Shortly after the Congressional Research Service released their report on the treatment of noncitizens in the House health care bill, the anti-immigrant hate group, Federation for American Immigration Reform (FAIR), was already patting itself on the back. “Case closed. Illegal aliens will be eligible to participate in the health care program offered by the House bill unless Congress acts to amend the bill,” stated Dan Stein, president of FAIR. However, CRS’ analysis was much more nuanced than Stein would like to admit and — if anything — it highlights how the health care bill could actually hurt undocumented immigrants more than it helps them in the absence of any major reform of our immigration laws.
Sec. 242 and 246 of America’s Affordable Health Choices Act of 2009 explicitly state that only individuals who are lawfully present in US will receive any of the benefits provided in the bill. Stein is right that the CRS points out that the bill does not contain a mechanism to verify immigration status. Yet he downplays a key point of the report: under §142(a)(3), the Health Choices Commissioner is responsible for determining the eligibility of individual affordability credits which implies that he’ll also have to determine the mechanism to verify the eligibility and immigration status of noncitizens.
CRS’ analysis is pretty much in line with what others have been saying. Edwin Park of the Center on Budget and Policy Priorities and Jonathan Blazer of the National Immigration Law Center have both asserted that verification mechanisms for the new subsidy program will be determined during the implementation process (after the bill is passed) which allows the government to choose the “mechanism [which] best matches the underlying process for getting a subsidy.” The report also points out that nothing in the House bill overturns the precedent set by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act which prohibited undocumented immigrants from being eligible for most public benefits and even severely restricted the eligibility of legal immigrants. It should also be noted that, in the case of Medicaid, stringent verification mechanisms are known to have barred more American citizens than undocumented immigrants at a high cost to taxpayers: for every $100 spent by taxpayers to implement documentation requirements in six states, only 14 cents were saved.
The report also exposes one of the more problematic aspects of the bill’s treatment of noncitizens. The House bill currently mandates that all citizens as well as “resident aliens” must have health insurance. However, “resident alien” is a term defined by tax, not immigration law and it includes undocumented immigrants who meet the “substantial presence test.” That means that all undocumented immigrants who fall into the category of “resident alien” would be required to obtain health insurance and will be fined if they fail to do so. However, that doesn’t in any way imply that the government is going to help them since only individuals who are lawfully present in the United States are eligible for any of the federal assistance provided in the bill. Ultimately — if the nation’s broken immigration system isn’t addressed — the proposed health care bill essentially penalizes undocumented immigrants for not having insurance that they won’t even have access to in the first place.
With that said, the CRS report ultimately sheds more light on the desperate need for immigration reform that addresses the problem of current and future flows of unauthorized immigration as opposed to the deficiencies of the House health care bill related to its treatment of noncitizens. While anti-immigrant activists continue to exploit health care reform to recruit support for their nativist agenda, the smartest way to approach both issues would be to pass immigration reform and turn uninsured undocumented immigrants into legal residents who pay into the system.