Part I: Benefits for Illegal Immigrants: What Congress Won’t Admit
“The truth is, there’s no plan that has ever been considered under health care reform in Congress that covers illegal immigrants. Nobody has proposed that. And yet, a huge percentage believe that that’s the case. So, anybody listening right now, let’s dispel that myth.”
– President Barack Obama, August 20, 2009
Christmas is over. We know about the gifts tucked into H.R. 3590, the Senate health care bill, including Ben Nelson’s $100 million Medicaid deal, Patrick Leahy’s $600 million Medicaid deal, and Chris Dodd’s $100 million hospital. The New Year will doubtless bring us even more costly add-ons when the House and Senate negotiate a synthesis of their legislation.
A mysterious $100 million hospital makes for good news, but the media is ignoring the giveaways that are really going to cost us. Issues like federal funding for abortions are the stuff of flashy headlines, but when the coffers are drained we will wonder why we did not pay more attention to the provisions that will quietly sink our ship while we are vexing over other things.
It is hard to conceive of a presidential campaign speech that does not include the words “fraud” and “abuse.” Both candidates used the terms liberally in 2008 while discussing the Wall Street meltdown, though neither stepped up to the plate to reveal exactly what instances of “fraud” they were referring to. If hordes of guilty Wall Streeters were being paraded through Manhattan in shackles, the Justice Department would make sure we knew about it.
The sums lost to waste and fraud in our health care entitlement programs are so elusive that we are unable to even attach a figure to our losses. Estimates vary from President Obama’s “hundreds of billions” to a widely accepted guess at $60 billion for Medicare alone.
Part of the problem lies with the concepts of “waste” and “fraud,” which mean different things to different people. What Congress might consider a legitimate provision in a bill may seem more like fraud to the people who have to pay for it, particularly if the legislators who inserted that provision were less than forthcoming about their real intentions.
When senators washed their hands of the public option, they needed a mechanism to provide low-cost health care. Their legislation includes billions of dollars of additional funding for Medicaid, for community health centers, which are expected to assume much of the patient load from the Medicaid expansion, and for the National Health Service Corps., charged with providing an adequate supply of personnel to staff the centers.
Socialist Senator Bernie Sanders (I-Vermont) is a big fan of community health centers, and he advocated for and received a $10 billion provision in the bill for expanding the clinics. A Congressional Quarterly article posted on Sanders’ website notes that the legislation would cover an additional 25 million individuals by expanding the health centers, for a total of 45 million expected to be served.1
Community health centers, including migrant health centers, are required to treat everyone who presents at their doors, regardless of immigration status. They are pay-what-you-can-afford facilities, so their free or low-cost services play an important role in providing health care to low income individuals. 34.8% of those who use the clinics are Latinos.2 The Department of Health and Human Services Substance Abuse and Mental Health Services Administration refers to a Kaiser Family Foundation article showing that immigrants who are not U.S. citizens fall back on safety net health care services, including community health centers and migrant health centers3 The article also suggests that if health care reform is passed, this dependence will continue because of legislative barriers to other benefits.4
The issue of health care for illegal immigrants under the House and Senate proposals has focused on the potential to access insurance exchanges or a public option plan if adequate citizenship verification procedures are not in place. There has been almost no discussion of guaranteed access through community health centers, which receive a massive infusion of taxpayer dollars under both bills, and are required by the Public Health Service Act to treat all comers. If a public option is not included in the final, consolidated bill draft, the sky might well be the limit for funding these centers.
Politicians love to play semantic games, and are still trying to deny what their constituents have already figured out: legal citizen children of illegal immigrants are already eligible for federal health benefits. The SCHIP Reauthorization signed by the president in February 2009 erased the 5-year wait period for legal immigrants, giving illegal immigrants’ U.S.-born children faster access to taxpayer-funded health benefits. To claim that this is not a federally-subsidized benefit that potentially puts taxpayer dollars in the pockets of illegal immigrants is simply not true.
Both the House and Senate health care bills would permit medical care to be provided to illegal immigrants at federally-qualified community health centers. Nevertheless, our government steadfastly refuses to acknowledge that these centers are destined to become an increasingly larger conduit for bestowing taxpayer-subsidized benefits on non-citizens.
After health care reform, immigration reform is at the forefront of the 2010 legislative agenda, and if the two initiatives intersect, we are sunk. Luis Gutierrez’s (D-Illinois) Comprehensive Immigration Reform Bill not only provides a path to citizenship, but also includes provisions to make the DREAM Act a reality, granting amnesty and state resident tuition rates to illegal immigrants. (see Selling Out Our Dream). Given the zeal with which the current Congress is spending our money, one can only imagine how quickly former illegal immigrants will qualify for subsidized health insurance once they have been granted amnesty.
For what it is worth, we are probably sunk anyway, though. There is another big giveaway in the legislation that the media has not deemed sufficiently shocking to discuss.
Next: what, precisely, qualifies as “fraud and waste”?