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On Health Care, Bending to Anti-Immigration Extremists Will Hurt Citizens

September 11, 2009 - Posted by Maurice Belanger

Money up in smoke


In the President’s speech to a joint session of Congress on September 9, the President was confronted by
a Congressman who called the President a liar when the President said that the health care proposals now making their way through Congress would not cover undocumented immigrants.  The myth that heath care reform is a giveaway to undocumented immigrants has been addressed in numerous venues.  (Even Consumer Reports weighs in on this lie, giving it a bad rating.  Here is what, a project of the Annenberg School for Communication at the University of Pennsylvania, has to say about the President’s speech.)


Where the lie gets dangerous is when it is combined with the Congressional propensity to mollify liars—in this case by piling on documentation hoops that everyone will have to jump through to qualify for health care.


It’s been done before, and the results have been disastrous for American citizens. 


In 2006, in an effort to keep undocumented immigrants from getting Medicaid, Congress added a requirement that all Medicaid recipient, and persons applying for Medicaid, be required to prove their U.S. citizenship by showing a birth certificate, a passport, or certain other documents.  Prior to this requirement, Medicaid recipients were able to attest to their citizenship under penalty of perjury.  


Many recipients of Medicaid did not have the required documents.  Before the law went into effect, the Center on Budget and Policy Priorities in Washington commissioned a survey that found,


[a]bout one in every twelve (8 percent) U.S.-born adults age 18 or older who have incomes below $25,000 report they do not have a U.S. passport or U.S. birth certificate in their possession. Applying this percentage to the number of adult citizens covered by Medicaid over

the course of a year indicates that approximately 1.7 million U.S.-born adults who are covered by Medicaid could lose their health insurance because of the new requirement or experience delays in obtaining coverage as they attempt to secure these documents.


More than one tenth of U.S.-born adults with children who have incomes below $25,000 reported they did not have a birth certificate or passport for at least one of their children. This indicates that between 1.4 and 2.9 million children enrolled in Medicaid appear not to have the paperwork required.


Shortly after the law went into effect, in July 2006, states around the country began reporting large numbers of persons being dropped from their Medicaid roles.  Was the new law filtering out undocumented immigrants?  No. In Iowa, for example,


“The largest adverse effect of this policy has been on people who are American citizens,” said Kevin W. Concannon, director of the Department of Human Services in Iowa, where the number of Medicaid recipients dropped by 5,700 in the second half of 2006, to 92,880, after rising for five years. “We have not turned up many undocumented immigrants receiving Medicaid in Waterloo, Dubuque or anywhere else in Iowa,” Mr. Concannon said.

Lacking Papers, Citizens Are Cut From Medicaid,” New York Times, March 12, 2007


This phenomenon was seen in state after state, as documented by, among others, the Center on Budget and Policy Priorities and the Government Accountability Office.  A year after the provision went into effect, a Congressional survey found that, for six states that could document the cost of implementing the new provision verses the number of undocumented immigrants discovered, the new documentation requirements resulted in the removal of eight undocumented immigrants in total.  Implementing the provision resulted in approximately $25 million in state and federal costs.  For these states, for every $100 spent implementing the new documentation requirement, there were 14 cents saved.


This experience should be a lesson to Congress.  Trying to satisfy anti-immigrant extremists by mandating burdensome documentation requirements as a condition for obtaining health care will mostly hurt U.S. citizens.  Such requirements will greatly reduce the impact of any legislation designed to help Americans who are now hurting so badly because of lack of affordable health insurance.  In any event, such a concession is not likely to gain the support of people who are using lies to try to preserve the status quo.  


You can find more information related to this topic in our Research Center.


Photo from flickr user purpleslog

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