Why Democrats Should Not Submit To Nativists’ Health Care Demands

Almost as ridiculous as the “death panel” conspiracy theories that are currently being propagated by right-wing lunatics is the notion that the “Obamacare bill will allow illegal aliens to receive taxpayer-funded health care.” Today, the Atlantic’s Derek Thompson tweaked his pro-immigrant argument to include the counter-intuitive suggestion that Democrats should essentially bow down to obstructionist nativist rhetoric to save both health care and immigration reform from its decimation:

“If Democrats lose health care over immigration, then they don’t just lose health care — they also lose immigration reform. Once Republicans stoke fears about illegal aliens snatching up all their taxpayer-provided Medicaid subsidies, the debate over immigration will have already been poisoned by the notion that Americans will not support reform that incorporates illegals. By nipping the illegal care issue in the bud, and strengthening the provisions to bar illegals from receiving subsidies, the Obama administration saves its gunpowder to fight for immigration reform at a later date.”

Thompson’s assessment is flawed on a variety of levels. To begin with, two eligibility enforcement amendments were already proposed in the House, and Democrats defeated them for a good reason. The Heller Amendment would have given private insurance providers unprecedented access to the sensitive income and identity information of all those applying for health care assistance while curtailing the privacy and redress responsibilities that the Social Security Act requires of government agencies. Another failed amendment presented by Rep. Nathan Deal (R-GA) would have “narrowed the categories of legal immigrants who would be eligible for affordability credits,” according to Health Policy Attorney Sonal Ambegaokar, and “imposed a burdensome and costly documentation procedure that we know has been a sledgehammer for a non-existent problem.”

Thompson should know that, ultimately, it doesn’t really come down to if an enforcement mechanism will be established, but rather when and how. Edwin Park of the Center on Budget and Policy Priorities admits that the bill doesn’t articulate a specific eligibility verification system. However, he points out that it will be determined once health care reform is passed and “the work of establishing the new system gets underway.” In the meantime, right-wingers should rest assured that there is nothing in the bill that overturns the harsh verification requirements of Medicaid. Jonathan Blazer of the National Immigration Law Center further explains why verification mechanisms for the new subsidy program will be determined during the implementation process (after the bill is passed):

“The appropriate verification mechanism depends on the structure of the subsidy and its delivery system in the final bill; most importantly whether the subsidy comes through the tax system…The federal government already has several verification mechanisms readily available, and it will chose which mechanism best matches the underlying process for getting a subsidy. This better ensures that the system will ‘work’ in the real world.”

Whether lawmakers decide that “provisions to bar illegals” should be beefed up before or after health care reform (hopefully) passes, they should seriously consider the consequences that it will have on the successful implementation of the bill. The Hoefstra Law Review points out that when Colorado passed a series of stringent measures requiring applicants for state benefits to prove their immigration status, US citizens suffered the brunt of the effect. It cost the state $2 million in its first year alone and, despite having promised to eliminate 50,000 undocumented immigrants from the state’s public benefit rolls, as of October 2008 state officials could not identify how many, if any, undocumented immigrants were being denied public services. Another study by the Government Accountability Office found that documentation requirements used to prove medicaid eligibility caused thousands of eligible U.S. citizens to lose Medicaid coverage without saving taxpayers any money: for every $100 spent by taxpayers to implement documentation requirements in six states, only 14 cents were saved.


For those reasons, Thompson is absolutely right that the best way to solve the problem is to pass immigration reform and turn uninsured undocumented immigrants into legal residents who pay into the system. He also wisely observes that if immigration kills the health care debate, then immigration reform is likely dead on arrival. However, appeasing wingnuts who are spreading lies and misinformation about both runs the risk of legitimizing their position by passing provisions that threaten effective health care reform and set the tone of the immigration debate before legislation is even written.