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Why immigrants get short shrift on health reform

By Suzy Khimm

President Obama’s health law has brought the Democrats closer than ever to achieving their dream of universal coverage, with their plan predicted to insure some 95 percent of Americans who are legally in the country. But even if everything goes according to plan, there will still be
some who will face major barriers to accessing coverage -- including groups that the Affordable Care Act goes out of its way to exclude.

As the AP points out today, there are about 7 million unauthorized immigrants who will be prohibited from buying insurance on the newly created exchanges, even if they pay out of their own pocket. And the exclusion of this group from health reform -- along with other restrictions that affect fully legal immigrants as well -- could create a massive coverage gap that puts a strain on the rest of the health system as well.

Immigrants-rights advocates tried to prevent this scenario from happening. But amid all the politicking and deal-making that shaped the final phase of the health reform debate, they ended up losing a number of key battles. Unauthorized immigrants were never going to receive government subsidies to buy insurance, but the House bill tacitly allowed them to access the exchanges by not making insurance plans contingent on citizenship status. When it became clear that the Senate bill was going to include the prohibition, due to the intense political pressure from conservative and moderate members, the White House quieted a potential revolt from Hispanic lawmakers by promising to move forward on comprehensive immigration reform after health-care reform passed.

But since the passage of the bill -- which ended up preserving the Senate’s restrictions on the exchanges -- it’s become increasingly clear that the White House and Democratic leadership are unlikely to take up immigration reform anytime soon. And there were smaller, less prominent health reform battles that immigrant advocates lost as well. Democratic leaders had indicated that they’d include an amendment that would lift an onerous five-year waiting period that legal, fully naturalized, tax-paying immigrants must ensure before receiving Medicaid benefits. But highly politicized battles like the abortion fight sucked all the oxygen out of the room, and the provision was ultimately left by the wayside.

Facing such restrictions, both legal and unauthorized immigrants will have to find alternative means to find health care. Fortunately, as the AP explains, the law does inject some $11 billion in new support for community health centers, which target immigrants among other underserved groups. But such a limited safety net can only go so far. And continuing to exclude a major, growing segment of the country’s population from the health-care system could ultimately have major costs.

By leaving unauthorized immigrants out of the exchange, the health law excludes a group that tends to be younger -- and typically healthier -- than average, which would have helped lower premiums for everyone else in the pool. What’s more, the exchange’s citizenship verification requirements could end up deterring the young and legal immigrants who are qualified from enrolling in it, as happened with Medicaid after such restrictions were imposed in 2005.

Without access to affordable coverage, both legal and unauthorized immigrants will continue to resort to measures like costly emergency room visits, which state governments end up subsidizing. Conservatives frequently warn that providing benefits to immigrants would encourage
them to flood the country and sponge off U.S. taxpayers; excluding them from health reform will impose an even bigger cost on the system.

Suzy Khimm is a journalist who covered health-care reform at the
New Republic and is now a political reporter at Mother Jones.

By Washington Post editor  |  April 5, 2010; 2:20 PM ET
Categories:  Health Reform , Immigration  
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It's really a rather sad reflection on our society that the moderate position was to pointlessly inflict suffering on ourselves just to make sure that immigrants feel the pain.

Posted by: theamazingjex | April 5, 2010 2:46 PM | Report abuse

This actually caught me by surprise. Here, all along I've been thinking that immigrants would at least have purchasing power on the exchanges. Gah and double-gah.

It does make you question what the anti-immigrant crowd thinks they achieve by barring paying, non-subsidized customers from the exchanges. They're here already, they theoritically have money to purchase policies, and they'll turn up in emergency rooms eventually. We might as well skim some money from them for care. It is a triumph of politics over policy.

Posted by: strawman | April 5, 2010 2:55 PM | Report abuse

The solution is not to allow illegal immigrants to access the exchanges but to legalize the otherwise law abiding immigrants now and to deport all criminal aliens. The implementation of a biometric social security card will make it very difficult to work without authorization and that will curb future illegal immigration.
Any politician, Democrat or Republican, who oppose immigration reform in 2010, or sit on the sideline will be punished hard at the polls in November and beyond.

Posted by: mehuwss | April 5, 2010 2:57 PM | Report abuse

Actually almost all immigrants, legal and illegal, are fully covered by single payer health care plans in their countries of origin. They can easily take advantage of this coverage by returning home. I know of no organized efforts to stop them from doing so. Alternatively, their home countries could agree to pay for their health care while they are in the United States (which provides at least partial medicare payments for retired expatriates). Either way, the health care benifits provided to illegal immigrents with my tax dollars should not exceed the cost of a one way airline ticket home.

Posted by: WoodbridgeVa1 | April 5, 2010 3:01 PM | Report abuse

How is this in the least surprising?

