OK, so apparently after Joe Wilson was publicly rebuked for calling the President a liar, the administration decided rather than ignore the outburst, they’d throw him—and his fellow xenophobes, a bone. Obama has made it clear from the start that undocumented immigrants will not have access to any government programs or subsidies for health care. But over the weekend, the administration decided to go further and released this statement about limiting access to the proposed health exchanges on Monday:
“Under President Obama's plan, undocumented immigrants would not be allowed to enter the exchange. People who are lawfully present in this country would be able to participate in the exchange.”
That statement, which echoes a provision that is included in the newly-released Senate Finance Committee’s version of health reform, means that even undocumented workers who want to pay out of pocket for health insurance—with no government subsidy—will be denied access to the exchanges.
This is a short-sighted political move that is designed clearly to pander to the Conservatives who have dredged up the illegal immigrant issue (along with abortion and end-of-life counseling) in an attempt to block any version of health care reform. It won’t garner more support for reform legislation, it eliminates cost-savings and it moves us further from the stated goal of being a compassionate nation.
There are an estimated 11 million illegal immigrants living in the U.S. According to Rep. Luis Gutierrez (D-IL), some 40% of them already get some insurance through their employers—the meat packing plants, hotels, restaurants and home health agencies that employ them. Of those remaining, it’s unlikely that a huge number would even be able to buy full-priced insurance. But if they could, why wouldn’t we want them to pay into the system, get preventive care and avoid costly trips to the emergency room?
Michael Scherer, writing on the Time blog Swampland puts it this way:
“Though the political reasons for taking this position are not in doubt, the White House stand does present a potential policy irony. The purpose of the exchange, and health care reform as a whole, is to decrease the number of people who avoid insurance and choose instead to get health care in hospital emergency rooms, a cost that is eventually picked up by the local, state and federal government. By frustrating the opportunities for illegal immigrants to purchase insurance with their own money, the White House position suggests that those here illegally could continue to cost public money by using emergency rooms. In other words, by banning illegal immigrants from paying their own way on the exchange, it is possible that the taxpayer cost of health care for illegal immigrants would be higher, not lower.”
Baucus’s plan also includes more stringent verification of citizenship status that includes social security information and a cross-check with the Homeland Security Office. This will undoubtedly add administrative costs to the system and, as was apparent in the 1990s when Medicaid began requiring more documentation, it will end up making it harder to enroll those vulnerable Americans we do want to insure.
As for documented permanent residents—the kind of immigrants who came here legally and pay taxes—the health reform plans all still require a five-year wait before they can become eligible for Medicaid. Republicans like Mike Enzi and Chuck Grassley want legal permanent residents to wait those same five years before becoming eligible for government subsidies on the health care exchanges, but Democrats have allowed for all “legal residents” to be eligible.
As I have discussed before on HealthBeat, there are many good reasons to provide health care coverage to immigrants—even the undocumented ones. Unfortunately, the immigration issue has been used as a divisive wedge to drive dissent between Republicans and Democrats, and even between liberals and moderates in Congress. The outrage originated with xenophobic and really, racist, individuals who irrationally see “foreigners” as the root of all that’s wrong with this country. They distort figures on the “burden” immigrants place on the health care system and refuse to acknowledge their very real contributions to society.
Time will tell how important the immigrant issue will be to the successful passage of health care reform. Obama has already made enough concessions to the Joe Wilson’s of this nation—increasing verification of citizenship, banning illegal immigrants from public programs and the health insurance exchanges. Before he gives away more—the public option, reasonable subsidies, taxes on the health industry, individual mandates and other strategies the Republicans oppose—let’s make sure it’s not an exercise in futility.
The overwhelming majority of politicians will not support providing health coverage to illegal(not undocumented) aliens because this position is radioactive. Your point that these folks could not enter the exchange is largely theoretical, as most would be unable to afford it. Presumably, these workers would still be able to continue to get free care in our emergency rooms or pay cash to physicians for care. Health Care for All is an appealing mantra but this should be juxtaposed against a policy of Fairness for All. While some advocate that illegal immigrants should be afforded health care rights, education rights, employmnet rights, etc., some of us who are not xenophobes wonder if these should be American policies. http://www.MDWhistleblower.blogspot.com
It seems like Joe “You Lie!” Wilson from South Carolina has lied to the American public. He told reporters that he knows immigration law, he was an immigration lawyer. Turns out that nobody, nowhere, has any record of him being an immigration lawyer.
