Immigrants and the uninsured
As Dr. Robertson explains in my previous post, a key factor in the rising cost of health insurance is the expenses shifted from the growing ranks of the uninsured onto those who have coverage. Several of the comments to that post blamed illegal immigrants for the increase in the uninsured. That doesn't appear to be the case.
According to the Center for Information Studies, immigrants -- legal or illegal -- are indeed more likely to be uninsured than native-born citizens. Although immigrants made up 12.5% of the population in 2007, they represented about 27% of the uninsured. There are two other factors, however, that suggest it's wrong to pin the healthcare inflation problem on border crossers. Separate studies of data from 2001, 2003 and 2006 showed that immigrant children and immigrants in generalconsume significantly less medical care per capita than native-born Americans. Noncitizens also make significantly fewer visits to the emergency room, on average, than citizens do. Second, Health Affairs reported that citizens without insurance accounted for 75% to 80% of the growth in the ranks of the uninsured from 2000 to 2006.
Rep. Joe Wilson (R-S.C.), a newly notorious member of the congressional peanut gallery, has used his 15 minutes of fameto argue a different aspect of the issue: that the House versions of the healthcare reform bill would enable illegal immigrants to receive taxpayer-subsidized insurance. The bill flatly prohibits subsidies to go to undocumented immigrants, but as Wilson correctly noted, there is no specific enforcement mechanism to guard against illegals from fraudulently obtaining subsidies. Still, that doesn't mean administrators of the subsidies would make it easy for that kind of fraud to take place. If illegal immigrants make disproportionately low use of the care they can legally obtain, what are the chances of them trying en masse to defraud a program they're not eligible for?
Although I haven't seen the Republicans' proposal for an enforcement mechanism, I think it's worth debating. I suspect, however, that many of those clamoring for a more airtight approach won't be satisfied until the laws that make emergency care available to everyone, regardless of immigration status or ability to pay, are repealed. People who feel that way -- and you'll find at least one in the comments on Dr. Robertson's views -- are letting their cost-cutting zeal (and perhaps their resentment of immigrants) cloud their judgment. It doesn't take much imagination to see what a public health nightmare such a move would create.
-- Jon Healey