Immigrants, Health Reform, and “Lies”


In a much-anticipated prime time address to Congress, President Obama made the case for health care reform.  One ostensible goal of the speech was to correct misinformation about the bills proposed by Congress.  As a scholar who studies both health care and immigration (and sometimes the intersection between the two), I’ve grown increasingly frustrated with the misconceptions surrounding this issue — and I very much hoped the President would deflate the myth that health reform would provide federal benefits to undocumented immigrants.

Of course, when President Obama made this very point (”The reforms I’m proposing would not apply to those who are here illegally”), he was greeted with a heckle from South Carolina Representative Joe Wilson, who shouted “You lie!”  Although Rep. Wilson later apologized for his “lack of civility,” he didn’t recant the basic factual assertion, making clear that he still disagreed with the President’s statement that health reform doesn’t cover undocumented immigrants.  Of course, the media has jumped on this story, but perhaps unsurprisingly, few bothered to clarify the underlying factual dispute.

Neither bill published by the House or Senate covers undocumented immigrants.  In fact, both bills state in pretty plain terms that they don’t do it.  The House bill, titled America’s Affordable Health Choices Act of 2009, states in Section 242 that those not lawfully present in the United States are not eligible for insurance subsidies or tax credits.  To make it even more clear, Section 246 is titled “No Federal Payment for Undocumented Aliens,” and states “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”

Likewise, the Senate Health, Education, Labor, and Pension Committee’s bill, titled the Affordable Health Choices Act, states in Section 3111(h) that “Nothing in this Act shall allow Federal payments for individuals who are not lawfully present in the United States.”  The Senate Finance Committee has yet to release its bill, but it’s a good bet that undocumented immigrants similarly will be excluded.

Although nothing in the bills apparently would prohibit undocumented immigrants from purchasing health insurance in the new national marketplace (called an “exchange” and a “gateway” in the House and Senate bills), it’s not clear why anyone would take issue with immigrants purchasing insurance on their own, without federal subsidies.  Moreover, although nothing in the bills seems to alter federal funding for emergency care provided to immigrants, nothing creates such a benefit either — thus undercutting Rep. Wilson’s contention with the President.

This controversy should remind us that immigrants remain in a sort of health care purgatory, caught in our two most dysfunctional systems — immigration and health care.  In the mid-1990s, Congress severely limited immigrant access to programs like Medicaid as part of welfare reform, making it difficult for even lawful immigrants to enroll.  In fact, even lawful immigrants aren’t eligible for Medicaid for five years after entering the United States — and various peculiarities of immigration law often push this waiting period to ten years.  At the same time, immigrants do receive indirect federal funding for health care through the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals with emergency departments to screen and at least stabilize patients presenting with emergent conditions.  Thus, hospitals must provide emergency care regardless of the patient’s immigration status.

Unfortunately, most immigrants are ineligible for means-tested public insurance programs like Medicaid.  This regulatory framework has led to “medical repatriation,” in which hospitals effectively deport immigrant patients to unload expensive long-term care burdens.  Of course, hospitals — most of which are run by state and local governments — complain about unfunded federal mandates like EMTALA.  Hospitals can be “stuck” treating immigrants whose medical needs have shifted from acute to long-term (as with the car accident victim who needs neurological rehabilitation and nursing care).  As Prof. Boozang discussed, a growing number have begun “repatriating” immigrant patients by sending them back to their country of origin — without consulting immigration officials — sometimes by purchasing commercial plane tickets or even hiring air ambulances.

Certainly, there are more humane ways to handle health care for immigrants.  California, for example, legalized cross-border health insurance, thus allowing immigrants living in the state to purchase insurance with lower premiums and deductibles that covers care provided in Mexico.  Arizona and Texas have considered similar legislation, to no avail.  Recently, UCLA researchers estimated that over 950,000 people travel from California to Mexico for medical care every year.  For a population being left out of health care reform, traveling to Mexico for care may be the future — whether voluntary or not.

Professor Cortez teaches and writes in the areas of health law, FDA law, administrative law, and the legislative process at SMU School of Law.  His scholarship focuses on international and comparative health law, particularly the regulation of emerging international markets in health care and biotechnology, such as cross-border health care, medical tourism, and clinical trials.  He also writes about immigration federalism.

Before joining the SMU law faculty, Professor Cortez practiced with the Washington, D.C., law firm Arnold & Porter, where he represented medical technology clients in administrative, legislative, litigation, and transactional matters, with a special emphasis on health care fraud and abuse, FDA enforcement, health privacy, and the Medicare and Medicaid programs.  Professor Cortez is a frequent contributor to Health Reform Watch, where this post first appeared.

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47 replies »

  1. I just received a request for donations from Swedish Heart and Vascular Institute in Seattle. It’s from Howard S. Lewis, M.D. I’m curious about how much Dr. Lewis makes?
    Does anyone know?

  2. Phillip,
    that was paid for illegals and excludes any contributions they make and taxes paid.
    There are roughly 8 million people that want insurance and can’t afford it or get it. 11 billion is $1,375 towards fixing each of their problems.
    I love how the left wants to ignore 11 billion on illegals and another few billion on tort reform, and the billions wasted on medicare and medicaid fraud but OMG did you see how much the CEO of United Health made!!! Those insurance company profits if the left could get rod of those everything would be all right.
    Majority of Americans don’t think their tax dollars should be buying care for illegal aliens. Who are you to decide their concern doesn’t matter?
    “Elections have consequences.”
    Is that why the left supported the war when Bush won? Be a little more hypocritical there.

