Baucus Should Be More Inclusive With Health Care Plan

Posted September 22, 2009 at 10:51am

Senate Finance Chairman Max Baucus’ (D-Mont.) much-publicized proposal to exclude undocumented immigrants — and legal immigrants here less than five years — from purchasing health insurance coverage through the National Health Exchange runs counter to several core components of health care reform. It fails to contain costs, increase preventive care services or streamline the delivery of health care.[IMGCAP(1)]Keep in mind that American taxpayers are already paying for the health care costs of immigrants when they use emergency and social services. Americans currently pay $56 billion annually to ensure the uninsured’s use of emergency care. The fiscally prudent response, then, would be to seize the opportunity to have the uninsured pay for their own health care, instead of everyone else — something I have pushed for as part of comprehensive immigration and health care reform efforts.One wonders what Baucus is thinking. A few questions immediately come to mind.Firstly, how fiscally rational is it to exclude individuals willing and able to share in the responsibility of paying into the system? It is not rational, especially given that the proposals introduced by the president and Congress seek to institute an individual mandate for purchasing coverage, which counts on the participation of millions of healthy individuals to drive down the cost of health care. Similarly, the greater the number of immigrants purchasing health care results in the lowering of health care costs for all Americans.In fact, to not allow immigrants to purchase coverage will create a bigger burden on taxpayers. Chairman Baucus’ proposal will only add to uncompensated care costs and costly emergency room visits. Costs due to such visits will be shifted and distributed among all those who have been mandated to carry insurance.Secondly, if Baucus is concerned that immigrants will create a burden on the health care system, this argument, too, is specious. Immigrants tend to come to the U.S. during prime working years, and they tend to be younger and healthier. Immigrants have been shown to seek substantially less medical care even while carrying insurance than native-born Americans. Immigrants spend 55 percent less on health care than U.S.-born individuals. Thus, immigrants’ contribution to the health care system would buoy the affordability of health care for everyone else in this nation. Thirdly, does Baucus realize that a preventive approach, which our House bill supports, saves taxpayer dollars and acts as pre-emptive policy against pandemics? Investing in preventive care is cost-effective and results in better health outcomes and long-term cost savings. Yet, the success of a prevention framework is critically dependent upon access to health coverage. Allowing undocumented immigrants to purchase unsubsidized, private health insurance coverage will contribute to the goal of replacing emergency care with the increased use of much cheaper preventive care.Prevention also aids in pre-empting pandemics. Disease and illnesses do not discriminate based on immigration status, and neither should America’s health care policy. The threat of pandemics and other infectious diseases demonstrate particularly well the folly of politicized public health policy. For example, the rapid spread of H1N1 flu should make policymakers cognizant of and guarded about the public health implications of denying access to health care coverage to a large portion of the population.Fourthly, does Baucus realize the adverse and costly impacts of implementing an immigration status verification requirement? As we learned from implementing Medicaid citizenship documentation requirements under the Deficit Reduction Act of 2005, such verification requirements are cumbersome, ineffective, expensive and create administrative barriers that prevent eligible citizens from getting the health care they need. Twenty-two of 44 states reported declines in Medicaid enrollment because of the requirement, and a majority of these states attributed the declines to delays in or losses of Medicaid coverage for individuals who appeared to be eligible citizens. Remember, the higher the number of people paying into the health care system, the lower the costs will be for everyone. That is why we caution against imposing verification requirements that will prevent citizens and other eligible individuals from obtaining health care coverage.I urge Chairman Baucus to rethink his proposal to prohibit undocumented immigrants, and legal immigrants here less than five years, from buying unsubsidized health care coverage. It is ill-advised from fiscal, administrative and health perspectives. We must pass strong health care reform that includes all measures possible to reduce health care costs for American families. Baucus’ bill does not.Rep. Mike Honda (D-Calif.) serves on the Appropriations Subcommittee on Labor, Health and Human Services, and Education.