Immigration + Health Care = Run Away

by Tim Foley

categories: Obama and Congress, The Uninsured and Underinsured

Published May 25, 2009 @ 10:10PM PT

I’m prompted by both a post by my fellow blogger-editor Dave Benion (“Three Public Health Care Reasons to Pass Immigration Reform”) and by recent comments by Sen. Max Baucus to bring up an obvious if ugly political fact.  There are many, many reasons why quality, affordable health care for all should include both undocumented workers and legal immigrants, both out of public health and economic self-interest, to say nothing of humanitarian concerns.  Dave’s post points out three of them.  But we know without a doubt that the same people willing to take on the right-wing noise machine when it comes to health care are going to duck the fight when it comes to including everyone in America.  In this as in so much else, immigrants are considered expendable for the sake of expediency.

To be clear, it has nothing to do with your documented status, or whether you’re here legally or illegally.  We’re backbone-deprived when it comes to both sets of immigrants. When SCHIP was reauthorized this year, it included an expansion that removed the 5 year waiting period for immigrants who were here legally to access the program.  Why on earth was that waiting period there in the first place?  These are folks who have visas or green cards and all the proper documentation, who are paying taxes, and have played by the rules.  Why a 5 year waiting period on them?

Sen. Ensign from Nevada was most elucidating in his explanation: “It would seem to me that we are giving more incentives for folks to come to the United States, not just to participate in the American dream, but to get on the government dole.”  Now this drivel does not at all describe the experience of most legal immigrants.  Either they have a work visa – in which case, someone is here explicitly to work full time for a specific job – or they’re a permanent resident through employment, a family member who has legal standing, or after winning a lottery.  There are a million reasons why they might want to start their life anew in this country.  But they’re not coming here specifically to be uninsured and be taken care of.  If they were, they’d be sorely disappointed:  of the 46 million+ who are uninsured, 80% represent families where at least one person works full time, but just doesn’t receive benefits from their employer.  In a majority of states, those working adults receive nothing, no matter what their residency status.  If they’re lucky, their kids get coverage.  That’s it.

Sen. Ensign’s comments only make sense if you’re prepared to believe that all immigrants – all immigrants – are here solely to mooch off your hard-earned, red-blooded tax dollars.  It is the latest manifestation of a decades long attempt to paint anyone who takes government assistance, be it Medicaid, welfare, SCHIP or public housing vouchers, as inherently other, an underclass whose poverty is their own fault, and whose very acceptance of help is cause to suspect them as a waste, a fraud, an abuser of public funds.  Guilt by association and the Protestant work ethic, which presumes lack of success implies sinfulness, are alive and well.

So we find ways of means-testing them for Medicaid.  We find ways to exclude them for SCHIP unless they’re what Reps. Boehner and Cantor called, “Only… certain legal residents,” implying that if you came here as a humanitarian refugee, that’s OK, but if you came here as anything else, you came here for a hand-out.

Let me put this another way.  For ten years, our members of Congress and our Presidents from both parties told us it was intolerable for kids to have to go to the emergency room for asthma attacks… unless they weren’t born here.  Then it was OK.

So no, it didn’t surprise me to hear that Sen. Baucus declared, point-blank, “[w]e're not going to cover undocumented workers. That's too politically explosive.”  Nor did it surprise me that the best he could come up with for what would happen when those families got sick or injured was, “There will still be charity care.”

Uncompensated care via the emergency room is, of course, not just the most expensive way to treat anything, it’s also a preventable cost that gets paid by all of us.  You know how I know?  Max Baucus told me, when he said in his white paper, “Today, the costs of care for 46 million Americans without health insurance are largely borne by those with insurance; providers charge higher prices to patients with private coverage to make up for uncompensated care, and these costs are passed along to consumers in the form of increased premiums.  The cost of that uncompensated care is also unnecessarily inflated because patients without insurance often wait to receive care until they have to go to the emergency room.  Requiring all Americans to have health coverage will help end the shifting of costs of the uninsured to the insured.”

Talk about cutting off your economic nose to spite your fearful face.

Republicans know there’s power in making people feel like they’re being cheated – they’ve been getting elected off chimeras like welfare queens and the threat of illegal immigrants “stealing” American jobs for decades.  Democrats know it too… which is why once again, they’ll run away.

(Photo credit:  Korean Resource Center on Flickr.)