As Democrats prepare to expand the State Children’s Health Insurance Program (SCHIP), House Minority Leader John Boehner (R-OH) and Republican Whip Eric Cantor (R-VA) are calling on Speaker Nancy Pelosi (D-CA) and President-elect Barack Obama to continue denying health insurance to immigrant children. In a letter to the Democratic leaders, Boehner and Cantor stipulate that “only U.S. citizens and certain legal residents should be permitted to benefit from a program like SCHIP”:
Only U.S. citizens and certain legal residents should be permitted to benefit from a program like SCHIP. We believe SCHIP legislation must include stronger protections to prevent fraud by including citizenship verification standards to ensure that only eligible U.S. citizens and certain legal residents are controlled in the program.
The issue in question is the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), which subject most legal permanent residents to a five-year ban on eligibility. Under the provision, legal immigrants who are not refugees, humanitarian immigrants, active-duty members or veterans of the Armed Forces and their families (presumably this is what Boehner and Cantor mean by ‘certain legal residents’) can become eligible for SCHIP after a five-year residency period, provided they meet the program’s other income and categorical eligibility requirements.
The Democrats’ bill to expand SCHIP is expected to give states the option of lifting the five year waiting period and allow as many as 4000,000 children to apply for federal health programs.
Indeed, since 1996, immigrant children and pregnant women with no other source of coverage have been prevented from obtaining essential health care. The ban contributes to “higher costs for emergency room visits and poorer health outcomes” and has “exacerbated the disparity in health coverage between immigrants and native citizens,” contributed to the increasing uninsured rates among immigrants, and “shifted the burden of covering this population to sates and local safety net providers.”
But the argument for including tax-paying non-citizens in the SCHIP program is as much economic as it is moral. Forcing immigrant children to go five years without seeing a medical professional only increases SCHIP’s costs once the now sicker children become eligible for insurance.
As Chris Jennings explained at a recent CAP health event, “if people go in and out of the system you can neither prevent that problem nor can you coordinate the disease [management] well if you don’t have coverage.” Diagnosing and treating childhood diabetes or asthma before those conditions progress, improves the health status of the patient and saves money on costly treatments within the system.
Luckily, most Americans support lifting the ban. According to a survey commissioned by the child advocacy group First Focus, 67 percent of Americans “favor eliminating the five-year waiting period for legal immigrant children, while 19 percent were opposed.”
Still, perhaps the best solution to the SCHIP-immigration issue is comprehensive immigration reform that provides non-citizens with a path to full citizenship and benefits. Coupled with health care reform for all, such an approach can bring everyone into the health system and contain the nation’s spiraling health costs.
Update
Senate Finance Committee Chairman Max Baucus (D-MT) released an outline of his $31.5 billion, 4.5-year proposal. Read it here.
Update
,The Washington Post clarifies that while “the House bill would give states the option of allowing legal immigrants into the program,” “the Senate version…would maintain the status quo.”
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