I have addressed this issue in another venue, and the following is adapted from those comments:
During his recent speech to Congress, President Obama asserted that proposed healthcare reform legislation excluded illegal immigrants from insurance coverage. Representative Joe Wilson shouted “You Lie”, and gained instant notoriety in the media. Who was right – the President who claimed the illegals were excluded, or Representative Wilson, who claimed they were covered?
To this nation’s enduring shame, the President was right and Wilson was wrong. We are now committing ourselves to punishing illegals with the threat of illness, pain, suffering, and death.
I understand the political forces that have imposed this obscenity on healthcare reformers. I am convinced that in their hearts, they would wish to extend to illegals the compassion we owe to all human beings. I understand that their first priority must be to achieve reforms of a healthcare system spiraling toward catastrophe. Still, at a deeper level, it is something I truly don’t understand. What have we become as a nation when the greed for political advantage forces us to forfeit our basic humanity? Is it worth it for the winners of that concession to have scored such a decisive victory over compassion? Is it worth it for those who made the concessions to sacrifice the victims for the sake of others? Sadly, the answer to the latter question is probably yes.
Illegal immigration confronts us with vexing challenges. These must be addressed – to some extent with more secure borders, and to a greater extent by enforcement of laws against fraudulent employment. Enforcement requires penalties, but the “get sick and die” penalty should not be among them.
If we today can blithely ignore employment regulations so as to enjoy the benefits of cheap labor by illegals, can we not find ways to temper healthcare regulations that leave the same laborers uncovered by insurance – including insurance they would pay for to the extent possible.
It is not that we are asking taxpayers to cover all their healthcare costs at our expense. We do that for some individuals, but we wouldn’t for the illegals. We do it for felons imprisoned for murder, rape, armed robbery, child molestation, and other crimes. If they fall ill, they go to the prison hospital and are treated – a gift from the taxpayer. But they are in this country legally, and that makes all the difference. They are Americans.
On most occasions, being American is something to be proud of.
Not this time.
Fred,
Thanks for sending your thoughts on this issue–I agree with your views. I also believe that we need to develop a sensible immigration policy that focuses enforcement on border security and employers who knowingly hire illegal immigrants instead of on denying care to immigrants and hoping they’ll leave (or die from lack of treatment).
Michael,
I think offering people who are working and living in our country–making our beds, caring for our elderly parents, processing our meat–access to health care is a very American policy–at least in the America I’m proud to live in. Immigration policy needs an overhaul too, but in the meantime, it seems senseless (and certainly, unfair)to continue to use taxpayer money to pay for expensive emergency room care.
And, in 2003, Joe “You Lie” Wilson actually voted to provide federal funds for illegal immigrants’ healthcare. The vote came on the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003, which contained Sec. 1011, authorizing $250,000 annually between 2003 and 2008 for government reimbursements to hospitals who provide treatment for uninsured illegal immigrants. The program has been extended through 2009 and there is currently a bipartisan bill in Congress to make it permanent.
Once again, Obama is caving in to the right wing hysteria.
They have backed him into a corner so he will pass a health care bill no one can be proud of.
As a progressive, I am deeply dissappointed by Obama’s willingness to answer every hysterical charge. It’s making him look weak. Furthermore, no matter how many “bones” he throws to the right wing, they will never be satisfied until he is out of office.
I want to second Gary G’s comment! Plus I wholeheartedly agree with Naomi’s replies to Fred and Micheal.
Let’s tackle these issues head-on. It’s time to enact far-reaching policies that are sensible, effective, and humane. We CAN do it. Health care, immigration, the economy, are crying out for strong and bold progressive leadership. The majority of the country will support these urgently needed efforts. (Hello, President Obama, can you hear us??)
Where’s the passion, vision, and political courage of a couple in the White House like FDR and Eleanor Roosevelt when you need them? I thought we finally had that again.
Time will tell.