  3. Beth,
    The vast majority of the people want healthcare reforem in this country and more people than not want the public option.
    You need to wake up and smell the coffee. Obama won a huge election victory. He has the mandate to move his agenda forward. Healthcare has been a central theme in his agenda for a long time. Elections have consequences. You no longer get to call the shots, as you lost the election. Try again in 2012.

  4. Nate,
    Even if you are right on the $11 bn to treat illegal immigrants that is only 0.6% of the average $2 trillion that is spent on healthcare every year. And if you assume that part of that is likely paid by illegals themselves from the taxes they pay, then the cost of illegals in the healthcare system is negligible. That is the point, given all the challenges and problems with healthcare, illegal aliens are so far down the list of real problems. Illegals are a red herring that is being used by the right-wing to try and tie the immigrant debate to the healthcare debate. It is being done for pure political reasons. Joe Wilson is a liar and by him even bring up illegals, he is doing this just to try and move the dicussion off what is really important in the healthcare debate.

  5. With all due respect to Mr. Cortez and his education in both health care and immigration perhaps he should spend some time educating himself on policy and enforcement. Its strange that for some reason any addition to the bill that is meant to enforce the touted legislation language has been defeated in a partisan way.
    Its also funny that the president himself said (after Joe’s outburst) that he would now include enforcement language in his supported bill. Hmmm, must have been some reason for that, eh?

  6. Joe Wilson completely lied by saying that Obama lied. Wilson, mister healthcare reform, should know that the bills explicitly say that illegal immigrants are not include, just like Obama stated. It was Joe Wilson that was lying.
    If you want to argue about more enforcement, that is a competely separte issue and something that Obama hardly lied about.
    All I would say about enforcement is, I hope when you go to emergency that they ask you for your proof of citizenship before they treat you. It is a complete joke.
    You immigrant bashers are all the same. Try to blame all societies ills on them. Been the same for ever with you people. No different than when the Irish came to this country.
    If you want to blame anyone for illegal immigrants in the U.S. you should be blaming the employers that hire them. They are the people who invite these illegal immigrants to this country. Why don’t you push to put a few of these employers in jail. We can start with half the agricultural, construction and restaurtant industries.

  7. Are you auditioting for the role of village idiot Jerry? Are you disputing the facts outlined by NYT and WaPo? Luci had opinions about how she thought things were. I replied with facts about how they really are. And you chirp in with another Shorter, which I must admit was every bit as funny and enlightening as the other times you have used that. I think you should respond to every comment with a Shorter Nate, they are that brillant.

  8. Luci,
    You must not spend much time with these people. Almost every illegal alien I have ever know has ID in multiple names. Further you don’t need ID you can have it auto deposited to just about any bank account you want. Further still you can get the money when you file with the advances at which time the money goes to the tax preparer.
    From NYT
    Tens of thousands of foreigners are illegally obtaining Social Security numbers by using fake documents, a typical first step to identity theft and other crimes,
    From WaPo
    The Social Security cards were then used in the continental United States to obtain driver’s licenses and credit cards. And then mortgages. Special Agent Ashan Benedict said people were able to establish good credit scores by making timely payments for months or years, all under false identities.
    You seem to be badly misinformed about reality. Maybe if you knew the truth you wouldn’t be such an apologist for them?

  9. I’m wondering how they are able to “receive refunds” as you say, if they are using stolen or fake SSN’s? The system would catch this, thus not sending anything back to them. Let’s say, for example, Jose has a valid yet stolen card for John Doe, he pays taxes claiming only his stay at home wife and daughter as dependents, at the end of the year, how is he going to get any money back, or receive refunds? If the government sends him a check, it’ll be in the name of John Doe and therefore Jose can’t cash it. A SS card only says one is legal to work, but one cannot create an identity using a SS card. For example, Jose would not be able to walk into the DMV office to get a drivers license using a SS card as proof of identity. If the card is a fake, yet in Jose’s name there will be no refund sent to Jose as the system will mark it as a fake SSN being as the number and the name do not match up in the system. The logic seems so simple.
    Don’t judge them so harshly for lying on tax returns, if you could claim 5-6 dependents on your tax returns and pay virtually no taxes and would never be caught for it, you’d probably do it too… as would the majority of Americans, even though fundamentally we understand the importance of these taxes. The repercussions for such actions could be great, and not nearly worth the risk, so we don’t.

