Saturday, September 26, 2020

Healthcare Reform Ignoring Illegal Immigrants

As the health care debate continues and policies begin to form, one very large portion of the American population has been continually left out of the discussion. Of the numerous proposals presented thus far, not one has included coverage or even addressed the issue of the estimated 11 million illegal immigrants living in the United States.

John Sheils of the Lewin Group, a nonpartisan health care consulting firm owned by UnitedHealth Group, has analyzed numerous studies in order to determine the exact number of uninsured illegal immigrants living in the US. “We’ve estimated about 6.1 million of the uninsured are actually undocumented,” Sheils says. That number only accounts for about half of the total population of illegal immigrants. Sheils explained that it is likely that the rest of the population is “getting employer health benefits as part of their compensation.” For instance, many illegal immigrants use false documents to work and in turn receive benefits and incur regular tax deductions.

The fact that so many illegal immigrants are insured via their employers is something that lawmakers should be aware of when crafting legislation. Sheils says, “If you design a plan improperly, you actually would wind up taking away their insurance, creating new uninsured people.”

It is important to determine just how much health care the 6 million uninsured illegal immigrants consume. Paul Fronstin of the Employee Benefit Research Institute says “the economics aren’t as great as they’ve been made out to be.” He went further to explain that because illegal immigrants are as a whole younger, and in turn healthier than the overall population, they visit the doctor less often. He estimated that they account for about 1 or 2 percent of the total share of the health care system, with only a small portion of that being paid for with public funds.

Roughly $1 billion dollars is paid by Emergency Medicaid each year to cover emergency care for patients who would qualify for Medicaid but can’t prove their legal status. Sheils explained that this figure is but a tiny portion of what is the national health care system, only two-tenths of 1 percent. The issue arises, though, that although the number is small it can have a larger impact when it is concentrated in a particular area, like hospitals along the southwestern US border.

“Some hospitals have had to cut back services to their community at large because they have to absorb the added costs,” says Carla Luggiero of the American Hospital Association. According to Luggiero, as more hospitals have been caring for increasing numbers of illegal immigrants in the past decade, some have had to raise fees and others qualified for extra federal subsidies if they have an especially large number of Medicare or Medicaid patients. Luggiero explained that this can be a way to indirectly cover part of the cost of caring for the undocumented. Luggiero believes that if Congress does not include illegal immigrants in any health plan, hospitals will expect these federal payments to continue.

Peter Harbage, of the Center for American Progress, thinks health care for illegal immigrants is as much a political question as an economic one. Harbage believes an interesting tension occurs because generally no one wants to provide free health care for those with no right to be in the country, yet it is accepted that no one is turned away for emergency care. Harbage went further saying “if some of those dollars were used up front, you could have, maybe, a more efficient system. But that’s not the conversation that’s being had on Capitol Hill.”

NPR