The title here is a little misleading. The reform is not at the expense of immigrants. It’s at the expense of tax payers. An illegal immigrant will not have fewer options tomorrow than he has today, which is mainly pay providers directly out of pocket (on housekeeping and landscaping wages?) or get expensive (to the hospital and tax payer) care in an emergency room.
As for Joe Wilson, he certainly threw himself into the stereotype ‘out of touch’ republican, which should keep the partisan bickering at current levels.
The President and his congress can pass whatever legislation he wants, so quit whining about the republicans and show us what you can do. Unless of course, you already have. The clock is ticking, only 18 months until the election cycle picks up again for the Presidency.
“President Obama’s speech last week really moved me. Despite what my colleagues think of me. If what he says is what will EXACTLY happen, how can I not hope and work towards that cause”? Mike Oliphant runs a small Utah health insurance website http://www.benefitsmanager.net/SelectHealth.html and http://www.dentalinsuranceutah.net whom deals with hundreds of people on a day to day struggle to be approved for health insurance. “I get hopeful that I can finally tell people they can qualify for coverage REGARDLESS of their pre-existing medical condition”. Mike’s concern is that Obama’s people won’t deliver what he urges on areas within his speech. “I really have been moved by this guy and wish we could just talk so he could understand the frustration of a health insurance agent. I have been involved on a political level within the state of Utah and their struggle for health care reform. I have seen and regrettably been part of politics at work. I have learned lessons through baptism of fire with politics. For instance, I struggled against House Speaker Clark and H.B. 188 because that was what I was urged to do from our industry (that was all I knew). But after awhile and countless meetings with state and private carriers in Utah, I began asking myself if I was doing the right thing. I realized over time that House Speaker Clark really means what he says and is hard nose about getting reform done in Utah. I got that there wasn’t any behind the scene conspiracy scheme or personal objective of Mr. Clark. His bill makes allot of positive changes in the “health insurance reform” world of Utah. He claims that reform just doesn’t stop there, it must continue through “health care reform”. You see, there is a major difference between the two reforms. Clark “gets it” but I really worry that Obama’s administration doesn’t because if you have noticed the subtle language change of dropping “health care reform” and going to “health insurance reform”. See more about what Utah has accomplished here which utilizes private carrier involvement with true reform. If you can believe it, they reached it with an objective of $500,000. Perhaps the feds should take a look at Utah and House Speakers Clark’s bill 188. http://www.prweb.com/releases/utah_health_insurance/health_care_reform/prweb2614544.htm. Now I find myself on the “other side” of the fence furthering Utah’s cause. Let’s hope we don’t all have a mental breakdown nationally and just take a honest look at the proposals.
I don’t know why you would worry about healthcare for immigrants. We all know that amnesty is the next move on Obama’s agenda.
I was really enjoying Obama’s speech until he got to that point. He made clear that his principles of no longer denying our fellow human beings access to medical care did not extend to those who are here illegally, or to those who might need abortions.
Guess what? Millions of people are here illegally. Millions more are closely related to people here illegally and care about them a great deal. They are going to the emergency rooms and hospitals, whether we like it or not. Unfortunately, because they are denied access, by the time they finally see a doctor it’s often too late.
Just today, I saw a woman who has not seen a doctor for 8 years. She repeatedly has been told she cannot be seen because she is undocumented. She had stomach pain, I sent her the the emergency room, and they called me just a few hours ago to tell me that she has metastatic ovarian cancer. She’s been having symptoms for years. She spent the last 30 years cleaning people’s houses and caring for their loved ones as a home attendant.
She deserves respect. She deserved to have the chance to be seen before this turned in to such a large problem. She might have been one of the lucky few to have her ovarian cancer found early enough to actually be cured. But instead, because she doesn’t have the right documentation, she’s going to have a very painful year or two left to her, all of which will be paid for by us one way or another. In my opinion, we would have gotten a better deal, not so much fiscally as morally, had we taken care of her sooner.
Guess what else? One in four women will have an abortion during her lifetime. These are our mothers, sisters, and daughters. They need and deserve access to this legitimate medical procedure. It just so happens I have a story about this as well. Last week I saw a woman who works for the post office. This means that her insurance is subject to the Hyde Amendment, which states that no federal money can be used to fund abortions. Therefore, her insurance does not cover abortions (by the way, this is not as hot of a topic as one would think; 80% of insurers do cover abortion). She had been going back and forth for the preceding few weeks trying to figure out how to pay for it. Eventually she came up with the money, but at the price of having to undergo a longer, more painful procedure than she would have otherwise.