  10. Mr. Cortez,
    I beleive this is the point where you add an update admitting you where 100% wrong, say your sorry to those you slandered and refrain from pretending you know anything about healthcare. You said;
    “As a scholar who studies both health care and immigration (and sometimes the intersection between the two), I’ve grown increasingly frustrated with the misconceptions surrounding this issue — and I very much hoped the President would deflate the myth that health reform would provide federal benefits to undocumented immigrants.”
    The President now admits;
    Today, for the first time as far as we know, the administration is backing a provision that would require proof of citizenship before someone could enroll in a plan selected on the exchange.
    Here, the administration also concedes that hospitals would be compensated with public funds for the care of undocumented immigrants.
    The bullet points sent tonight by the White House:
    Undocumented immigrants would not be able to buy private insurance on the exchange. Those who are lawfully present in this country would be able to participate.
    Undocumented immigrants would be able to buy insurance in the non-exchange private market, just as they do today. That market will shrink as the exchange takes hold, but it will still exist and will be subject to reforms such as the bans on pre-existing conditions and caps.
    Verification will be required when purchasing health insurance on the exchange. One option is the SAVE program (Systematic Alien Verification for Entitlements) which states currently use to make sure that undocumented immigrants don’t participate in safety-net programs for which they are ineligible.
    There would be no change in the law that requires emergency rooms to treat people who need emergency care, including undocumented immigrants. There is already a federal grant program that compensates states for emergency room costs associated with treatment of undocumented immigrants, a provision sponsored by a Republican lawmaker.
    If there was no benefits for illegals why did the WH come out with this?

  11. to further Davis comment that fact the Democrats in the house and senate have now admitted the bill is lacking and that they are going to go back and amend it proves Wilson was right. Despite what the bill claimed illegals would have recieved benefits the same way they get jobs with fake documents.
    Once you claim every illegal alien is a hard working honest citizen who only wants to earn a better life you show your true narative and naievety. I’ll assume you avoided the simple question becuase you couldn’t answer it without hurting your argument. I never claimed all, a majority, or even sizeable number where, I simply asked if american employers also inited those illegal aliens.
    From your comments it seems apparent you have never lived in Las Vegas or Southern California. I do and have in both and can say from personal experience your full of S^(*. I can name specific illegal immigrants and street gangs if you like.
    They also file returns so they can get refunds. Did you know they can claim non citizen dependents in other contries as deductions?
    The part you miss is how many deductions they claim. From the numberous websites I read it is common knowledge that you can claim 5-6 kids and have next to nothing withheld. So you they may file but that doesn’t mean they pay anything.
    “And it is very debatable about how much extra costs illegal aliens really cost the U.S. healthcare system.”
    This isn’t debateable at all we know it cost UMC 21 million for dialysis and 70 million plus over all. Nationally we know it cost 11 billion to treat them. There isn’t a question to that, that is the number.

  12. Brittancus and Davis, you might just want to go straight to the microchips implanted beneath the scalp.
    Meanwhile, Rob Miller is closing in on $1M in contributions, thanks to the boorish lout from SC.

  13. Here’s the flaw in your article:
    The bills published by the House and Senate do exclude illegal immigrants from Obama’s health care plan, as noted by your direct citations.
    Why Mr. Wilson’s cry of “You lie!” is completely justified is that the bill fails to describe exactly how this provision will be enforced.
    As it stands, illegal immigrants exist and thrive within this country because, despite immigration laws, the provisions providing for the enforcement of these laws vary from city to city, county to county, state to state, in all varying degrees ranging from lackadaisical to blatantly turning a blind eye.
    As far as I’m concerned, Obama’s plan IS a lie until a provision is written into the bill that meticulously outlines a uniform system (such as a nationwide database) that verifies and monitors the status of all persons subscribed to his health care plan.

  14. The incident that occurred in Congress by Rep. Joe Wilson R-NC, illustrates the consequences of a blurring line between illegal immigration and health care. Our politicians have been alerted to the angry voices of the American people. For once they have disregarded the business campaign contributors and all the cloaked gifts given for services rendered by special interest lobbyists. Millions of US citizens are enraged with the status quo buying favors from our representatives that has led to our wilting economy. Today speaking on behalf of Washington committees on health care, the lawmaking emphasized that illegal aliens cannot access the new health reform package, that any person applying will be checked through government databases.
    E-Verify might be implemented for this very issue, that it has shown in the majority of cases remarkable successes in remove illegal alien workers from the working environment. E-Verify can solve this problem and bring sanity back to immigration enforcement. E-VERIFICATION OF EACH AND EVERY AMERICAN WORKER MUST BE MADE PERMANENT? NOT JUST VOLUNTARY POLICY, BUT AS A FULL FORCE OF OPERATION CARRYING STRICT PENALTIES. This operation will work under federal policies? But what about state laws? California as an example is a Sanctuary state for millions of illegal immigrants and their families? Other border states are also occupied by large proportions of unlawful populations of foreign nationals?
    This last year has culminated in huge financial losses in California caused by millions of low income illegal aliens, which has created a third world community within the United States. There must be federal measures to bring under control, massive spending benefits for people who have no right from benefiting from those who come here legally or were born here. How can any public health care option work at a state level, when states like California ignore federal law, regarding financial refuge to indigent people? Our own people remain homeless and in many cases without hope, when legislators have prioritized, health care, education an overloaded jail system and easy welfare money for illegal immigrants?
    The once golden state has been using taxpayer money, to support illegal aliens, when the same expenditures should have been adopted for a collapsing infrastructure. Highways, schools, tunnels, bridges and dams in a dangerous state of disrepair? Our legislators in many cases have been seduced by lobbyists and should be banned from any contact with our politicians. This will never happen, but something must be done? Millions have been spent on derailing the health care reform currently and in the past, as has immigration enforcement. Rescinding 287(g) federal training for local police enforcement of immigration laws, the NO MATCH LETTER and the cutting back on ICE raids on obnoxious businesses using foreign workers.
    The order to crush E-verify was given to Sen.Harry Reid, Speaker Pelosi, Janet Napolitano, but narrowly survived in the Senate chambers. Both political parties are equally to blame for not enforcing the 1986 Immigration Control & Reform Act that was inundated with fraud and a desire to weaken the laws. Now they want to rescind that law, offering yet another reform package that will never function? Let’s not kid ourselves! Huge veiled forces are at work to import as much cheap labor as possible with no restraints, lowering wages and an unconscionable burden on taxpayers.

