Opinion

Politics of Immigration Leaving Millions With No Health Care

Excluding immigrants from the benefits of health care reform is foolish.

Kathy Ko Chin is president and CEO of the Asian & Pacific Islander American Health Forum.
National Journal
May 28, 2014, 3 a.m.

Lines have been drawn on the fa­mil­i­ar is­sues in im­mig­ra­tion re­form: bor­der se­cur­ity, an earned path­way to cit­izen­ship, and visa pro­grams. Not­ably miss­ing from the con­ver­sa­tion on both sides of the aisle is how to provide health cov­er­age to the mil­lions of newly leg­al­ized im­mig­rants.

If past de­bates are any in­dic­a­tion, adding health care to the mix can be the pro­ver­bi­al light­ning rod.

Hard-liners have tried to de­rail im­mig­ra­tion re­form over claims that have been de­bunked by lib­er­als, con­ser­vat­ives, and liber­tari­ans alike. Chief among them is the er­ro­neous as­sump­tion that a path to leg­al­iz­a­tion would ef­fect­ively flood fed­er­al wel­fare rolls and hurt the eco­nomy.

If facts mat­ter, then the data paints a very dif­fer­ent pic­ture.

Im­mig­rants are any­thing but heavy users of gov­ern­ment ser­vices. They par­ti­cip­ate at lower rates than their nat­ive-born coun­ter­parts, and even when they do they use less in ser­vices, which means less in dol­lars.

At the same time, they prop up the Amer­ic­an eco­nomy and the very same pro­grams op­pon­ents claim they would drain. Im­mig­rants have sta­bil­ized the Medi­caid trust fund with $115 bil­lion dol­lars more than they drew in ser­vices. Their 2010 So­cial Se­cur­ity con­tri­bu­tions shored up the pro­gram to the tune of $12 bil­lion — net.

And the non­par­tis­an Con­gres­sion­al Budget Of­fice’s latest re­port con­cludes that im­mig­ra­tion re­form is a net win, with im­mig­rants sav­ing the fed­er­al ledger $200 bil­lion in the first 10-year peri­od alone.

But these sa­li­ent points have been largely si­lent among the polit­ic­al class. The res­ult means im­mig­ra­tion re­form could main­tain our in­ef­fi­cient health care status quo at best, or at worst, un­der­mine the na­tion’s health for dec­ades to come.

The Sen­ate-passed im­mig­ra­tion bill (S. 744) and the com­pan­ion H.R. 15 al­low the re­cently leg­al­ized to pur­chase cov­er­age in the Obama­care mar­ket­place, but without the af­ford­ab­il­ity tools an es­tim­ated 80 per­cent of mar­ket­place en­rollees have re­lied on. These im­mig­rants are ex­cluded from the health in­sur­ance tax cred­its and sub­sidies oth­er Amer­ic­ans now en­joy. With that help off the table, a sil­ver plan could run sev­er­al hun­dred dol­lars a month, ef­fect­ively put­ting in­sur­ance out of reach.

Ad­di­tion­ally, ex­ist­ing fed­er­al laws bar leg­al im­mig­rants from the same pro­grams their tax dol­lars sup­port. As a res­ult, strug­gling work­ers would be forced to delay crit­ic­al pre­vent­ive care for a dec­ade or more.

Mean­while, op­tions for un­doc­u­mented im­mig­rants, in­clud­ing young Dream­ers, are few and far between. They are com­pletely pro­hib­ited from buy­ing plans in the mar­ket­place, even if pay­ing full price with their own dol­lars.

While the state-of-play in the House is un­known, the eco­nom­ic and health im­pacts of top-down re­stric­tions on care are not. Nearly 20 years ago Con­gress ushered in eli­gib­il­ity re­stric­tions un­der the guise of wel­fare re­form. The in­ten­ded ef­fect may have been to min­im­ize costs in the short run, but the un­in­ten­ded ef­fect has been a chilling im­pact on ac­cess to needed care and hu­man health.

The polit­ics of these re­stric­tions do not line up with real­ity. With or without im­mig­ra­tion re­form, health costs will not dis­ap­pear. Every­one needs health care at some point and every­one pays for our in­ef­fi­cient, ex­pens­ive sys­tem that forces people in­to sick-care and emer­gency treat­ments.

Qual­ity in­sur­ance of­fers eco­nom­ic and health se­cur­ity. Max­im­iz­ing the num­ber of people who are in­sured avoids shift­ing the costs down the road, cur­rently born in the bil­lions by the fed­er­al gov­ern­ment and cash-strapped states. This is the prin­ciple be­hind Rep. Lu­jan Grisham’s Heal for Im­mig­rant Wo­men & Fam­il­ies Act. The bill, pending in the House, would re­move polit­ic­al in­ter­fer­ence in health pro­grams and al­low im­mig­rants leg­ally liv­ing and work­ing in the coun­try ac­cess to the same pro­grams their tax dol­lars sup­port.

With a dis­charge pe­ti­tion on track in the House, ac­tion on the na­tion’s out­dated im­mig­ra­tion laws may be in sight this year. But, some ac­tion should not be a sub­sti­tute for no ac­tion. Im­mig­ra­tion and health is not an either/or pro­pos­i­tion.

Pav­ing a fisc­ally sound way for the newly leg­al­ized to take re­spons­ib­il­ity for their health through the same health care op­tions as every oth­er Amer­ic­an is good eco­nom­ic and pub­lic policy. It’s time for Con­gress to pass im­mig­ra­tion re­form that is work­able now and in the dec­ades that fol­low.

Kathy Ko Chin is pres­id­ent and CEO of the Asi­an & Pa­cific Is­lander Amer­ic­an Health For­um. The Heal for Im­mig­rant Wo­men & Fam­il­ies Act is pending be­fore the En­ergy and Com­merce and Ways and Means com­mit­tees. H.R. 15, the com­pan­ion to the Sen­ate-passed com­pre­hens­ive im­mig­ra­tion bill (S. 744), has seen little move­ment since its in­tro­duc­tion in Oc­to­ber 2013. As a res­ult, Demo­crat­ic lead­ers have a dis­charge pe­ti­tion pending in the House to force a floor vote but have only 191 of the 218 sup­port­ers needed.

HAVE AN OPIN­ION ON POLICY AND CHAN­GING DEMO­GRAPH­ICS?The Next Amer­ica wel­comes op-ed pieces that ex­plore the polit­ic­al, eco­nom­ic and so­cial im­pacts of the pro­found ra­cial and cul­tur­al changes fa­cing our na­tion, par­tic­u­larly rel­ev­ant to edu­ca­tion, eco­nomy, the work­force, and health.  Email Jan­ell Ross at jross@na­tion­al­journ­al.com. Please fol­low us on Twit­ter and Face­book.

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