Remember the State of the Union? Remember Joe Wilson (R - Racismland) yelling, "You lie!" What do you think Wilson was talking about with that line?

The very thought of a brown skinned person with an accent being able to spend their own money on health care caused America's right wing to implode in a massive rage-gasm. Joe Wison's outburst being only the most widely reported of such angry right-wing outbursts.

Ironically, the only people who will be able to get a free ride on the government after the HCR legislation is fully operational is illegal aliens. And for that the illegals can thank the people who hate them the most.

Posted by: nisleib | April 5, 2010 3:05 PM | Report abuse


you do realize we've gone through "legalizations of illegals" before right? I'd like to think a biometric card would keep out future illegals but I'm not that naive. Its like baseball players using PED's. If they want to bad enough they'll find a way.

Posted by: visionbrkr | April 5, 2010 3:09 PM | Report abuse

Oh, please. I read this column regularly because it is blissfully bereft of sloganeering. Not today.

Though I agree entirely with your point, you lose every shred of credibility through the use of the phrase "both legal and unauthorized immigrants." Non-loaded, semi-responsible language, such as "both legal and illegal" or "both authorized and unauthorized", would both make your point adequately without being childish. Why can't Maureen Dowd stay confined to her own embarrassing column? What's next -- are we going to call the GOP "Republitards" and think that that adds "punch" to our argument?

I'm sick of people whose point I agree with ruining, by using terms of propaganda, the chances of ever making that point persuasively to someone other than a true believer.

Posted by: afaf1 | April 5, 2010 3:11 PM | Report abuse

Last week, the snake Senator Bob Menendez, NJ, told the Star Ledger that he had urged Obama to enact immigration reform in November AFTER the midterm elections. Virtually all analysts agree that the Democrats will lose congressional seats in November which will make immigration reform all but impossible. It is not the first time Menendez helps kill immigration reform. In 2007 he supported poison pill amendments that he knew were deal killers for many Republicans and "Conservadems". Obama talks a good game, but has shown no leadership on immigration reform. His betrayal and failure will not be forgotten.

Posted by: mehuwss | April 5, 2010 3:16 PM | Report abuse

I don't think Ms. Khimm is accurate in stating that "fully naturalized" immigrants are subject to a five-year waiting period for Medicaire benefits. Naturalized immigrants are citizens.

Posted by: cxkinbote | April 5, 2010 3:28 PM | Report abuse

Suzy: What statistics can you quote that support your argument? Don't you think that if healthcare was available to eveyone, legal or not, that it would encourage more illegals to come to America? Come on, we need to secure our borders to reduce costs and put more legals to work!



Posted by: my4653 | April 5, 2010 3:34 PM | Report abuse

"an amendment that would lift an onerous five-year waiting period that legal, fully naturalized, tax-paying immigrants must ensure before receiving Medicaid benefits."

1) there's a difference between an alien and an immigrant. My father is an immigrant, but not an alien (he was naturalized).

2) The Medicaid 5-year bar applies to legal (or documented) aliens, among others (PRUCOLS, etc.) It does not apply to naturalized _citizens_.

3) The CHIP authorization that passed in early 2009 granted Medicaid eligibility for 5-year barred children - the remaining 5-year bar mostly (entirely?) applies to adults.

Posted by: AronB | April 5, 2010 3:34 PM | Report abuse

The paper social security card that can be bought on the street is not enough to prevent illegal immigrants form finding work. The new, biometric tamper-proof technology is a game changer. If they cannot work here, they will stay home.

Posted by: mehuwss | April 5, 2010 3:36 PM | Report abuse

Have these folks not heard of communicable diseases? Considering how many recent immigrants, lawful or otherwise, work in occupations such as reataurants and child care where they come into contact with US citizens, and have children in the public schools, excluding them from health care services is spiting ourselves in addition to being inhumane. Particularly considering how many countries with superior health care would treat US travelers for free. We are really a peculiar people.

Posted by: Mimikatz | April 5, 2010 3:52 PM | Report abuse

WoodbridgeVa - you are incorrect that most immigrants are covered by universal care in their countries of origin. Mexico, which is the largest source of immigrants to the U.S., does NOT have universal coverage. China, the second largest sending country, also does not. I would stay out of health policy, if I were you.

Per my recollection of health reform, permanent residents will still be subject to the 5-year bar for Medicaid eligibility, although they will receive subsidies to purchase insurance on the exchanges. States, however, may choose to cover permanent resident children in SCHIP and receive federal matching funds. A lot of states will think - wrongly - that families sponsoring immigrants are required to provide health insurance (sponsors must maintain their spouses or children at 125% of poverty, but a lot of people at this income level don't have health insurance). I know that Utah debated whether to extend CHIP coverage to permanent residents and voted it down - which is unconscionable.

