The coverage of legal and illegal immigrants under the health reform legislation is now a prominent and contentious issue. Although a difficult issue for many, it has not been seen as an issue that would derail health reform until now. Many Hispanic community advocates initially tried to keep health reform and immigration, their two key issues, on separate tracks. However, they now believe this may have been a misguided strategy and are now actively engaged in the debate, arguing that health care reform is not taking into account the special needs of the Hispanic community. The Congressional Hispanic Caucus is increasingly vocal and adamant on what they want, and do not want, in any health care legislation.
Republican criticism following the President's speech on health reform before a joint session of Congress led President Obama and the Democrats on the Senate Finance Committee to conclude that a strong position on limiting access of illegal immigrants to any newly-created health care benefits is needed. As a result, the Senate Finance Committee bill precludes illegal immigrants from purchasing private insurance with their own money and precludes government subsidies on the newly-created federal exchange, a position supported by President Obama. The bill released by Sen. Reid maintains this prohibition and requires the Secretary to establish a program for determining whether a person is a US citizen or national or an alien lawfully present in the US.
The health care bill passed by the House is silent on the issue, but as there is no specific exclusion or eligibility requirements, the assumption is that illegal immigrants can purchase insurance on a newly created federal exchange with their own money and without government subsidies.
Proponents of access for illegal immigrants to the exchange argue that any indirect subsidy, because government money is used to establish the exchange, is so small that it would not amount to any significant benefit. Also, they say the cost of precluding access is very high and certainly greater than any possible indirect benefit. Without insurance, they argue that society pays the costs of health care for the uninsured and that verification of citizenship is expensive and would impose burdens on citizens as well. Opponents, on the other hand, argue that health care is being hijacked by the immigration issue and that anyone can purchase insurance on the open market.
There are some immigration issues that are widely supported by both sides. There is a widespread consensus that illegal immigrants should not get any federal subsidies or participate in any public option. Also, both bills provide that legal immigrants are eligible for government subsidies and can purchase insurance on the exchange. However, even here, there is debate over whether legal immigrants should be required to wait 5 years to be eligible for Medicaid, as is required under current law.
These issues will surface on the Senate floor and again in conference, and they will present a serious political hurdle.
Prepared by Tovah LaDier and Darryl Drevna, Bryan Cave
