Right-wing media are subverting Health and Human Services Secretary Kathleen Sebelius' message that immigrants should have access to affordable health care, claiming her purpose is to inflate “Obamacare enrollment.” But in doing so, they ignore the real human and economic costs to denying immigrants affordable health insurance.
At an event sponsored by a Latino community service group, Sebelius explained that undocumented immigrants who would be newly legalized under the Senate immigration reform bill would not be able to apply for subsidies to purchase health insurance, or have access to the health care exchanges and the expanded Medicaid program under the Affordable Care Act. She went on to say that this “is, frankly, why -- another very keen reason why we need comprehensive immigration reform.” Sebelius added:
SEBELIUS: We won't fix the immigration system, unfortunately, through the health care bill, but I think having the immigration bill that passed the Senate, pass the House, would be a huge step. In the meantime, I would say for those undocumented residents, we have continued access to the community health centers and an expanded footprint in the community health centers.
A number of right-wing sites, including CNSNews, Breitbart.com, and HotAir, highlighted Sebelius' comments using headlines like, “Sebelius: Pass Immigration Bill to Boost Obamacare Enrollment,” but ignored the core of her message.
According to an October 2012 report by the Kaiser Family Foundation, nearly 48 million people under 65 were uninsured in 2011. In a 2011 study, the Urban Institute estimated that about 14.6 percent, or almost 7 million, of the uninsured are undocumented immigrants. The study warned that without policy actions, the share of that population would grow and impose extra costs on state governments and hospitals:
If the reform law leads any of these [small] firms [that employ undocumented immigrants] to drop the coverage they offer, or if the exchange does a superior job of screening based on immigration status, undocumented immigrants could see further deterioration in their already low rates of private coverage.
The exclusions in the Affordable Care Act may also serve as a barrier to members of undocumented immigrants' families who might otherwise be eligible for one of the coverage options. For example, incentives to avoid enrolling native-born children with undocumented immigrant parents in Medicaid or the Children's Health Insurance Program may also reduce coverage in the exchanges for families containing one or more undocumented immigrants.
As health reform unfolds, and undocumented immigrants emerge as an even larger share of the uninsured population, it is likely that they will become a more prominent component of safety-net health care providers' client base. This could mean that such providers will feel financial stress, especially in light of the Affordable Care Act's cuts to Medicaid and Medicare disproportionate-share hospital payments.
Without health insurance, most undocumented immigrants rely on emergency room visits and community health centers for care, which tends to increase health care costs across the board. ABC News reported in September 2012 that the New England Healthcare Institute “estimates that the nation spends as much as $32 billion each year treating chronic and non urgent problems with emergency care instead of primary care.” The article added: “According to the organization, the same care costs two to five times less at a primary care doctor.”
ABC News further reported:
The federal government spends about $20 billion each year to reimburse these hospitals, reports the Times, for treating more than their fair share of the uninsured, including undocumented immigrants. But the new healthcare law cuts that funding in half, based on the idea that fewer people will lack health insurance under the new law.
In a February article, PBS NewsHour and Kaiser Health News noted that most patients who use Emergency Medicaid, a program for the poor that pays about $2 billion a year for emergency treatment, are undocumented immigrants. In fact, the Journal of the American Medical Association estimated that “99 percent of those who used Emergency Medicaid during a four-year period in North Carolina” were undocumented immigrants.
Hospitals have estimated that emergency room visits cost upwards of $1,000 for the uninsured, while care for “permanent patients” -- undocumented immigrants who languish in hospital care for months or years because they lack insurance or appropriate housing -- can cost more than $100,000 a year.
In April, the Associated Press uncovered the practice some hospitals used to get around these costs: deporting undocumented patients back to their home countries without their consent. According to the AP, “at least 600 immigrants were removed over a five-year period, though there were likely many more.” The article continued:
In interviews with immigrants, their families, attorneys and advocates, The Associated Press reviewed the obscure process known formally as “medical repatriation,” which allows hospitals to put patients on chartered international flights, often while they are still unconscious. Hospitals typically pay for the flights.
Now advocates for immigrants are concerned that hospitals could soon begin expanding the practice after full implementation of federal health care reform, which will make deep cuts to the payments hospitals receive for taking care of the uninsured.
The AP went on to report that "[s]ome patients who were sent home subsequently died in hospitals that weren't equipped to meet their needs. Others suffered lingering medical problems because they never received adequate rehabilitation."
The health community has consistently advocated for the long-term benefits of insuring more people, as the University of Southern California's Center for Health Reporting has noted. That's one reason California is spearheading an effort to insure all of its residents, including its estimated 2.6 million undocumented immigrants.
The New York Times noted that following implementation of the ACA in January, about 2 to 3 million residents will still be uninsured, down from 7 million. The Times reported that public health officials, elected representatives, and advocacy groups are “trying to cobble together ways to provide preventive care for such immigrants, who are expected to make up the largest share of the remaining uninsured once the state's expanded Medicaid program takes full effect.” The article continued:
By many measures, California, with roughly seven million people currently uninsured, more than any other state, is taking the lead in aggressively rolling out changes before January, when most Americans will be required by law to have medical coverage or pay a penalty, the so-called universal mandate. While other states are resisting efforts to expand Medicaid, California has already begun public campaigns to encourage more residents to enroll in subsidized health plans.
But in counties with large immigrant populations like Los Angeles, officials say that not including immigrants in coverage, regardless of their legal status, will only cost local government more in the long run. So they are lobbying state and federal officials to find ways to pay for preventive health care, rather than rely on emergency rooms to care for them.
Immigrants, who tend to be younger and healthier, also use less health care services than native-born Americans. This was borne out in a Harvard study released in May, which showed that over a seven-year period, immigrants contributed about $115 billion in Medicare taxes than they took out. USA Today wrote:
Studies had shown that immigrants use less health care than U.S.-born people, including in government programs, but no one had looked at their contributions to those programs.
In 2009, the researchers found, immigrants contributed $13.9 billion more to the Medicare Trust Fund than they used, while U.S.-born people spent $31 billion more than they contributed. Immigrants, [lead researcher Leah] Zallman said, essentially subsidize U.S. health care.