Could a health care reform law pave the way for an immigration reform bill?
Advocates and opponents of the Obama administrations’ plans for comprehensive immigration reform have staked out ground in the current health care reform debate, arguing in favor of or against verification clauses in the Senate and House versions of the bills.
Verification of US citizenship or legal residence in purchasing health insurance would be expensive and rely upon badly designed systems, insisted Marc Rosenblum, a senior analyst at the Migration Policy Institute(MPI), based in Washington, DC.
"And where do you locate that screening?" Rosenblum questioned. "There is a difference between screening out to make sure that unauthorized immigrants don’t get any benefits that they are not entitled to versus making sure that they are not able to purchase their own insurance, which adds a new restriction that doesn’t now exist.
"The downside is that any kind of screening requirement is costly and everybody has to get trained. It creates obstacles for legal immigrants to obtain care," added Rosenblum, who is a co-author of the MPI report Immigrants and Health Care Reform: What’s Really at Stake?
Verification screening ultimately would block US citizens who lack government-issued identifications or those wrongly screened out from receiving their health care benefits, Rosenblum told Homeland Security Today.
Such screening would act as a gateway, which would create disincentives for people to enroll in voluntary insurance programs–the main goal of health care reform, Rosenblum commented. Young, healthy people who should sign up may be discouraged by identification requirements.
Rosenblum further contended that an extension of the E-Verify employment verification system for verifying health care eligibility would be misguided. E-Verify is not 100 percent reliable, Rosenblum argued, so some US citizens and legal immigrants would be shut out of health care benefits. Moreover, the due process protections for E-Verify are not intuitive and not uniformly enforced, he said.
"With health insurance, that’s likely to be a bigger problem because with employment you have a relationship where the employer is trying to hire somebody," Rosenblum remarked. "With health insurance, if you have false non-confirmations come up or bureaucratic errors, you don’t have an employer with the same incentive to follow due process protections to hire the person they want.
"The other risk to importing the E-Verify model into health care is that are you then going to be screening all of the beneficiaries of the policy? When you hire somebody, are you going to have to verify the citizenship of their whole family? That would raise privacy issues and multiply the opportunities for errors," he said.
Finally, a discussion of immigration controls should not occur in a health care reform debate, Rosenblum said. The United States has never required verification for private individuals making purchases in a private economy.
"If you go and buy a tank ofgas or go to buy groceries, the clerk does not ask for proof of citizenship," Rosenblum said. "But to propose to add something like that when you go to buy private insurance? There are commercial costs to do that. If you really require people to do that kind of verification, it’s going to raise the cost of the service as that cost gets passed on."
The House passed the Affordable Health Care for America Act (HR 3962) on Nov. 7 without adequate provisions for verifying the legal status of individuals participating in the resulting insurance exchange, said Bob Dane of the Federation for American Immigration Reform (FAIR), also based in Washington, DC.
"The health care bill that passed the House has become a vehicle to totally reshape immigration and welfare policy," Dane told Homeland Security Today.
Dane pointed to three immigration-related problems with the bill. First, it would offer inadequate verification to prevent illegal aliens from accessing taxpayer benefits. Second, it would eliminate welfare rules that prohibit legal immigrants from getting federal benefits for the first five years of their residence in the United States. Third, it would grant access to the insurance exchange to illegal aliens if they simply pay the premiums themselves.
"If you claim you are a citizen, then you get checked through a brand-new system," Dane described. "It has never been tested. It requires no photo identification. That’s where the loopholes for fraud and abuse come into play. You have to give a name and a matching social security number when applying, and that’s great.
"The problem is that illegal aliens do have social security numbers and a lot of them have a whole bunch of social security numbers, which are not theirs," he added.
Rep. Dean Heller (R-Nev.) offered an amendment to the House bill that would have solved the problems by preventing illegal immigrants from receiving government-subsidized health care under any new health care system, Dane observed, but Democrats blocked the amendment from being heard. The Heller amendment would have required proper documentation including a photo identification to receive health care benefits.
The Senate version of the bill, known as the Patient Protection and Affordable Care Act, includes a check of a name and social security number in Section 1411 that do not represent a true verification of eligibility, Dane said. In addition, the bill would permit the Department of Health and Human Services to exempt beneficiaries from verification processes completely.
"The bill has matured to a point now where allowing the illegal aliens access is not an administrative oversight. It is clearly a deliberate attempt to include them," Dane objected.
Covering illegal aliens in the health care reform bill would deal with one of the major objections to comprehensive immigration reform for the estimated 12 million illegal immigrants in the United States, Dane argued.
Congress would already have dealt with the high expense of providing health care to illegal immigrants in the health care reform legislation, thereby diminishing opposition on the costs of immigration reform, he said.