  15. Nate,
    Once you bring in “drug dealers” and “street gangs” into the discussion on immigration and healthcare you reveal your true narrative. You are just another one of these right-wing nutters.
    Out of the 14 million illegal immigrants how many do you think are drug dealers and in street gangs? Are you a joke? Do you have any ideal what illegal immigrants do in this country? Do you think they come to this country so they can hang around and sell drugs and just use our healthcare. They come here to work.
    The question of; do illegal immigrants receive more government benefits than they pay in taxes? Is an old question that has been debated for years. There are plenty of studies done on this topic. Go read a few objective ones.
    The reality is that illegal immigrants put back a hell of lot into the tax system in the U.S.
    A few examples:
    “Illegal immigrants pay an estimated $9 billion in Social Security taxes every year. In most cases, the money comes out of their paychecks, which are processed using fake Social Security numbers. And they don’t get the benefits.”
    “Borthayre points out a lot of illegal immigrants file tax returns, too. The IRS will give them a Taxpayer ID number, even if they don’t have a Social Security number. And the IRS has pledged not to turn in illegals who pay their taxes. Why would illegal immigrants want to pay taxes? Borthayre says getting that Taxpayer ID number is crucial. People can use it to get loans and enroll children in school.”
    “The controversy over immigrants and taxes generally centers on illegal immigrants. Reliable numbers are hard to find, but researchers generally agree that 50 to 60 percent of illegal immigrants nationwide work for employers who withhold income taxes and Social Security and Medicare payments from their paychecks. The authors of the Urban Institute study assumed 55 percent do. To get jobs, many of those immigrants use false Social Security numbers. That means they pay into the Social Security system for benefits they will never receive and pay income taxes without ever filing a return to determine whether they have overpaid.”
    etc. etc. etc. etc.
    The point is that the talking point that illegal aliens are sucking the U.S. healthcare system dry and it is a big problem is a joke and being exaggerate by the right-wing. Illegal aliens do pay taxes, so they contribute to tax system that reimburses hospitals of immigrant costs.
    And it is very debatable about how much extra costs illegal aliens really cost the U.S. healthcare system. It more of a sideshow as there are much bigger fish to fry that are problem issues in U.S. healthcare.

  16. searching for how many deductions do illegals claim it seems to be pretty common knowledge to just say you have enough dependents that no taxes are withheld which really kills the whole they contribute more then they spend argument. If they illegally enter the country, steal SSNs, and break countless other laws I don’t find it far fethched they would avoid taxes as well.
    “Best Answer – Chosen by Asker
    Given the fact that I have worked as a manager over some illegals, the social security numbers they have are valid, just stolen. They buy them mostly in Chicago along with birth certificate and identification. They usually claim about 12 exemptions on their taxes, that way no taxes are taken out and most of them do not try to file at the end of the year. A few of my hubby’s close friends have filed even though they are illegals, but it was because their children had valid US social security numbers. They got a little back. Don’t always just assume they don’t have valid SSN, because like I said, most do they are just stolen and resold. Sometimes, I would have three or four of them using the same SSN and had to turn them away. Most DO NOT work under the table, as stated before. They work jobs most of us Americans don’t want to do. My hubby is hispanic, but still believes they should pay taxes. I think it’s ok they are here, they just need to pay taxes like the rest of us and not be allowed state insurance, food stamps, or TANF.”

    “Since my acquaintances are law-abiding, they do the paperwork. They tell me that the most common ploy is to claim six dependents on the W-2 form, apparently the magic number that is accepted by the IRS without scrutiny. This number is routinely claimed both by single immigrants, and by those who may have children not in the U.S. and thus not usable as deductions. Usually this results in no tax withheld, and since they never file an income tax return, the chances of their being caught are infinitesimal.”

  18. Luci,
    Do you know how many deductions each of them claim? I would bet they have learned by now that since they can’t file returns they claim enough deductions so their withholdings are minimial.
    Apparently they do have a way to recover;–43088487.html
    Large numbers of illegal immigrants file tax returns using phony Social Security numbers to cash in on the federal Earned Income Tax Credit, thanks to lax government management,
    Rubenstein also cited figures from the General Accounting Office (GAO) showing that as many as a third of all EITC claims are “improperly paid.”
    Here is why this is such a bad deal for America;
    Mr. Lima said that he had been a police officer for 16 years in Ecuador, before the country’s economic crisis left him unable to support his wife and three daughters on his wages. He sent them about half the $12,000 he made last year, he said.
    Of 1,700 ITIN returns prepared there between mid-January and early April, two-thirds of the filers owed money, said P. J. Kim, director of income policy at Food Change, a nonprofit agency in New York City that uses laptops and software lent by the I.R.S. The average income was $9,400 a year, the average tax bill was $623.
    $623 doesn’t pay for many social services, education, or anything else.