Posted by: weiwentg | April 5, 2010 3:57 PM | Report abuse

Since the exchanges won't even be in existence for another four years, what's the rush, seriously? From a political standpoint, a little distance from the HCR lies and distortions will only make it easier to address this issue in immigration reform legislation.

Posted by: Jaycal | April 5, 2010 4:00 PM | Report abuse

"Unauthorized immigrant." I like that. I think I'll start referring to DWI's as "unauthorized imbibers" or tax cheats (Hi Geithner and Daschle!) as "unauthorized income with-holders." Bank robbers can be "unauthorized cash with-drawers." The possibilities are endless!

Posted by: sgaliger | April 5, 2010 4:20 PM | Report abuse

This "editorial" reeks of a very one-sided attempt to push an increasingly unpopular agenda on the American people.

For starters, the simple virtue of the fact that our pamphleteer attempts to muddy the water between "immigrants" and "illegal aliens" should set the alarm bells ringing.

The dishonesty of this piece, however, shouldn't be any more shocking for those of us who are being bombarded daily by special interest media attempting to push their agenda down America's throat, making liberal use of this paper as one of their many mouthpieces. "7 million unauthorized immigrants"? Does anybody in America still actually believe their are "7 million unauthorized immigrants (pro-Amnesty speak for illegal aliens)" when most modern estimates put the number well in excess of 20 million?

Clearly, this poorly-written propaganda piece is a canard in every sense of the word.

Posted by: a_concerned_uhmerikan | April 5, 2010 4:28 PM | Report abuse

I'm one of those liberals who thinks that laws ought to be enforced. Illegal is illegal and I tend to agree with WoodbridgeVa about them returning to their country of origin if they want health care. If I were an illegal I don't think I would have the balls to demand that the country I am in illegally cover my medical expenses or offer me health insurance.

Posted by: LiberalForReal | April 5, 2010 5:23 PM | Report abuse

"If I were an illegal I don't think I would have the b---s to demand that the country I am in illegally cover my medical expenses or offer me health insurance."

With all due respect, it was not suggested that anyone who is here illegally receive one penny in subsidies. Since the subsidies come in form of Federal income tax credits, that would not be possible anyway for any one who is not a federal taxpayer.

What was suggested is that undocumented workers be allowed to participate in purchasing insurance in the exchanges. Just like they can buy a loaf of bread...should we also deny them food as well medical care? As long as they can buy the product at full price, and then be covered in case of accident or illness, what's the harm? How is it better for the citizens if an undocumented alien becomes severely ill or has an accident, and then comes to the emergency room at the expense of everyone else? If an illegal alien can afford to buy insurance, why deny that additional revenue to the insurance companies and thereby increase costs to citizens? What good does it do anyone to prevent anyone else from providing for their own health care needs?

Read the final two paragraphs of Ms. Khimm's posting.

Posted by: Patrick_M | April 5, 2010 6:42 PM | Report abuse

I think that preventative care for kids, immunizations and prenatal care would save us all money in the long run.

Your arguments make a lot of sense.

I also think that someone must be monitoring these comments, because I don't see all the Hate Speech, for once, Thank-God.

Posted by: celestun100 | April 5, 2010 7:51 PM | Report abuse

Health care is only one of the many many costs associated with "Illegals". As for the "only 7 million"! How about at least double that! You have to look at all the costs! SSI for Anchor Babies, education for all illegal children, Food stamps and a host of other costs.
One thing many forgot, we have had 8 amnesties since 1986! None have stopped the flow of million of illegals since then!
Then look at the simple fact of "Chain Immigration" or as Hillary prefers "family unification" which was Ted Kennedy's 1965 bill that allows EACH green card holder or legalized immigrant to sponsor or bring in their entire family who inturn sponsors theirs. Thus the "chain" So to say YES to one illegal now means saying YES to an average of 84 family members of that one illegal. Can we afford that! Answer! NO
it is all in the math and Obama as well as Bush try and tried to sell us on looking at just the 7 million. Yet all reports say there are at a min. 11 million!

Posted by: usmc1969 | April 5, 2010 9:46 PM | Report abuse

For the record it is not Hate Speech! It is reality! We can not afford illegals. We allow 1.5 million to come into the USofA annually the RIGHT WAY! Over 20 million did it the WRONG WAY! Just simple facts!
The vast majority of the 20 million never completed high school. A quick look at California says it all!

Posted by: usmc1969 | April 5, 2010 10:25 PM | Report abuse


We get the fact you want to end illegal immigration. But that is not the topic being discussed.