I ask your readers to consider how many people like this are in their lives. They have friends who live in families of mixed immigration status. They have friends and family members who have had abortions, or perhaps themselves have undergone the procedure.
I understand that Obama wants to stay away from these topics, but to categorically dismiss them, while he continues to vow that he will get coverage for all, is disingenuous.
Sharon
What is disingenuous, is claiming moral superiority at the start of your post, then discuss taking a life at the end. Crushing a fetus’s skull or severing the head with a metzenbaum scissor and evacuating the contents into a biohazard bag does not make it a “legitimate” procedure. In its most commonly done form, it’s taking a life for convenience. Period.
The Post Office employee could have had the baby for free and many a childless couple would have lined up to pay for the birth.
Maggie or Naomi – We need you to step back in before this topic, with important moral and economic implications, gets sidetracked into an abortion debate.
Jenga,
I appreciate constructive discussion on my posts and respect difference of
opinion–these are not straightforward issues we are taking on. But, when
comments begin to turn into rants, I reserve the right to remove them from
this public sight.
Sharon,
Thank you for sharing experiences from your real-world experience. When we
think about the issue of immigrants and health care I think it’s important
to recognize that there are millions of people here illegally (but
contributing to our economy). Denying them health care will not make them
go–it will only cause needless suffering.
Naomi
SOCIALISTS DON’T ALLOW ILLEGALS
All those great countries with socialized medicine ..
uh .. they do NOT allow ILLEGALS in ..
dang .. there’s a huge hole in your logic now ..
“As for documented permanent residents—the kind of immigrants who came here legally and pay taxes—the health reform plans all still require a five-year wait before they can become eligible for Medicaid. Republicans like Mike Enzi and Chuck Grassley want legal permanent residents to wait those same five years before becoming eligible for government subsidies on the health care exchanges, but Democrats have allowed for all “legal residents” to be eligible.”
As a legal resident is the US, who is in the process of becoming a citizen let me tell you that I’m beginning to feel truly unwelcome and officially hated.
Let’s be perfectly clear: My status is LEGAL, I WORK, I PAY MY TAXES.
Any questions??
Now, why should I even consider as legitimate, a law that deprives me of a health care option for YEARS, while I pay (via my taxes) into a system, that by design, I can’t access based on a truly arbitrary parameter?
I pay, but I can’t have?
Apart from being unbelievably offensive, I say this is nothing else than legalized theft.
Enough already!!
There are two arguments here. One is moral, one is fiscal. For those who are not swayed by the moral argument that I made above, I would submit that we’re paying a lot more money than we should as a result of not covering immigrants or certain reproductive health services. When people show up at the emergency room because they cannot access care any other way, they cost us money, and lots of it. When people don’t have access to reproductive health care, they cost us money. Lots of it. Every dollar spent on reproductive health care, including contraception, saves us four dollars in the future. In a system where most of what we spend is at best cost-effective, that is, the costs and benefits balance out (most preventive care unfortunately does not save money in the long run, although it importantly increases quality of life), saving $4 for every $1 spent seems like a really good deal.
Sharon – You have stated that on average, the net economic effect of preventive medicine is likely to be cost neutral rather than a cost saver. This is true when only medical expenses are considered. However, if we also factor in savings to the economy achievable by reducing the loss of worker productivity due to illness, net savings are likely to be substantial, possibly reaching $100 billion annually, or at least many tens of billions. One informative source is the Milken Report – http://www.milkeninstitute.org/publications/publications.taf?function=detail&ID=38801018&cat=ResRep
Thanks for pointing that out, Fred. It’s true that I’m only talking about medical savings, and I think it’s important that those who wave in their hands the many studies that show limited cost-effectiveness for many of our interventions remember that they don’t take economic productivity into account.
It’s true that only talking about medical savings, it’s important that those who wave in their hands the many studies that show limited cost-effectiveness for many of our interventions remember that they don’t take economic productivity into account.