  19. Phillip,
    You quoted a study done a couple of years ago on Health care and illegal immigration. Do you recall the name of it, or direct me to where I might find it? About 90% of my co-workers are illegal immigrants. I observe many things and come to many conclusions through observation. I am always interested in research on the subject. All the workers I work with pay taxes. Money that goes into the system, but because of false documents have no way or recovering what a legal worker could. Why isn’t this more commonly known? We seem to know all the costs they are incurring, but not what they are inputing.

  20. Peter does google gve you kick backs for my searching?
    In Texas, where the state comptroller estimates illegal immigrants cost hospitals $1.3 billion in 2006, the University of Texas Medical Branch in Galveston is considering denying cancer care to such immigrants.
    Data on health care costs for illegal immigrants are sketchy because hospitals and community health centers don’t ask about patients’ legal status. In California, a 2004 study by the Federation for American Immigration Reform put the state’s annual cost at $1.4 billion.
    From 2001 to 2004, spending for emergency Medicaid for illegal immigrants rose by 28% in North Carolina, said a March 2007 article in the Journal of the American Medical Association. Researchers cited increases in childbirth and prenatal care, as well as injuries and chronic disease complications.
    At the state and local level, illegal immigrants already cost more in public services such as education and health care than they pay in taxes, the Congressional Budget Office reported recently.
    California, which spent $51 million last year to provide more than 1,300 illegal immigrants with free kidney dialysis. Officials estimate that over time a single patient on dialysis will easily cost taxpayers more than $1 million.
    When the illegal immigrant’s transplanted kidney failed she lived in a state that didn’t offer free dialysis for illegal aliens so she moved to California for the costly, thrice-a-week treatment. Seventeen years and thousands of treatments later, she has vowed never to leave generous Golden State.
    Medical care received by illegal immigrants at Parkland Memorial Hospital cost more than $22.4 million this fiscal year, officials said.
    Of the 664 illegal immigrants in the study, 68% were uninsured. Only 19% had a chronic medical condition, compared with 38 percent of American-born adults,
    They might be younger and healthier but they also don’t pay. It’s still billions in public money that shouldn’t be spent and billions more in care not paid for,

  21. “I can show specific cost, 21 million at UMC for dialysis…”
    Nate, you’re going to have to expand that dialysis example you keep repeating as if it’s the norm. All I can come up with on Goggle is UMC, UMC, UMC. How much nationally does illegal immigrant long term dialysis or cronic treatment cost healthcare? Most illegals are young and therefore healthy.

  22. Phillip,
    Your debating facts with theories. The small amount of income and sale taxes that illegal immigrants pay go mainly to police, school, social services etc. They do prop up Social Security as they hopefully will never be collecting benefits. Reimbursement for uninsured care is done mainly through Medicare taxes, State Premium Taxes, and private insurance payments. Illegal immigrants consume billions more in healthcare then they pay in taxes. See dialysis at UMC for example.
    “Illegal immigrants, who in the end are invited here by American employeers,”
    Wow laying the hyperbole a little thick. Does this include the drug dealers and street gangs? What about those that are deported and sneak back are they invited? What do they get in return. Besides free education for their kids? Safe Place to live? More money in a month then they can make in a couple years back home? Your right I have no idea why so many sneak in they would be so much further ahead staying home.
    “They exaggerate how much of a problem uninsured illegal immigrants are to the U.S. healthcare system.”
    I can show specific cost, 21 million at UMC for dialysis and you show a theory where you think they contribute to care, who is exaggerating?
    What was the movie title, life without a Mexican or something where they all disappear one day. Lets see what would happen;
    1. Billions saved in uncompensated care
    2. million of open jobs available for the unemployed, labor shortage would drive up low income wages, in effect a huge increase in effectual minimum wage.
    3. As far as the uninsured; “Approximately 700,000 babies were born to post-1990 immigrants who lacked insurance. A study from the Center For Immigration Studies in examining this development concluded that, “new immigrants and their U.S.-born children ac¬counted for 73% of the growth in the uninsured population.” Uninsured illegal immigrants tend to have uninsured kids. We wouldn’t have any where close to 46 million uninsured if all the illegal immigrants where gone and took their American born kids.
    4. “Each year, approximately 350,000 late pregnancy alien mothers illegally cross the border expressly to have a baby citizen.”
    5. TB was almost gone in the US until it was brought back over our southern border.
    6. “The 18-24 month cost to treat MDR-TB is up to $1.2 million per patient. In California, 84% of MDR-TB patients were foreign born, from Mexico or the Philippines and are twice as likely to transmit the disease to others.”
    In fact by removing the illegal immigrants we could probably have universal healthcare without any increase in taxes. “From 2000 to 2006, remittances grew to nearly $24 billion a year from $6.6 billion” That is 24 billion per year out of our economy, apply some elasticity of money theories your talking about a 100 billion plus reduction to GDP. Federal government collects roughly 16% of GDP in taxes. That is $16 billion to work with. “The cost of treating illegal aliens amounts to nearly $11 billion a year, according to calculations done by the Federation for American Immigration Reform (FAIR), “ That takes us up to 26 billion. “Nationally, there are an estimated 5.1 million ESL students speaking 145 languages. 80% of ESL students speak Spanish. If 90% of the ESL students are children of illegal aliens then the education costs for children of illegal aliens is about $34.5 billion per year. “ That makes 60 billion and we can stop there for now. That would give us $2000 to spend per remaining uninsured assume we still had 30 million. Between newly employed and reduction in anchor babies most likely that number would be much lower. The huge reduction in uncompensated care would lower the cost of private insurance making it more affordable. It is safe to say we could almost completely solve our Health Care problem just by enforcing our border.
    If you would like to provide some actual numbers to go with your ideas we can debate it, so far your claim “You could eliminate all the illegal immigration healthcare costs and you would not do a single thing to get the 17% of GDP the U.S. spends on healthcare down or insure another person.” Doesn’t seem accurate.

