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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