Government

Immigrant coverage creates new rift in health reform debate

The House bill would let illegal immigrants buy into a public plan option, but they couldn't get taxpayer-funded benefits, a report to Congress says.

By Chris Silva — Posted Sept. 14, 2009

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A recent addition to the growing list of flashpoints in the health system reform debate is the question of whether illegal immigrants will be able to obtain government-sponsored health insurance under the overhaul plan envisioned by lawmakers.

The reform bill pending before the House does not contain explicit provisions preventing immigrants from purchasing coverage under its proposed health insurance exchange, according to a new report commissioned by Congress and released Aug. 25. The Congressional Research Service, an arm of the Library of Congress that conducts studies for lawmakers, examined the treatment of both legal and illegal immigrants in America's Affordable Health Choices Act.

While illegal immigrants are banned from receiving government affordability credits designed to help low-income people buy coverage, they could still put up their own money to participate in the exchange. The exchange would begin operation in 2013 and include choices of private plans along with a government-sponsored, national public plan option.

The finding has given ammunition to organizations that oppose the current bill on the contention that it would force taxpayers to foot the health bill for people who are illegally in the U.S. The Pew Hispanic Center estimated in an April report that nearly 15% of the nation's 47 million uninsured are illegal immigrants. Of the nearly 12 million illegal immigrants living in the U.S. in 2008, roughly 7 million, or 59%, were uninsured.

"Case closed. Illegal aliens will be eligible to participate in the health care program offered by the House bill unless Congress acts to amend the bill," said Dan Stein, president of the Federation for American Immigration Reform. "The loopholes and omissions in the House bill are not there by accident."

The question of who would qualify as a legal resident is also a point of contention. CRS said that without a provision in the bill specifying a verification procedure, a mechanism for determining coverage eligibility based on immigration status would be left to the health choices commissioner -- a new federal post that would be filled by presidential nomination if the bill becomes law.

Rep. Dean Heller (R, Nev.) offered an amendment to the legislation during the House Ways and Means Committee markup that would have required the use of existing citizenship verification tools to determine eligibility for taxpayer-funded health care benefits, but it was voted down.

"If the majority party insists on moving forward with [a] government-run health care plan, Congress should do everything in its power to curb abuse," Heller said. "Requiring citizenship verification for enrollment would ensure only citizens and legal residents receive taxpayer-funded health care."

But committee Democrats who voted against the amendment insisted that no taxpayer funds would go toward illegal immigrant coverage under the bill.

The CRS report "clarified the point that undocumented immigrants could participate in the exchange, but only to buy insurance, thus [they] are not eligible for any taxpayer-funded benefits," said Rep. Xavier Becerra (D, Calif.). Although the public plan would be government-sponsored, Democrats have said it will be sustained solely through beneficiary premiums, not federal tax revenues.

The dispute about coverage spilled over into President Obama's Sept. 9 health care address to Congress. After the president said that "the reforms I'm proposing would not apply to those who are here illegally," Rep. Joe Wilson (R, S.C.) shouted, "You lie!"

Wilson later apologized for his outburst. The White House did not specify whether Obama was referring to the issue of illegal immigrants receiving any government-sponsored insurance or just the affordability credits.

Some pro-immigration organizations said the concerns about who will receive subsidized insurance coverage are overblown.

"To fear-monger on the basis of a bill that hasn't even passed is silly," said Tamar Jacoby, president of ImmigrationWorks USA, based in Washington, D.C. "Honestly, I find it very unlikely that Congress or American voters are going to want to provide government-paid health care for illegal immigrants."

The health coverage issue for those lawfully in the U.S. is also complex. CRS concluded in its report that the House bill would require certain categories of legal residents to purchase insurance but would make them ineligible for federal assistance, regardless of income.

CRS noted that most "nonimmigrants," such as migrant workers or others who are in the U.S. for a specific purpose and time, could not receive federal affordability credits. Examples of nonimmigrants who could obtain credits include victims of human trafficking or other crimes, fiancé(e)s of U.S. citizens, and those who have had applications for legal permanent residence status pending for three years.

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ADDITIONAL INFORMATION

Sizing up the immigrant population

According to the Pew Hispanic Center, there were approximately 40 million foreign-born individuals in the U.S. in the beginning of 2008, of which nearly 12 million were illegal immigrants. In a separate study, the Center for Immigration Studies concluded that the illegal population dipped to 10.8 million in the first three months of 2009. Here's how Pew said the foreign-born population broke down in March 2008:

Naturalized citizens 14.2 million (36%)
Legal permanent residents 12.3 million (31%)
Legal temporary migrants 1.4 million (4%)
Illegal immigrants 11.9 million (30%)

Note: Percentages rounded.

Source: Pew Hispanic Center, April 14 (link)

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