages not offered on state exchanges, though this might be more difficult in the new system.
"It might be harder to buy insurance outside the exchange, because of increased premiums," predicts Jennifer Ng'andu, the deputy director of the health policy project at the National Council of La Raza (NCLR), the country's largest Latino civil rights and advocacy organization. "I think time will tell."
Congress could address the issue in the future by either removing these restrictions on illegal immigrants, or creating more pathways for them to become U.S. citizens.
There is already an expectation that Democratic leaders and White House officials will move towards overhauling current immigration policy to address the concerns that had to be shut out of the health care debate to ensure the bill's passage.
In a recent interview with CNN, Obama senior strategist David Axelrod emphasized the importance of consolidating the issues in policymaking, stating that health care overhaul was "not the vehicle through with to address our immigration issue."
In the end, it was the decision to increase access to legal immigrants seeking health insurance that helped groups like NCLR to support the bill despite serious reservations.
"This bill is better for legal immigrants, and it was ultimately key in our decision to support it," said Ng'andu. "In the very last changes to the bill, it drastically improved affordability for this group."
Significant measures in the bill, finalized during the reconciliation process, allow legal immigrants to participate in the exchanges and apply for Medicaid. Like U.S.-born citizens, they will be subject to the mandate, but not if it is too costly.
To have these privileges, however, legal immigrants must have lived in the country for five years or more. What is known as the "five-year waiting period" will be lifted only for children and pregnant women living in states that choose to provide Children's Health Insurance Program benefits.
Emma Dumain covers health care for Congress.org.
http://www.congress.org/news/2010/04/13 ... _uninsured
