From the Fact Check Desk: Illegal Immigrants and Health Care Reform

By Gorman Gorman

Sep 10, 2009 5:43pm
Defending his reasoning, if not his outburst, today Rep. Joe Wilson, R-SC, declared that “the Congressional Research Service has indicated that indeed the bills that are before Congress would include illegal aliens.”

What Rep. Wilson had so bluntly yelled was a “lie” last night was a different assertion; President Obama had said, “the reforms I’m proposing would not apply to those who are here illegally.” In other words, the president had changed the debate from any specific legislation to what he was proposing – and, indeed the White House last night posted a 2 ½ page legislative outline called “The Obama Plan” on its website, which as of today seems to be the only plan White House officials are willing to discuss or defend.

But be that as it may, we decided to take a look at the August 26 Congressional Research Service report "Treatment of Noncitizens in H.R. 3200," the House bill. (You can read a copy HERE.)

The non-partisan analysts conclude that:

*             some illegal immigrants — those who "meet the substantial presence test" — would be taxed if they don't obtain health insurance that meets the requirements of the law;

*             there are no immigration-related restrictions on who can participate President Obama’s proposed health insurance exchanges;

*             to qualify for any subsidies for health insurance, "individuals must be lawfully present in a state in the United States." That does not preclude those in this country legally who have illegal immigrants in their family from qualifying for the subsidies.

*             how will the government make sure that subsidies don't go to illegal immigrants? The mechanism is left entirely up to the Health Commissioner, who is instructed by law that he or must have some process to establish immigration status before giving subsidies. Sec. 241(b)(1), pg 130 : “the Commissioner shall establish a process whereby, on the basis of information otherwise available, individuals may be deemed to be affordable credit eligible individuals."  That “shall” is key.
 
The one way the H.R. 3200 could end up in more health care being provided to illegal immigrants by taxpayers comes from the expansion of Medicaid.

Illegal immigrants are already eligible for emergency care through the Emergency Medical Treatment and Active Labor Act, signed by President Reagan in 1986. This emergency care is often paid for by Emergency Medicaid, private insurance if the patients have it, out-of-pocket, or it's written off as bad debt or charity care by the hospital.

H.R. 3200 would extend Medicaid coverage up to 133 1/3% of poverty for populations that previously were not covered such as some parents and childless adults.

That expansion could – could — mean more illegal immigrants would become eligible for Emergency Medicaid.

Which is not to say that citizens don't pay for those costs anyway through extra hospital fees, but this would clearly be a more direct billing to the taxpayer.

**

As long as I have your attention, I should point out that all of us already pay the costs of health care for illegal immigrants — through emergency room visits, Emergency Medicaid, hidden fees by hospitals, workplace safety incidents, and the like. This idea that we all aren’t paying for this one way or another is non-reality-based.

**

But back to the fact check desk: do President Obama’s proposed reforms apply to those in the U.S. illegally?  No.

To recap on what CRS says: Does the House bill provided subsidies to illegal immigrants? No.

Would the House bill require illegal immigrants to have health insurance? Some of them, yes.

Would the House bill allow illegal immigrants to purchase health insurance in a health insurance exchange? It doesn’t restrict it, though White House press secretary Robert Gibbs today said he didn’t think the version of the law the president would sign would allow such a thing.

Could the House bill expand emergency Medicaid laws as they already exist, perhaps – perhaps — expanding coverage for illegal immigrants in keeping with current law?

According to CRS: Yes.

-jpt

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