Cover the Uninsured, but Not the Undocumented?

By Michelle Chen Jul 31, 2009

The recent jury decision supporting the deportation of Luis Jimenez illustrates a chilling dilemma in the healthcare system. Jimenez, a former laborer left paralyzed and brain damaged by a car accident, was discharged to his native Guatemala because his Florida hospital believed it was in his best interest to be deported, as there were apparently no other options for long-term care. Whether or not it was wise to send Jimenez back, the best interest of millions of undocumented immigrants has been carefully ignored in the health care reform debate. The taboo surrounding “illegals” means that any serious consideration of including undocumented immigrant in health care reform is political contraband. But Christopher Beam at Slate parses the price of exclusion and argues that the rationale behind insuring the undocumented follows the logic of insuring the very poor—it’s simply more expensive to do nothing.

The case for insuring illegals is simple. Society already pays the price for treating them. But it pays in the least efficient way. When someone who doesn’t have insurance shows up at a hospital with a bronchial infection, doctors are required by federal law to treat him or her. The hospital then passes on those costs to the rest of us in the form of higher prices for other patients, which leads to higher insurance premiums and, in the cases of Medicaid and Medicare, higher taxes. Better to insure those patients so that they can go to a doctor at the first signs of illness—not when they start coughing up blood.

Yet in terms of the political price, the undocumented may be one of the few groups for whom unsustainable public health care costs are used to justify the shrinkage, not expansion, of services. In California and Massachusetts, officials are anxiously slicing the undocumented out of public health services to paper over budget gaps. The emerging House healthcare reform proposal explicitly excludes undocumented immigrants, and some are even want to squeeze out legal residents. Although the Congressional Budget Office has not accounted for the cost of insuring undocumented immigrants in its latest health care reform analyses, a 2007 CBO report states that “more than 15,000 health care providers have registered for payments” throuh a program that reimburses the cost of emergency care for undocumented immigrants, and that “the total awards allocated to states have increased each quarter.” These numbers might be spun as a pretext for clamping down harder on illegal immigration. But to others, such as the Coalition for Immigrant Equity in Health Care, they make the case for a system of care based on realistic assumptions about the cost of covering everyone. Yet this concept amounts to barely a footnote in the debate over healthcare reform, especially as lobbyists and centrist lawmakers work to neuter it. President Obama has admonished that the government simply can’t “reward” people for the country’s failure to provide a reasonable path to legalization.

undocumented workers who are here illegally — we want to create comprehensive immigration reform so they can get on a path to citizenship. Until they do, we can’t reward them with some of the benefits which quite frankly cost us a lot of money.

This omission is no error. It reinforces the political consensus in Washington that to be unauthorized is to be less than human. Whatever healthcare reform plan ultimately arises from the political horsetrade, it will almost surely perpetuate a distorted standard for “universal”–under which hospitals would opt to ship the sick out of the country rather than carry out a commitment to a human right. Image: Josh Haner / The New York Times