As if immigration and health-care reform aren’t sufficiently daunting in their own rights, the two issues are now joined.
Last week, the Senate Judiciary Committee approved a bill that would give the roughly 11 million undocumented immigrants in the U.S. a chance to become citizens. Immigrants who meet a series of conditions would be granted provisional legal status, allowing them to work in the country legally.
The legislation would prevent those immigrants from receiving federal benefits for at least 10 years. The prohibition includes qualifying for Medicaid and getting federal subsidies to purchase health insurance.
Excluding such immigrants from government health assistance has its appeal. Although the cost of extending such benefits is hard to estimate -- the Congressional Budget Office hasn’t analyzed the issue -- it’s likely to be expensive. In addition, some critics view subsidies for immigrants as a perverse reward for breaking immigration laws.
Yet withholding health benefits is even more problematic. First, legalizing immigrants without providing access to health care will give employers an incentive to hire immigrants over American citizens. The Affordable Care Act requires employers with 50 or more employees either to provide health insurance or pay a penalty as high as $3,000 per uninsured worker. Employers could avoid doing either by hiring immigrants that are excluded from the program.
In addition, excluding immigrants will weaken the new health-care system, which is predicated on bringing healthy young people into the insurance market, both to balance the risk pool and to reduce expensive (and publicly funded) emergency care. If that economic logic holds for citizens and legal residents, it should also apply to undocumented immigrants. (Actuarial tables don’t care about your immigration status.)
In fact, the economic argument for bringing immigrants into the health-insurance market is strong. The median age of undocumented immigrants in the U.S. is 36 -- 10 years younger than the median age of citizens, according to the Pew Hispanic Center.
Younger people are generally healthier, and young immigrants, in particular, typically use fewer health-care services than nonimmigrants. More than two-thirds of adult immigrants working without authorization had no insurance in 2011, according to estimates from the Migration Policy Institute. Their participation in insurance pools would help keep costs down for everyone.
That argument was recently underscored by some House Republicans, who propose that immigrants with provisional status be required to carry health insurance. (If this sounds like the individual mandate enshrined in the Affordable Care Act, welcome down the partisan rabbit hole that is Washington.)
Requiring immigrants to buy insurance -- with limited access to employer-based coverage, and without access to federal subsidies -- imposes a large burden on a population in which 32 percent of adults and 51 percent of children live in poverty. If we want these future citizens to contribute to their communities, saddling them with steep financial obligations probably isn’t the best start.
Instead, Congress should ease their access to the health-insurance market. At a minimum, that should include access to coverage for the estimated 1 million undocumented immigrants younger than 18, and enabling immigrants to purchase insurance on state exchanges with their own money -- even if Congress unwisely blocks subsidies. If no subsidies are available, a mandate to carry insurance can’t be justified.
Giving 11 million undocumented immigrants a chance at legal status makes economic and ethical sense. Denying them the chance to get affordable health coverage in the meantime does not.
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