For the non-citizens that are already here, does it make sense for them to bear their own costs for health care by allowing them to buy their own private health insurance policies on the exchanges (using their own money)?

Or is there some reason we are better off prohibiting them from having their own policies (so that the rest of us will bear the costs when they inevitably need treatment)?

For what reason is it better to prevent non-citizens already living in this country from being insured?

Posted by: Patrick_M | April 5, 2010 11:25 PM | Report abuse


Did you actually read the post (or the comments)?

We get the fact you are unopposed to benefits for legal immigrant citizens. But that is not the topic being discussed.

For the non-citizens that are already here, does it make sense for them to bear their own costs for health care by allowing them to buy their own private health insurance policies on the exchanges (using their own money)?

Or is there some reason we are better off prohibiting them from having their own policies (so that the rest of us will bear the costs when they inevitably need treatment)?

For what reason is it better to prevent non-citizens already living in this country from being insured?

Posted by: Patrick_M | April 6, 2010 2:58 AM | Report abuse

Nice ghoulish article … very fitting for the season and impressively damn interesting.

Posted by: estherrolle06 | April 6, 2010 4:07 AM | Report abuse

"and impressively damn interesting"


just the usual off-topic troll spam, and not interesting at all.

Posted by: Patrick_M | April 6, 2010 4:33 AM | Report abuse

Why is Suzy writing for Ezra. Could Ezra not come up with his own liberal drivel on immigration? Suzy, amnesty is always the liberal answer to illegal immigration. As you know we couldn't possibly enforce the laws. I often wondered liberals, what if there comes a day when 7 million or more tea party (or baggers as you like to giggly call them in your girlish titter) decide not to pay taxes? I would bet that you would find a way to enforce that law--Nancy Harry and Obama would find a way. But we are powerless in the face of illegal immigration... That is bull excrement. And the point of this article is excrement too. Illegal aliens aren't going to join an insurance pool. Medicaid works just fine for them. They aren't stupid like you guys.

Posted by: RedStater3 | April 6, 2010 6:56 AM | Report abuse

Somebody above stated that Mexico doesnt have guaranteed public healthcare, and then posted a wikipedia link. Did they even bother to read it? Here's a quote:

"Public health care is provided to all Mexican citizens as guaranteed via Article 4 of the Constitution."

So it is indeed true that every Mexican citizen living in the USA is eligible for guaranteed public healthcare in Mexico. Whether that public healthcare is any good is another debate entirely.

Posted by: platon201 | April 6, 2010 8:08 AM | Report abuse
What is the argument here? every single alien "BROKE THE LAW!" Our Government, past & present, Republican & Democrat, have allowed the invasion of 20 to 30 million criminals and uneducated peons which is the largest invasion of any Nation, at any time, by any means & in direct violation of Article IV, Section IV of our Constitution.

This refusal to abide by our Constitution or enforce our Immigration Laws should be classified as Treason of the most foul kind, & as grounds for impeachment & trials for Treason!

Not only have they allowed the invasion, they force American tax payers to pay Billions on Billions of dollars to provide Welfare, Prison cells, Educate the invaders numerous children, and free medical care, at the same time the invading horde break numerous laws and massive document fraud, & are destroying our schools, hospitals, communities, culture and standard of living while Robbing, Raping, Killing & Assaulting American Citizens WAKE UP PEOPLE!

Posted by: pyrostevo | April 6, 2010 9:23 AM | Report abuse

mehuwss wrote:

"Obama talks a good game, but has shown no leadership on immigration reform. His betrayal and failure will not be forgotten."

Oh please. Liberals haven't abandoned Obama over the public option. The won't abandon him over this. Obama is actually smart to stay away from immigration reform. It's a loser for Democrats.

Posted by: dcdude1 | April 6, 2010 1:50 PM | Report abuse

"Either way, the health care benifits provided to illegal immigrents with my tax dollars should not exceed the cost of a one way airline ticket home."

And yet the cost to you of having a legal workforce with a living wage would make you pout and whine. Can't have it both ways, wingnut.

Susie would do well to be more precise in her terminology, but her main point still stands -- Congress is happy to stick it, once more, to immigrants who come to the US 'the right way'. Since they can't vote, they're an easy target.

Posted by: pseudonymousinnc | April 6, 2010 3:19 PM | Report abuse

I feel quite sorry for Suzy Khimm. She obviously did not receive a proper education, or she would understand the difference between "unauthorized" and "illegal." This distinction seems to afflict many of the liberal establishment, who never met a criminal they didn't love.

Posted by: Ogman | April 6, 2010 4:32 PM | Report abuse

Contact me for a free home and flood insurance coverage quote

Posted by: jameslinda07 | April 7, 2010 6:46 AM | Report abuse

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