EagleTribune.com, North Andover, MA

August 23, 2009

Reform bars coverage of illegals, but enforcement is lacking

By Taylor Armerding

Would President Barack Obama's proposed health care reform require taxpayer-funded coverage for illegal aliens?

No, but...

And that makes the matter both contentious and confusing.

There is nothing in any of the current drafts of the 1,018-page bill that expressly calls for government-funded insurance of illegal aliens. In fact, Section 246 of the House bill, titled, "No federal payments for undocumented aliens" states the following: "Nothing in this subtitle shall allow federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States."

So Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, could claim with a measure of accuracy, as he did several weeks ago, that, "We're not going to cover undocumented aliens, undocumented workers."

President Obama himself said, in an interview with CBS News anchor Katie Couric, that illegals would not be covered under his vision of health care reform, although he said he might support an exemption for children.

But, if the government is going to prevent ineligible people from receiving a benefit, it must have a mechanism to determine who is eligible. The current bill contains no language that requires any verification of citizenship or legal residency before health insurance is provided.

In fact, the House Ways and Means Committee, controlled by Democrats, recently rejected a proposed amendment to the bill by Rep. Dean Heller, R-Nev., that would have required those applying for any government funded health insurance to be screened by two systems now in use to verify immigration status — the Income and Eligibility Verification System and the Systematic Alien Verification for Entitlements program.

The two systems cross reference Social Security numbers and employment information to verify whether a person is a citizen or a legal resident.

Neither Heller nor his press aide, Stewart Bybee, responded to numerous requests for comment.

So does the defeat of the amendment mean that coverage will be provided for illegal aliens? It depends on who you ask.

First, the president's comments to Couric notwithstanding, it is significant that when he speaks of insuring 47 million people who now lack health insurance in America, he is not speaking only of citizens. According to the Center for Immigration Statistics and the U.S. Census Bureau, 15 percent to 22 percent of that number — 7 million to 10 million people — are illegal residents of this country.

That makes the answer obvious to Ronald W. Mortenson, who writes in a paper for the conservative, Washington, D.C.-based Center for Immigration Studies that 75 percent of working-age illegal aliens use fraudulent Social Security cards to find employment. Many of them also have driver's licenses. In other words, they may be illegal, but they are not undocumented.

With that documentation in hand, and with no effort to verify their status, what is to prevent them from getting coverage?

Steven Camarota, director of research at the center, agrees that forbidden does not necessarily mean prevented.

"The bill does not envision covering (illegals) with Medicaid or a public option," he said. "It seems to bar them, and 'seems' is probably all you can get in a bill like this.

"But, all the proposed enforcement mechanisms have been consciously left out. It's a little analogous to putting a speed limit on a road that nobody patrols."

Camarota says he doesn't know why Heller's amendment was rejected.

"Most other means-tested programs require screening with databases," he said, "and most of them work pretty well. They do weed out some people who are ineligible."

However, Edwin Park, of the more liberal leaning Center on Budget and Policy Priorities, also in Washington, D.C., said he believes critics of the bill are exaggerating the risk of illegals being covered.

Park notes that the bill does not change the verification requirements of Medicaid, which forbids coverage of illegals except in emergencies. And he contends that those requirements are so "onerous" that their major impact is not so much to screen out the ineligible, but to prevent coverage for those who are in fact eligible but don't always have documents like original birth certificates. He said African Americans and Native Americans find it especially difficult to comply.

Park agrees that there is nothing in the various drafts that establishes a specific enforcement mechanism for the public option — if there is one — like that for Medicaid. But he said he believes that will be developed once the legislation is passed and the work of establishing the new system gets underway.

"You can't have everything in the bill," he said. "People are already complaining that, at more than 1,000 pages, it is too long."

Fifth District Congresswoman Niki Tsongas, D-Lowell, was not available for an interview. But, in an e-mail response to The Eagle-Tribune's questions, she agreed with Park that, "If health care reform becomes law, the executive branch will likely employ similar regulations and documentation requirements, which have successfully prevented undocumented workers from receiving Medicare, Medicaid, and Social Security benefits."

Her press spokesman, John Noble, added that, "this discussion also illustrates why (Tsongas) believes in the need for comprehensive immigration reform. It shouldn't fall to doctors, hospitals, etc. to enforce the nation's immigration laws."

Ultimately, the regulations determining whether illegal aliens are covered under health care reform will be the result of political decisions, subject to all the lobbying and debate that is surrounding the proposed bill itself.

Stories by the Associated Press, the Los Angeles Times and other newspapers highlight the debate between those who don't want health care reform to get bogged down over coverage for illegal immigrants and those who say there are important reasons for illegals to be covered. Advocates of the reform bill ridicule the "myth" that illegals will be covered, while others claim that uninsured illegal aliens will clog emergency rooms or spread disease throughout the population because they have not been treated.

Jennifer Ng'andu, deputy director of the National Council of La Raza's Health Policy Project, told the Associated Press she believes any plan that doesn't include undocumented immigrants won't last.

"If we don't talk about integrating communities that have been traditionally shut out, we're going to be talking about health care reform again in 15 years," Ng'andu said.

Any legislation as complex as health care reform is subject to reinterpretation for years after it is passed. In short, this is a question that will not be answered definitively until long after reform, in whatever form, is enacted.


Do you have a question about health care reform that you'd like to see answered? Then send it to The Eagle-Tribune. E-mail your question to kjohnson@eagletribune.com with the words "Question on health care reform" in the subject line. Or mail your question to: Ken Johnson, The Eagle-Tribune, 100 Turnpike St., North Andover, MA, 01845.