US healthcare bill leaves illegal immigrants excluded
Omission was price of bringing conservative Democrats on board, particularly in states such as Texas

Chris McGreal in Houston
guardian.co.uk, Monday 22 March 2010 21.00 GMT Article history

The Texas governor Rick Perry has vowed to challenge the 'unconstitutional' healthcare bill.

The woman with the small child in tow outside the Clear Lake medical centre has every reason to celebrate health care reform. Except one.

She is not covered because she cannot afford the sky-high insurance premiums charged in Texas. As a part-time domestic worker in one of the sprawling waterside houses just outside Houston, her earnings would qualify her for heavily subsidised health coverage under the new law.

But the Mexican-born woman is an illegal immigrant – one of the undocumented, as the Americans call them – and the new legislation bars her from benefiting.

"My daughter is six. She was born here. The state pays for her to go to hospital," she said. "If I get sick I do what all the Mexicans do: I go and sit in the emergency room where they cannot turn you away."

That will not change after the law comes into effect in 2014. The government says the new legislation will extend coverage to 95% of the population, bringing in 32m people who lack insurance because of cost, existing health problems or through choice. But there will still remain about 5% of the population who fall beyond the provisions of the reforms.

The Congressional budget office estimates that five years after the law comes into effect there will still be 23m people in the US without insurance. One-third of these will be illegal immigrants – many have lived in the US for years and their children are Americans. Others are likely to be young people who will choose to defy the requirement for compulsory insurance and pay the relatively small fine.

Excluding illegal immigrants was a price Barack Obama paid for bringing conservative Democrats on board, particularly in states such as Texas, which has the highest rate of uninsured people in the country. One in three adults of working age in Texas – about 6m people – do not have health insurance. Children and the elderly are covered by state programmes.

The Centre for Public Policy Priorities in Austin, the Texan capital, says the bulk of those not covered are on low wages in jobs without health insurance and cannot afford the high premiums. "Part of the assumption is that there are still some who will chose to remain uninsured," said Anne Dunkelberg, associate director of the centre. "Then there are undocumented immigrants. They have been historically excluded from health insurance and they will continue to be excluded."

She says that, while the census does not ask about people's immigration status, a conservative estimate is that about 1m of those without health insurance in Texas are in the US illegally.

"Texas not only excludes the undocumented but also legal permanent residents who aren't US citizens from buying in to the state's health care coverage," she said. "Texas has a very poor record at access to social programmes such as free health care and food stamps."

But the state has deeper objections to the new law. The governor, Rick Perry, says Texas will launch a legal challenge to the legislation as unconstitutional and an infringement on personal liberty.

"Unfortunately, the health care vote had more to do with expanding socialism on American soil than it does fixing our health care finance and delivery systems," said Perry. "The Obama health care bill undermines patient choice, personal responsibility, medical innovation and fiscal responsibility in America."


http://www.guardian.co.uk/world/2010/ma ... immigrants