  23. Stephen Motew,
    The connection between taxes and free healthcare is this.
    Hospitals get reimbursed for uninsured immigrants healthcare from government. Illegal immigrants pay taxes, both sales taxes and often income taxes (as they often have fake social security numbers). In many cases illegal immigrants might be paying as much taxes as you and me. Therefore, illegal immigrants, because of their paying into the tax pool, also help pay for the uninsured illegal healthcare costs, therefore, as a group they are not getting 100% free healthcare. Illegal immigrants, who in the end are invited here by American employeers, bust their ass for this country every day and what do they get in return, very little.
    Nobody is ignoring anything. It is just clear that many conservatives see it very politically smart to tie the immigration issue to healthcare. They exaggerate how much of a problem uninsured illegal immigrants are to the U.S. healthcare system. You could eliminate all the illegal immigration healthcare costs and you would not do a single thing to get the 17% of GDP the U.S. spends on healthcare down or insure another person.

  24. Stephen Motew,
    The government reimburses hospitals for providing service to uninsured immigrants.
    and this:
    If many illegals pay taxes, either sales taxes and very often income tax (as many have fake social security numbers) then they are making a tax contribution to the country, adding to the tax pool. They are therefore also helping to pay for the government reimbursements to hospitals for immigrant care. The point is that they are not just getting a complete free ride. They do also help pay for it through the taxes they pay.
    Now imagine if illegal immigrants actually had health insurance that they even paid for directly themselves and could avoid a lot of those desperate expensive emergency room visits.
    Nobody is ignoring anything. The point is that illegal immigrants are not the major cost problem that many would like to make them out to be. They are just being largely scapegoated by those conservatives who see it makes big political sense to tie the illegal immigrant issue to healthcare.
    You could could completely eliminate all illegal immigrant costs to the healthcare system and it would do absolutely nothing to get the 17% healthcare costs per GDP down. It would also not really get one more person covered by healthcare.

  25. I don’t expect them to afford insurance I expect them to get their illegal ass out of our country. I then expect the basic laws of supply and demand to take over. If farmers in CA and rich liberals need labor they are going to have to start paying more for it. If they don’t pay more then they can pick their own vegitables and watch their own kids. At the same time our government needs to stop screwing up the economy. Labor demand is warped when the government pays people not to work for 26, 32, or more weeks. Who would spend a day picking fruit in 90 degree weather for $10 an hour, let alone $7.25 when Uncle Sam will give you that much to stay home and play X-box? The only reason illegal labor is so cheap is it is hard for them to collect unemployement. If they could make $10 an hour to stay home they would to, then farmers and liberals would be forced to pay more to draw people out of unemployement. Businesses shouldn’t have to compete with welfare for workers, on a Liberal could dream up this system.
    We need to eliminate unemployement immediatly. If you lose your job you have a choice of finding anything that pays while you look for better work or you can sort trash for minimum wage at the government job bank. Government is just as much to blame as business. Liberals with their Gardners and Nannys are still hypocrits.

  26. Illegals and Medicaid. Why would it be any different with proposed healthcare bill?
    Republicans never tell us who’s going to pick our food, slaughter or food, clean our homes, build our houses, do our yard work, care for our children, or any of the other low wage jobs that even Republicans want done if we don’t accept labor from Mexico. I would side with Republicans if they pushed for higher wages and better working conditions to replace illegals with legals, but Republicans have always fought against higher wages and better working conditions, especially in the South. And remember illegals are paid by legal business owners.
    “They should get health care, but they should pay for it. They should get insurance, they should be required to get it, but they should pay full price for it.”
    Nate, we actually agree on this, but how do you expect low wage illegals to afford insurance under the present system, and how do you expect them to continue to pay their premiums if they are injured/sick?

