Thursday, February 02, 2012
Two of the hottest topics on the political circuit are illegal immigration and "Obamacare." They can come together into a third steaming discussion: How the Democrats' Affordable Care Act of 2010 would hasten America's journey toward a more orderly immigration program.
As a recent article in Health Affairs predicts, once the health care reforms settle in, undocumented immigrants will become the largest share of the uninsured. As legal residents enjoy universal coverage, those without would be more noticed. (The authors are Stephen Zuckerman, Timothy A. Waidmann and Emily Lawton, all of the Urban Institute's Health Policy Center.)
Contrary to much propaganda hurled at the Affordable Care Act, the law guaranteeing coverage to all Americans excludes illegal immigrants. It does not let them join the expanded Medicaid program for the poor. It denies them low-income subsidies to purchase coverage through the health-insurance exchanges. It even bars them from buying affordable coverage through the exchanges with their own money.
Illegal immigrants might avoid enrolling their native-born children, who are citizens, in Medicaid or the Children's Health Insurance Program, the article suggests. While helping these children obtain the medical care they are entitled to may be the right thing to do, it's undeniable that Affordable Care Act restrictions shrink one incentive for coming to this country illegally.
Experience suggests that illegal immigrants generally do not try or succeed in joining public programs. For families with incomes below 133 percent of the federal poverty level, there's been little difference in private coverage rates. But the gap in public coverage is "dramatic." Within this low-income group, one in four native-born Americans and one in five legal permanent residents find coverage through a government program. Only one in 10 of the undocumented immigrants does.
It's a hard reality that the United States can't supply American-style health services to any poor person who crosses the border. No country could. Even many Americans can't afford American-style health care -- a national disgrace that Obamacare seeks to remedy. Canada unapologetically patrols its government programs against unauthorized users, and so must we.
To quote the conservative economist Milton Friedman, "It's just obvious that you can't have free immigration and a welfare state."
Obvious, yes, though I wish Friedman had used a less loaded word than "welfare." Extending health care security, supported by government subsidies, is one way America can ease some of the growing inequalities pounding its working class. The elderly enjoy government-guaranteed medical coverage, as do prisoners and the poor. We don't call Medicare "welfare," even though it requires huge transfers of taxpayer money. Why should the working poor -- whether native born or legal immigrant -- be the only ones left in the cold?
The Affordable Care Act might speed up "self-deportation," whereby a tougher environment for illegal immigrants prompts some to return home. (That's already happening due to a weak labor market and recent stepped-up application of the immigration laws.)
Ideally, strict enforcement would be paired with a last-time amnesty for otherwise law-abiding illegal immigrants already here. Many have deep roots in this country, and their American-born children know no other. These people would be folded into the health care program.
The Affordable Care Act, "Obamacare" or whatever you want to call it, is essential to America's well-being on several fronts. It will help curb rising health care costs. It will round some sharp edges in our freewheeling capitalistic system: No longer will loss of job mean loss of health coverage as well. And for those staunchly worried over immigration, it will darken the line between legal and not legal.
Conservatives opposed to illegal immigration should reconsider their vows to kill off the health care reforms.
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