It's the Immigration, Doctor!

By James R. Edwards, Jr. on August 2, 2012

Hospitals in areas with lots of illegal aliens fear certain looming cuts in the Obamacare law. The New York Times recently reported on providers' reliance on federal funds for a portion of the care rendered to uninsured illegal aliens.

Certainly, uncompensated care imposes a financial strain on hospitals and other providers. And that's caused by treating any and all uninsured patients, not just immigrants. Add to that the fact Medicare and Medicaid pay providers substantially less than the actual costs of medical services those patients receive. The Disproportionate Share Hospital (DSH) program, the pot of money the Times article focused on, is scheduled to go from a $20 billion budget to $10 billion in 2019.

Under health reform, Medicaid (medical welfare) is expanded drastically. Medicaid, because states and the federal government share roles carrying out the program, has gobbled up breathtaking shares of state budgets. It has been a Pac-Man eating up state dollars. Medicaid growth has become practically unpredictable and unmanageable — and unsustainable. Following the Supreme Court's ruling that states can't be punished for not expanding their Medicaid, that program is hardly an option for providers to get illegals' medical treatment covered. Besides, illegals are disqualified from the program.

The insurance exchanges coming in each state, which will mete out graduated, taxpayer-funded premium subsidies, also disallow illegal aliens from getting health insurance there. There are problems and potential loopholes, but the bar against illegals' eligibility remains in the health law.

The real problem, where uninsured illegal aliens are concerned, arises from the political unwillingness of this administration to do anything to discourage illegal immigration, the political unwillingness of Washington to reduce legal immigration to manageable levels, and the weakening of public charge doctrine, which traditionally bars immigrants who can't be self-sufficient.

Healthcare providers should consider how federal failure to enforce our immigration laws, coupled with mass immigration biased toward immigrants lacking skills, education, and the ability to carry their own weight in this society, puts those medical facilities on the hook. Rather than remaining silent about the truth of the situation, providers would be better off if they would stand up for the rule of law and smarter immigration priorities. Ironically, attrition through enforcement, the end of chain migration, and lower legal immigration with better-educated immigrants would financially relieve hospitals, clinics, and every medical provider that now treats poor or illegal immigrants.