  27. There are 80 illegal immigrants going to emergency for dialysis up in Nevada, at a cost of millions. For anyone that is knowledgeable about dialisys, a person on dialisys is not going out and working much the other days of the week.
    It is doubtful that illegal immigrants pay taxes to the extent that most of us legally here do. It is not doubtful that they use more government services then most, between translation, ESL and various other programs, including those aimed at illegal immigrants, they do.
    They should get health care, but they should pay for it. They should get insurance, they should be required to get it, but they should pay full price for it.
    This is the section referred to. Now, I am going to propose that if you think this makes it illegal for an illegal alien to get either health care, health insurance, or the affordability credit, you have read it incorrectly.
    The law has to be read with its plain meaning, do not add any of your assumptions to it. It also has to be read in light of other laws, and in light of the administrative rules and in light of court rulings and so on.
    This says section merely says nothing in this subtitle (Subtitle C–Individual Affordability Credits) shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States. It refers only to that specific subtitle.
    There is no verification, there is no subsidies or payments shall not be made for illegal aliens. In fact, the health insurance programs are open to illegal aliens, the payments to their employers if they meet other criteria, even payments to illegal aliens are all fine depending upon the administrative law that does not exist.
    That is why there needs to a specific exclusion.
    Open borders will not work with a welfare state, especially since neither Mexico, Canada, or our other neighbors have opened or wish to open their borders to the extent that they provide public paid for or subsidized health care to illegal aliens. The only way that will work is if all three countries are one country and generally the same in all areas of the economy, law etc.
    Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully
    present in the United States.”

  28. Tort reform already exists in Florida which is sufficient to deprive injured patients of civil court remedies. (That was the goal of our sweeping tort reform several years ago, right?) But medicine hasn’t gotten any less expensive nor has the quality of care increased. Case in point – me. I wrecked a motorcycle and injured my back. I went to see Dr. Ramy Hanna of Titusville, Florida, who is an orthopedic surgeon. I filled out the intake form and I stated that I was allergic to Hydrocodone. Dr. Hanna read that statement at least three times and even corrected the spelling of the word – hydrocodone. He then asked me to handle his real estate law case because that was very important to him at the time (I am a lawyer) – but I refused. He then prescribed a pain medication for me called Lortab. Unbeknownst to me, Lortab is hydrocodone. Three days later, I was in the hospital because of the Lortab poisoning. The emergency room physician scolded me for taking Hydrocodone. I denied that I was taking Hydrocodone and instead I told him that I was taking Lortab. He said they were one and the same. I bled and itched all over my body for a solid month. It took in excess of 9 months for the itching flareups to become minimal. The State of Florida administratively prosecuted Dr. Hanna for poisoning me. (DOH Case #: 2007-27355; License #: ME0077911) In order for the state to do that, they first had to have their medical expert make a preliminary determination that Dr. Hanna committed malpractice. A Final Order issued on December 19, 2008 wherein Dr. Hanna paid a fine, received a “Letter of Concern” from the medical board and had to take a class on laws and rules, but he wasn’t required to pay my medical bills that he was responsible for – and he has continued to refuse to pay them ever since.
    I tried to hire a medical malpractice lawyer, but no one would take the case. As I only lost a month of work from the bleeding and itching, it wasn’t cost effective to represent me. The new tort reform law requires that victim/patients pay thousands of dollars up-front for a medical expert to render an opinion of malpractice before a lawsuit may be filed. Malpractice lawyers told me that If I lost my life or suffered a “permanent and substantial” injury, then I would have a case – but there was no case for small injuries. That’s tort reform. What did it get Floridian’s? Crappy medical care and physicians who can now hide behind the medical malpractice shield.
    I filed my own lawsuit recently to challenge the state law that requires a medical opinion before suing a doctor. I think that if the State of Florida’s medical expert says that Dr. Hanna committed malpractice, that ought to be a sufficient substitute for my own store-bought medical expert opinion of malpractice. That case is in Judge Davidson’s court (Circuit Court of Florida, County of Brevard – case number 05-2009-CA-035241) Hearing on their motion to dismiss is set for September 29, 2009. Email me for a free copy of the pleadings. (321-795-5151) 3005 Irwin Avenue, Mims, FL 32754
    Suggestion #1: Give a patient an administrative remedy against a physician to recover out of pocket costs and losses; alternatively,
    Suggestion #2: Give a patient a right to appear at a Department of Health hearing against a physician and request restitution.

  29. Nathan, you need to study harder or be less partisan, as your argument is either week or dishonest.
    “it’s not clear why anyone would take issue with immigrants purchasing insurance on their own, without federal subsidies.”
    You really don’t get why someone would object to illegal aliens buying insurance that no longer has pre-existing limitations, annual or life time caps, and is community rated or contains minimal underwriting? Common sense would seem that any illegal immigrant in need of major medical care could just sneak into the country and by law be allowed to buy a policy with complete coverage for a fraction of what their known claims are. I could see Mexico handing out maps and brochures with instructions on how to take advantage of this, they already help them sneak in. If you missed this obvious issue you really need to sit out the remainder of the debate.
    Why when given multiple opportunities to clearly forbid illegal aliens from receiving care did Democrats block the Amendments? Republicans proposed clear and enforceable amendments that would eliminate any confusion, if the bill doesn’t intend to allow it then why keep them out? Why are Democrats creating an argument when supposedly there isn’t one?
    “although nothing in the bills seems to alter federal funding for emergency care provided to immigrants,”
    UMC in Las Vegas is spending 21 million a year providing emergency dialysis to illegal aliens, their entire budget deficit of 70 million can be contributed to illegal aliens. Why if we are reforming the system to make it work would the President and Democrats not only refuse to specifically address this problem but leave it in such a gray area. This is as dishonest as the refusal to even discuss tort reform.
    “Congress severely limited immigrant access to programs like Medicaid as part of welfare reform”
    BS every study done on Medicaid says the states have no clue who is enrolled in Medicaid. Every eligibility audit ever done says citizenship can’t be determined for 5-10% of enrollees because no one is checking.

