As Congress debates comprehensive immigration reform, members of both parties have insisted on barring undocumented immigrants who achieve provisional legal status from receiving Medicaid coverage or Obamacare subsidies (a provision that was already part of the health law). But preventing these immigrants from gaining basic health benefits is actually a fiscally irresponsible model that will only raise health care spending and contribute to a sicker U.S. population.
The common argument against providing health care to undocumented immigrants is that, since they’ve broken the law, they should be punished. A part of that punishment involves denying them health care services through public entitlement programs or federal subsidies that are dependent on Americans’ tax dollars. “We must value the contribution of immigrants to our country. In doing so, we must protect our borders, we must protect our workers, and we must protect the taxpayer,” said House Minority Leader Nancy Pelosi (D-CA) on Thursday.
But the taxpayer already foots the bill for undocumented immigrants’ care — just in an incredibly inefficient and half-baked way. Under the auspices of the Reagan-era Emergency Medical Treatment and Active Labor Act (EMTALA), hospital emergency rooms can’t turn away patients based on their citizenship or insurance status. That doesn’t mean that their care magically becomes free — undocumented men and women who use the emergency room are still slapped with a hefty hospital bill.
However, if they are unable to pay that bill — which is fairly likely considering that they probably don’t have any insurance — then a combination of the federal government, state governments, hospitals, and other American consumers of U.S. health care are forced to absorb the cost. In turn, that raises prices for medical services, since hospitals want to recoup some of their losses. Some studies have estimated the price of subsidizing undocumented immigrants’ health care at about $10.7 billion per year.
The federal government has long been aware of this problem. In fact, soon after EMTALA’s passage, lawmakers authorized a special Medicaid fund that mostly goes towards subsidizing emergency treatments for undocumented immigrants. The program costs about $2 billion per year, and most of that money is used on delivering babies for pregnant, undocumented women who go to the emergency room.
Unfortunately, that’s about all the money is good for. Medicaid doesn’t cover the preventative treatments that might have prevented the need for an emergency room visit in the first place, nor does it provide for the prenatal services that would ensure the health and safety of both mother and child. And in health care, any system that promotes after-the-fact medical consumption — i.e., “sick care” — is one that undermines the general public health and drives up everybody’s health care costs.
The lack of access to preventative and primary care services is a particularly pressing problem given that low-income undocumented immigrants tend to have specialized and chronic health care needs, since poverty and social exclusion perpetuate unhealthy living habits that can cause and exacerbate costly diseases such as diabetes and obesity. And studies have shown that those who pursue quality preventative care services early on in their lives consume less care in their twilight years, which is when most health spending occurs.
But the immigration reform proposals being considered right now would leave undocumented immigrants on provisional status anywhere from 13 to 15 years. Consequently, these immigrants would be banned from accessing any preventative or primary care services for that long. And chances are, by the time they do enter the “officially” subsidized health care market through Obamacare or Medicaid, their health will be considerably worse. So by denying undocumented immigrants Medicaid, Obamacare subsidies, CHIP, and Medicare, lawmakers are essentially eschewing relatively small preventative and primary health care spending now in favor of considerably more public health care spending in the future.
Congress’s insistence on punishing undocumented immigrants by restricting their health care access also runs afoul of public opinion. By a 63 to 33 percent margin, Americans believe that undocumented immigrants who achieve provisional status should have access to Medicaid, and 59 percent believe they should have access to Obamacare’s insurance subsidies. That includes over 40 percent of Republicans on both counts.
Those numbers reflect the fact that Americans favor immigrants’ rights to a far greater extent than Congress. For instance, 64 percent of Americans support a five-year path to citizenship, rather than the 13-year timeline the Senate is considering. And younger Americans are even more likely to view immigrants positively, with only 38 percent of 18 to 25-year-olds agreeing with the notion that immigrants are burdens on society that abuse government resources. In all of these cases, Congress is considering much harsher — and even counterproductive — measures against undocumented immigrants compared to what the public wants.