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.
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