March 25, 2010; New America Media | This commentary from a health policy attorney at the national Immigration Law Center in Los Angeles will hopefully correct some of the misconceptions contained in articles that we at NPQ may have cited as sources on the treatment and standing of immigrants in the new health insurance reform legislation passed by the House.
According to the author, “the status quo in obtaining affordable health insurance will only change for some immigrants. Others will continue to be left out.” Here are the main issues to be understood: Immigrants who have become naturalized citizens and immigrants who are “lawfully present” will be able to get the same access to health insurance in the “insurance exchanges” to be established by the legislation. Similarly, they will be required to get health insurance and would face a penalty if they don’t.
However, for Medicaid, documented (lawfully present) immigrants will be ineligible or be required to wait years to enroll. So, while lawfully present immigrants can buy insurance in the exchanges, which essentially offer competing insurance packages available on the market, they wouldn’t be immediately eligible for the lowest cost insurance available to other low-income Americans, Medicaid. Undocumented immigrants, however, simply would not be allowed to buy health insurance on the exchanges, even if they use their own money (though children who are citizens or legal immigrants, even if their parents are undocumented, would be able to apply for federal tax credits in order to purchase affordable health insurance; go figure out how this bureaucratic nightmare of eligibility and ineligibility is going to be monitored).
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Similarly, by existing laws not overturned in the health reform bill, undocumented immigrants are not eligible for federal health care programs, including Medicaid. So how many undocumented immigrants end up uninsured under health insurance reform? Seven million? More? Everyone should know that depriving undocumented immigrants of federally subsidized insurance or Medicaid doesn’t mean that the nation’s taxpayers shun the costs. Immigrants without health insurance end up in hospital emergency wards and community health care clinics, paid for in part by federal subsidies to those institutions, in part by charitable and philanthropic giving to help them provide health care for the indigent.
It is silly to imagine that the nation can wish away the health insurance needs of low income documented immigrants who should be eligible for Medicaid and undocumented immigrants who should be able to purchase insurance coverage simply by writing these populations out of the health insurance reform legislation. As NPQ’s special issue on immigrants and nonprofits made clear, this is but one more inequity in our nation’s treatment of immigrants that has to be fixed for reasons of practicality, and more importantly, for justice’s sake.—Rick Cohen