Immigration's Zero-Sum Impact on Health Care

By James R. Edwards, Jr. on February 11, 2010

President Obama and congressional Democrats are trying to figure out how to get health reform back on track. The president took a desperate, rare step and invited in GOP leaders this week to give his quest an air of bipartisanship. A key goal of those driving this "reform" has ostensibly been to extend access to health coverage to the uninsured.

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The untold truth is that immigration is driving much of the growth in the uninsured population. Even relatively low-immigration states such as Minnesota face the consequences of huge immigrant health care burdens. California, the number-one destination of the foreign-born both legal and illegal, has seen many hospital closures. Many couldn't sustain the oppressive amounts of care demanded by uninsured patients, in many cases aliens.

It strikes some as hard-hearted to say so, but immigration is a major reason hospitals face much of the crushing levels of bad debt and uncompensated care. The reason is simple. As CIS's Steve Camarota has reported: "34 percent of immigrants lack health insurance, compared to 13 percent of natives. Immigrants and their U.S.-born children account for 71 percent of the increase in the uninsured since 1989."

Legal immigrants' sponsors are supposed to bear financial responsibility for new immigrants during their first five years in the country. Sponsors are supposed to have sufficient income to meet both their own family's and the sponsored immigrants' needs. But the legal minimum income for visa sponsors is a paltry 125 percent of the official poverty level. That's $27,562 for a family of four. This income level is far too low to ensure sufficient financial wherewithal in case of medical or other need. And there's no requirement that visa sponsors have health insurance or obtain satisfactory insurance to cover their entire household, including prospective new immigrants. Throw in the chain migration visa categories that swell legal immigration far beyond reuniting nuclear families. That's a recipe for insurmountable cost stresses on things like the health care system.

Some also regard it as hard-hearted to say that immigrants bear individual responsibility for the financial burdens they place on this society, including our health system. But they are here because of a choice they made to come to this country – many outside the law. The expectation should be that they assume the risks associated with life in the first world's most developed nation with the highest standard of living. That means spending their scarce dollars on health premiums, not remittances sent back to their home country.

And individual responsibility constitutes a core principle of America, whereas the "nation of immigrants" line is largely sentimentalism. You don't exchange core principles; you do leave sentimentality behind when it's unrealistic or unsustainable.

Shouldn't immigrants be expected to abide by our American core principles like individual responsibility? Is it too much to ask of those who live here, even illegally, that they act responsibly in this one area and obtain health coverage, rather than risk imposing a burden on society? How is it our moral responsibility to provide thousands or millions of dollars' worth of medical treatment to someone who, except for an overly generous immigration system or insufficient law enforcement, wouldn't even be in this country, who provides false information on hospital forms, who has either no means or no intention of paying his medical bills, who apparently regards it as a right that he's due medical care while some poor American, perhaps also uninsured, is forced to wait longer for care behind a foreign resident or even forego needed treatment?

Health care is basically a commodity. Medical goods and services are relatively scarce. That makes health care a zero-sum game. There will be winners and losers. If the public is forced to pay for part of it for other people, in addition to one's own health care, then hard choices must be made. The easiest options are to stop bringing in more people who can't pull their own weight, send back those who show themselves incapable or unwilling to assume individual responsibility where health care is concerned, and to allow health care providers to turn away people who have no prospect of paying for the scarce care they demand. Many providers will treat them anyway, but then it's a conscious decision, not something forced upon them by the heavy hand of the law.

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Topics: Health Care