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Think Tank

Assessing Health Care Impacts of Reforms for Immigrants

With the national debate turning from health reform to immigration reform, health policy experts, immigrants and immigrant rights organizations are assessing the health care impacts of one sweeping reform already signed into law and the potential impacts of the next one.

In California, where the immigrant population is large and growing, the ramifications of both reform efforts are particularly significant. In some parts of California, immigrants are almost as numerous as those who are native born.  According to the 2000 census, foreign-born residents accounted for 40.9% of the population of Los Angeles. That number could be higher in the 2010 census.

The new health care reform law specifies that documented immigrants and naturalized citizens will have the same access to affordable health insurance as U.S.-born citizens in the new insurance exchanges. As will all citizens, immigrants have health insurance or pay a tax penalty if they fail to secure it. They can apply for tax credits to help pay for health insurance or they can apply for an exemption from the requirement if health insurance remains unaffordable.

Many lawfully present immigrants will remain ineligible or be required to wait years to enroll in Medi-Cal, California’s federally subsidized Medicaid program. While they can buy health insurance and apply for tax credits in insurance exchanges, this option may still be unaffordable for low-income immigrant families.  

Undocumented immigrants — children, as well as adults — are not recognized in any way in the health care reform law. Undocumented immigrants are not eligible for federal health care programs, nor are they eligible for coverage through insurance exchanges.  Undocumented immigrants cannot legally buy health insurance even with their own money.

We asked experts to consider two questions:

How will the new health care law affect immigrants in California? How might immigration reform affect health care for immigrants in California?

We got responses from:

Immigrant Inclusion: California's Health Depends on It

California’s future depends on ensuring that immigrants have access to affordable health care. Although the recently enacted health care reform law marks a first step toward addressing this broken system, it fails to address the needs of many immigrants who live with citizens in families and communities and whose contributions remain critical to the state’s economy.  California must address these gaps, to achieve health care reform’s ultimate goal:  the health and economic security of the state’s families.

Under the new health reform law, lawfully present immigrants will be able to buy health insurance in the new state insurance exchange, apply for premium tax credits, enroll in the new high-risk pool (covering persons with pre-existing medical conditions) or keep the coverage they have today.  In turn, they will be subject to the individual mandate, requiring most Californians to purchase health insurance or face a tax penalty.  Unfortunately, many low-income immigrants remain ineligible for the most affordable federal health coverage, Medi-Cal, California’s Medicaid program. 

For more than a decade, California has covered lawfully residing immigrants through Medi-Cal and Healthy Families, California’s version of the federally subsidized Children’s Health Insurance Program. California recognized that it is more cost-effective to provide preventive care than to wait until simple problems become emergencies.  

The health care reform law prohibits undocumented immigrants from purchasing health insurance at full cost in the state insurance exchange. Although undocumented immigrants are not subject to the individual mandate, preventing them from buying health insurance does not eliminate their need for care.  This short-sighted policy, which forces families to forego or delay care, will cost more in the long run.  Including this population, which is generally younger and healthier than citizens, in the insurance pool would help spread the risk and make health insurance more affordable for everyone.  In order to enforce this exclusion, everyone who seeks to buy coverage, including citizens, will be obligated to prove their status, creating additional layers of red tape and costs.

Immigrants represent a vital component of the state’s economic engine and social fabric. California must demonstrate leadership in addressing the coverage gaps that affect a large number of its residents. Doing so will reduce the overall health care costs and will ensure that our communities remain healthy and strong.  We should also remind our representatives in Washington that more work is needed to ensure that all Californians have the opportunity to grow and thrive in our great state.

Path to Legalization Is Path to Health Care Access

The historic passage of health care reform is an event those of us in California’s health care community have been eagerly awaiting for many years. As the health home to the state’s uninsured and underserved populations, California’s clinics and health centers are as enthusiastic as any provider when it comes to monumental coverage expansions. And yet, for all the excitement, there remains a glaring hole in the final reform package.  Undocumented immigrants are forbidden from participating equitably in America’s new health care system.  And even those here legally, but who have not been in the U.S. long enough, continue to be barred from public health care coverage programs.

Coverage for immigrants was ultimately removed from the health care reform package because it threatened to derail reform entirely.  Immigration reform offers the opportunity of rectifying the gap unaddressed by health care reform, and there is already national momentum.  The Obama administration has committed to pursuing immigration reform and is now even more keenly attentive after Arizona recently passed immigration legislation that allows authorities to ask anyone for documentation that proves they’re in the state legally. The Obama administration has called the new law “misguided” and “irresponsible.”

