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Health Care and Immigration: Uncomfortable Bedfellows

Tom Williams/CQ Roll Call File Photo
Gutierrez, who has led the Congressional Hispanic Caucus’ immigration efforts, has said the two parties don’t see eye to eye on who should have access to health care.

What Gutierrez was referring to is a position that led one Republican in the House bipartisan group negotiating an immigration package — Rep. Raúl R. Labrador of Idaho — to bolt. Labrador is a vehement opponent of the health care overhaul. He believes health care is everyone’s personal responsibility, and that should include, an aide to the congressman said, paying all of their medical bills. If they don’t, Labrador believes they should be asked to leave the country, the aide added.

It shouldn’t come as a surprise that lawmakers are not eager to mix health care and immigration. President Barack Obama delivered that message in his 2009 State of the Union address, in which he promised that no illegal immigrant would be covered by a health overhaul. The health care law made good on that pledge. And in June 2012, when he issued an executive order that young people who were brought here illegally as children and have gone on to college or the military would not face deportation, Obama decided that those so-called DREAMers — named for the legislation that would have legalized them — would not be covered by the health care law.

In his executive order and speech, Obama “created a marker on this issue,” said Clarissa Martinez-De-Castro, director of civic engagement and immigration at the National Council of La Raza. Even advocates such as Martinez-De-Castro see the peril in insisting that the immigration overhaul include health benefits for this group.

“There is a danger that taking on this debate in the context of immigration endangers the prospects for immigration reform,” she said in an interview. But, she added, by not helping these illegal immigrants get health benefits, lawmakers would be “adding a burden to that population” that the country will have to come to grips with in the future.

The Senate proposal does take one baby step toward providing a pathway to health insurance for this population by allowing them to buy insurance on the exchanges. But a report from the nonpartisan Migration Policy Institute shows that without access to subsidies, the vast majority of illegal immigrants likely would not be able to afford to buy insurance from the exchanges.

The report says 7 million, or 71 percent, of illegal immigrants are uninsured. And 84 percent of them, it says, have incomes below 400 percent of the poverty line, which would allow them to qualify for federal subsidies. Without such assistance, said Migration Policy Institute Senior Vice President Michael Fix, these immigrants are unlikely to be able to afford coverage.

Martinez-De-Castro said the irony of making it virtually impossible for these provisional immigrants to be part of the health exchanges is that it would undermine the economics of how those marketplaces are supposed to work. This population is disproportionately young, she explained. “Look at the math. You want more people who are young and healthy to create an overall pool to take care of those who are not,” she said.

There’s another financial aspect of this debate that works against those who want health benefits for this population. Given the current budget climate, lawmakers supporting this effort know it must be budget-neutral to succeed. Allowing these immigrants to get the health law subsidies would add to the cost of the immigration overhaul.

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