Even after the Patient Protection and Affordable Care Act is fully implemented in 2019, about 23 million Americans will remain uninsured. About one-third of these will be undocumented immigrants, according to estimates by the Congressional Budget Office.
This is by design. Illegal immigrants will not be permitted to buy insurance through government-run exchanges even if they pay with their own money. They will not get federal subsidies to buy insurance and will remain ineligible for Medicaid and Medicare; and even legal immigrants will have to endure a five-year waiting period before they can sign up for Medicaid.
During the health reform debate, there was not political space to compromise on any of these elements. (Remember Joe Wilson?) As a result, the Congressional Hispanic Caucus at times seemed ready to sink the legislation. But according to a good piece in Politico today, the caucus backed down because they were assured by congressional Democratic leaders and/or the White House that their health care priorities would be addressed as part of immigration reform.
Reports Politico’s Carrie Budoff Brown:
They signed on only after receiving assurances that their concerns would be rectified as part of the immigration reform battle, according to lawmakers, advocates and Hill aides.
“The expectation was that everybody knew it was unfair and that a new immigration bill would correct that,” Rep. Raul Grijalva (D-Ariz.) told POLITICO.
Asked at what level he received such signals, Grijalva said: “High enough to feel secure about it.”
It stands to reason that if comprehensive immigration reform really happens – this is far from a certainty – there could be a pathway for this population to join the ranks of the insured. After all, if immigration reform transformed undocumented immigrants into documented ones, everything could change. If these people were made legal residents or even citizens – just a hypothetical – they would most likely be able to get insurance. Whether that would be government-subsidized or include public insurance programs is less certain.
But Budoff Brown smartly points out yet another landmine for those in Congress pursuing immigration reform. What will Rep. Wilson have to say about this?
I should also note that the uninsured illegal immigrant population already has many folks worried about the future, from hospitals along the border, which will still have to treat uninsured illegal immigrants, to policy folks who would rather see this population included in risk pools. (Despite rhetoric that illegal immigrants come to the U.S to take advantage of free health care, surveys indicate that these people are younger – and therefore healthier – than the average American and use the system less. The exception is for hospitalization due to childbirth, where rates are higher among illegal immigrants than citizens.)
In addition, the same stresses that uninsured citizens put on the U.S. health care system exist from the uninsured non-citizen population. Emergency room crowding, poor management of ongoing chronic diseases that can cost more if left untreated, etc. Many health care system experts argue it’s good policy to insure illegal immigrants – that it actually saves more money than it costs and indirectly improves the health of legal citizens. Of course, no one is arguing that it’s good politics.