Immigration reform offers an opportunity to address longstanding, inequitable laws that block access to health care services for millions of Californians based solely on their immigration status.

For clinics and health centers in California, immigration issues are inextricably connected to health care. Nationally, only American citizens and generally those who have been in the country legally for more than five years can make use of comprehensive public health care services.  Therefore, providing a path to legalization will provide a path to health care access.  We have an opportunity to fix what we all agree is broken and fill the gap left unsolved by health care reform. 

Immigrant Health Key to California's Prosperity

Comprehensive immigration reform will allow California’s immigrants to stay healthy, to contribute even more to our economy and to participate more fully in our society. Immigrants are an integral fabric in our society and need the opportunity to stay healthy for California to reach its full potential and prosper.

Our country was founded by immigrants, built by immigrants and supported by immigrants. According to a report by the California Immigrant Policy Center, “Looking Forward: Immigrant Contributions to the Golden State,” immigrants not only make up the majority of our farming, maintenance and production work force but they are also the founders of technology giants such as Google, Sun Microsystems, Yahoo! and eBay. Their spending and tax contributions help support our economy — with immigrants in California making up a combined federal tax contribution of more than $30 billion annually.

Providing immigrants with a path to citizenship through comprehensive immigration reform will benefit everyone. Under the new health care reform law, undocumented immigrants are not able to buy health insurance from a state health insurance exchange, even with their own money. This is not only discriminatory policy, it is bad policy. Insurance only works well if there is a large pool, where risk is shared among many people. By closing the health exchange to a certain population — a generally healthy population of over one million people — we have lost an opportunity to increase purchasing power and further bring down cost. As more undocumented immigrants have the opportunity to become citizens, the health insurance exchange will become more effective.

Lawful immigrants in California will enjoy all of the benefits of health care reform. Health insurers will no longer be able to deny coverage for pre-existing conditions or drop it when they get sick and need it most. Immigrants on Medicare will get rebates on drugs and free preventive care. With the passage of comprehensive immigration reform, more Californians will be able to get affordable, comprehensive health coverage, enabling them to receive preventive care and avoid serious illness — a much more effective use of our public dollars.

Finally, immigrants will continue to have access to care as a result of the increased funding to California’s community health centers, and they may benefit from the new tax credits to small business to help provide coverage for their employees. The new health care law also promotes healthy living through worksite wellness programs and community grants to improve access to healthy foods and physical activity.

Millions of Californians, including immigrants, will benefit from health reform. Comprehensive immigration reform with a path to citizenship will increase benefits for all Californians — increasing our purchasing power in the health insurance exchange and using our public funds more effectively. With both reforms in place, all Californians can stay healthy and fully contribute to California’s economy and productivity.

Immigration Will Drive Up Health Care Costs

Sensible health care reform is urgently needed. The new health care legislation is a fiscal disaster, mainly impacting middle-class American taxpayers and our children.

Waste in our health care system could be as high as $850 billion annually, according to a Thomson Reuters report released last October. Not only has this waste not been cut, immigration — another major factor to substantial increases in health care costs — has not been seriously addressed under the new health care law. Furthermore, the pro-amnesty push by President Obama and his allies in Congress will further drive up the overall health care costs.

According to the March, 2007 Current Population Survey conducted by the U.S. Census Bureau, about one-third of all foreign-born people — documented and undocumented — lack health insurance. Immigrants and their U.S.-born children under 18 accounted for nearly one-third of all people in the U.S. without health insurance and more than 70% of the growth of the uninsured population in the U.S., according to the census report.  The new health care law states it will not cover people illegally in the U.S., but does not require that a person’s immigration status to be verified. So how do we know if a person is illegally here?

By law, undocumented immigrants can continue to go to emergency rooms to seek non-emergency care at the expense of American taxpayers. Non-citizen documented  immigrants will be covered under the new health care legislation, which essentially subsidizes low-income immigrant families as well as U.S. citizens. The worst may yet to come with ever-increasing immigration.

Every year, one million documented  immigrants, at least half a million undocumented immigrants and hundreds of thousands of professional and “guest workers” continue to enter the U.S.  These newcomers and their U.S.-born children will also need health care, in addition to jobs, education and other social services. Instead of enacting some sort of immigration moratorium so that we have a chance to address health care and many other problems, President Obama promotes amnesty for possibly more than 20 million illegal migrants.