Immigration Debate Continues: Who Should Get Health Care?

IMMIGRATION DEBATE CONTINUES: WHO SHOULD GET HEALTH CARE?

Volume 28, Issue 496 July 23, 2007

Matthew Gever

The difficult issue of immigration reform may be dead (at least for now) in Congress, but it’s very much alive in the states. And it’s no less divisive.

As of April 13, state legislators in all 50 states had introduced more than 1,000 immigration-related bills and resolutions in their 2007 sessions (updated numbers to be released at NCSL’s Annual Meeting in August). Of those, 92 were related to health care. While some of those bills seek to restrict access to care for undocumented immigrants (who are in the United States illegally), others would protect it.

In Rhode Island, Senator Juan Pichardo introduced SB 415, which would sidestep both federal mandates and a state law by allowing income-qualifying, documented and undocumented children to enroll in RIte Care, the state’s Medicaid program. The Ocean State would forgo a federal match, using state-only funds to pay for care.

“Denying health insurance to residents of our state does not save money—it just shifts the cost of care in ways that result in higher costs to the health-care system,” said Senator Pichardo. Children who can’t get preventive and primary care will be forced to wait until a crisis drives them to emergency rooms, he adds.

On the other end of the spectrum, Representative Richard Singleton introduced HB 5859, which would require citizenship or legal status for anyone receiving health benefits. The legislation would amend the Health Care Accessibility and Quality Assurance Act, which the state implemented in 1997 as a means of monitoring managed-care plans. The bill states, “Any individual receiving health benefits and/or elderly health care benefits must be a U.S. citizen or have legal immigrant status.”

“It’s very disturbing to me that soldiers who return from Iraq with serious injuries cannot receive proper health care from our government, yet we’re giving away health care to immigrants who are here illegally,” said Representative Singleton. “That doesn’t make any sense to me. Our state certainly cannot afford to provide health care to illegals any longer, nor should we.”

At the Federal Level

Prior to 1996, permanent documented immigrants had the same access to public benefits as did U.S. citizens. But that year, Congress enacted a law that prohibited certain classes of documented immigrants who arrived after Aug. 22, 1996 from obtaining federally matched Medicaid coverage during their first five years in residence. In addition, the 2005 Deficit Reduction Act requires that all Medicaid applicants provide proof of citizenship and identity.

Nevertheless, believing that basic health services such as prenatal care are cost-effective, nearly half the states have developed programs that use state-only funds to cover documented immigrants. Currently, 21 states (including Rhode Island) and the District of Columbia have such programs, which offer basic health services to children and pregnant women who otherwise would be barred from enrolling in Medicaid or SCHIP, according to a new report from the Center for American Progress. States that traditionally have had large populations of immigrants, such as California, New York and Texas, are among them.

For years, policymakers have debated whether immigrants contribute to or drain state coffers. A new report from the Center for American Progress found that states take in more revenue from undocumented immigrants than they pay out in services. For example, 7 percent of the Texas population is made up of undocumented immigrants, for whom the state paid $58 million in health-related expenses in 2005. That same year, the state collected nearly $500 million in revenue from this group.

Both legal and illegal immigrants tend to consume fewer health services than the general population because they’re much less likely to be insured, the report states. And contrary to popular belief, immigrants rarely use emergency room services, in part because they fear questions.

“No credible research says illegal immigration imposes large economic costs on America,” said Gordon Hanson, director of Center on Pacific Economies at the University of California/San Diego. He argues that illegal immigration has a minimal impact on state and federal budgets, although states pick up more of the costs than the federal government.

Meanwhile, the Federation for American Immigration Reform (FAIR) recently released a report showing that illegal immigrants in New Jersey annually contribute $488 million in tax revenues to the state, but cost more than $2.1 billion for education, medical care and incarceration.

A 2006 study from the Texas State Comptroller’s Office found that in FY 2005, the 1.3 million undocumented immigrants in Texas added $1.58 billion to state revenues—far more than the $1.16 billion worth of state services that they received. However, local governments bore the burden of $1.44 billion in uncompensated health care and law enforcement costs.

The debate continues in state legislatures. “Illegal aliens should not be using public health care,” said New York Senator Frank Padavan. The senator introduced SB 73, which would prohibit publicly funded facilities from providing health care—except in emergencies—to anyone whose legal status cannot be verified. The bill also would require state agencies to verify the citizenship status of anyone seeking public health care and to report those suspected of being in the United States illegally.

In Texas, Representative Garnet Coleman introduced HB 2381, which would preclude hospital employees or emergency medical technicians from inquiring as to a patient’s immigration status while receiving emergency services. The bill ultimately failed.

In this story, legal or documented immigrants include “green-card” holders and legal temporary residents, such as students, travelers and high-tech workers. “Undocumented” immigrants are those who do not fall into any legal categories. Two groups account for most undocumented immigrants: (a) those who entered the country without valid documents, including people crossing the Southwestern border clandestinely; and (b) those who entered with valid visas but overstayed their visas’ expiration or otherwise violated the terms of their admission.