  30. So, are people who’ve come into this country illegally not actually people, in the “human beings” sense of the word?
    A society’s best judged on how it treats the most vulnerable within it.

  31. Technically illegals are not covered, however in fact they will be because all of the amendments by Republicans that would require proof of citizenship have all been rejected by the dems. So, if HR3200 passes, all you’d have to do is say, “Yep, I’m a citizen!” Now, if you’re here illegally in the first place, would you feel any ethical obligation to not sign up for government health insurance because you’re here illegaly?
    Another take on the speech: article called Show me the Money

  32. Simple to solve this issue. Put a statement that anyone in this country illegally will not be covered by this plan now or with any future amnesty legislation. Obama says it is a lie and wants to assure the people that those here illegally are not in the plan, but that statement into the bill. We all know this is weasel language he used and that he fully intends to have them in the plan. If he does and thinks it is right to cover them, than say that and tell us why and how it will happen with budget Neutrality now and in the future? As to statements they are paying taxes like sales tax and so deserve to have some benefits given to them by the government, one could also say a bank robber who buys things pays sales tax and should also receive amnesty and government benefits. Illegal people are breaking our laws and the government should never reward illegal behaviour. We tried amnesty a few years ago and promised to stop the influx. citizens of other countries are not our problem. those who enter legally are welcome and should have every right they deserve in the process. If some want to have open borders, let them step forward and make the case to change the laws and stop rewarding illegal behaviour.

  33. Beth, from your “fact”? check link:
    “(And by the way, when has ANY Government plan been deficit neutral?)”
    Certainly not the War in Iraq or the tax cuts for the wealthy.
    “We wanted tort reform, which would, by the way, reduce cost.”
    Yes, for insurance companies and doctors, not the system or premium payers.
    “What he doesn’t say is that your employer is not required to keep your coverage the way it is…”
    No your employer is not, he can cut/eliminate benefits and raise premuims just as he has been now in an attempt to keep ahead of increasingly unaffordable healthcare costs.
    “He also didn’t address the doctor shortage…”
    Brought to you by the present system. And which doctor shortage would that be, overpaid specialists overutilizing, or under paid PCPs?

  34. Phillip,
    I was not aware of the connection between sales tax and free health care? The same could be said about income tax because if so I should have a great coverage policy, though I am not sure that illegals ‘often’ pay this.
    Please refer to the following for a disturbing example of how ‘free’ health care can affect a large academic center and to address the misconception that the ‘sick’ do not cross borders:
    Las Vegas Dialysis Care
    The bottom line is that ‘we’ pay for this, and this may continue to be the status quo, but to ignore the impact on health care dollars is silly.

  35. Illegals will continue to get healthcare the way they do now. It simply will not be covered by Uncle Sugar. Yet it will be provided by the Emergency Departments. A steal of a deal, don’t you think?

  36. Not sure what the big deal is with illegal immigrants and healthcare costs. Illegal immigrants pay taxes, both sales taxes and often income tax. It is not like they are completely sucking up free healthcare. They are helping to pay for it with the taxes they do pay.
    Secondly, quoting from a study done on illegal immigrant healthcare costs a few years ago:
    “Immigrants in general tend to be young, working people and they tend to be healthy,” said Ralph Silber, executive director of the Alameda Health Consortium, an association of eight nonprofit community health centers. “People who are incredibly sick tend not to be crossing borders, and certainly not crossing borders illegally.
    Illegal immigrants might contribute to crowded emergency rooms and hospitals’ financial losses, but they are not the driving factor, said Jan Emerson, spokeswoman for the California Hospital Association.
    “It is unfair for the public to place the blame for all of societal ills — in this case, hospital ills — on undocumented or illegal immigrants,” she said, adding that the vast majority of the country’s 46 million uninsured people are native-born or legal residents. “If we were to resolve the issue, we still have major problems with our health care system.”
    The whole healthcare/illegal immigrant issue is just another paranoid racist issue. Not surprised that idiot Joe Wilson came from South Carolina. South Carolina has one of the highest rates of uninsured in the country. Maybe that idiot should spend his time with getting health insurance/care to the people of his state instead of lying to the American people about a BS issue.

  37. I can’t for the life of me imagine why the the nativists and bigots are so set against opening the borders to the masses of Asia and Africa.

  38. Without a mechanism in place to require people to prove they are a lawful immigrant/citizen, there is no way to enforce these provisions. Typical political doublespeak.

  39. Thank you for this well reasoned post. Of course politics and political statements have little to do with the truth, necessarily. When appealing to an uninformed constituency does it matter to the politician that he speaks the truth or that he says what that constituency wants to hear? I think we know the answer. Joe Willson has made it plain, as have many others before him.

  40. You know I am not supporter of illegal immigration..but I do beleive we need to create a borderless society.
    Afterall it is free market. Is’nt it!
    Having said that, I would think it would be tragedy to not treat people properly. Any person not happy on american land will speak of our values or lack their of.

  41. If Joe Wilson genuinely believes that he’s telling the truth, he can hold a press conference, point directly at the pages of legislation in question, and read it outloud. Because of his outburst last night, he’s guaranteed an audience on national TV. Anyone willing to bet if he does that?

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