Immigrant Care Costs at Issue

Congressional Quarterly Weekly
December 5, 2009
By Rebecca Adams, CQ Staff

One tactic Republicans have used against the Democrats' health care legislation has been to accuse them of planning to subsidize insurance coverage for illegal immigrants.

That was Rep. Joe Wilson's point when he shouted "You lie!" at President Obama during the president's September address to Congress.

Six years ago, though, when the Republican-controlled Congress and the Bush administration worked to enact the Medicare prescription drug benefit law, they included an extra $1 billion over four years to reimburse hospitals for treating illegal immigrants.

A third of the money was set aside for the six states with the highest number of apprehensions of border-crossers.

The rest was distributed to all 50 states based on their estimated illegal immigrant population.

That reimbursement fund was the brainchild of Jon Kyl of Arizona, a Republican on the Senate Finance Committee.

But in the current health debate, Kyl's been a leader among those insisting that citizens -- not permanent legal immigrants and certainly not illegal ones -- be first in line to buy subsidized coverage through the new insurance exchange envisioned in the Democrats' bill.

Kyl would make legal immigrants wait five years before they could qualify for subsidies and would bar illegal immigrants from buying insurance in the new market even with their own money.

Kyl acknowledges that some might think his support for hospital subsidies in 2003 is inconsistent with his current views about subsidized insurance. But he distinguishes between them. Federal law, he says, requires hospitals to provide emergency care to anyone, regardless of ability to pay and legal status. Given that mandate, and the government's responsibility to prevent people from crossing the border illegally, Kyl thinks the government should help shoulder some of the costs of treating illegal immigrants. In fact, he supports renewing the hospital reimbursements.

"Society has to absorb some of those costs. Yet we shouldn't simply turn a blind eye to the illegality," he said of the economic consequences of the illegal immigrant population. "I tried to help where I can by not attempting to change the principle, in other words that the person is here illegally, but change the consequences for the law-abiding hospital so they don't get whacked by the costs."

According to Rep. John Shadegg, who's also an Arizona Republican, Kyl has been criticized for the hospital reimbursements by the most passionate advocates of immigration control in their state.

Regardless, says Republican Sen. John Cornyn of Texas, paying the hospitals that care for illegal immigrants "should not be seen as an endorsement of the federal government providing health care to people who are here illegally."

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