Covering The Undocumented Is Cheaper, Actually

Rep. Joe Wilson gave a bumbling, stumbling response to his comments last night.



Once again the media has taken one sensationalistic remark and let it overshadow the entire speech last night, which was a political winner for reform. But it's worth digging down into the substance of the claims and the actual policy behind it. Right now, the way things are, undocumented immigrants (there are no illegal people) can go to an emergency room and get treatment. They can purchase their own health insurance. They can go to a free clinic. They can, in a variety of ways, access health care if they need it.

The plans on the table would provide more security for those with insurance, and provide exchanges for those without coverage. The undocumented can access those exchanges, because it would require them to pay for coverage with their own money. The bill would also provide subsidies to people who cannot afford coverage. The undocumented would not be eligible for those subsidies. It says that in every single bill draft. Rush Limbaugh, being a little more honest than usual today, says "It will cover undocumented aliens. Now it may not specifically say so in the bill... " He's talking about enforcement and verification statutes, which is a red herring, because a driver's license or some form of ID is typically required at the point of service if you have an insurance card. There are lots of checks in the system already.

That said, I agree with this:

The Baucus plan currently going around, of course, explicitly states that "[no] illegal immigrants will benefit from the health care tax credits" and limits the insurance mandate to U.S. citizens and legal residents. But Dana is right to ask whether undocumented immigrants should be covered in some capacity. Beyond potentially skewing employer hiring incentives, the exclusion of immigrants from the plan will create a financial burden on the system anyway -- which seems to be conservatives' big concern. By law, hospitals are not allowed to refuse care to anyone in an emergency situation, whether the person is insured or not. The cost of the uninsured then falls both on the hospitals and on the government, which provides $250 million annually as reimbursement through Section 1011 of the Medicare Modernization Act, which has been extended through this year.

So, tax dollars are already being spent on care for uninsured and undocumented immigrants. And hospital resources are being strained since the losses aren't fully accounted for, which can have an effect on the quality of medical care provided to the general population. Regardless of the system in place, coverage of undocumented immigrants is a problem that's going to need to be dealt with. Given that, shouldn't we be working toward a solution that's more transparent and just?

The President talked about the $1,000 hidden tax on everyone with insurance as a result of funding ER care. That would not change if immigrants had to use continue to use the ER as their primary doctor. That status quo is grossly inefficient and we all pay for it; in fact we pay more than if we just offered subsidies and brought everyone under the umbrella of universal care. In addition, having an underclass of people prone to disease without preventive care is a major public health problem.

In a general sense, this kind of "blame the brown people" argument will be consistently made until we deal fully with the undocumented within our borders, through both workplace enforcement and some legitimate path to citizenship. Until you do that, these political footballs will always surface, and cowardly Democrats will thunder "we will not pay for undocumented workers!" when we already are paying for them, and could lower that payment.

...I knew somebody would turn that into being Obama's fault.