Obamacare Loopholes May Benefit Illegals at Taxpayer Expense

By James R. Edwards, Jr. on May 8, 2012

The Los Angeles Times recently reported on program known as ROC-MD in Southern California that provides a form of health coverage designed for illegal aliens.

The program was started by the Restaurant Opportunities Center of L.A. and St. John's Well Child and Family Center. Uninsured illegals are charged $25 a month and can seek medical services at one of the St. John's clinics.

This program targets illegal aliens because they ostensibly don't qualify for coverage through Obamacare. However, the law already had some loopholes through which illegal aliens could tap taxpayer-funded health care.

One potential loophole is if the partner clinics receive federal or state funds as a community health center. Those dollars would conceivably subsidize illegals' treatment. Also, if the facilities collect Medicaid, Children's Health Insurance Program, or other welfare monies, the fact the funds are fungible exposes taxpayers to paying for a portion of the services the ROC-MD illegals receive. It's hard to believe $25 a month would fully cover the services one might demand.

This program also highlights a flaw in Obamacare. The law excludes illegal aliens from the federal mandate requiring individuals to buy health coverage or else be penalized. It also continues the law forcing medical providers to provide "emergency" services, regardless of one's ability to pay.

Thus, illegal aliens, including those participating in ROC-MD, could pay peanuts for low-cost, basic care at a community health center, yet still get big-ticket medical care for "free" at an emergency room — courtesy of John Q. Taxpayer, who either has government-mandated health insurance, has been forced into Medicaid, or pays a severe fine for foregoing coverage. So, John Q. is taxed for himself and for illegal aliens' health care. That leaves illegal aliens as "free riders" under the "reformed" health care regime.

There is also the prospect of ID fraud enabling some illegal aliens to "auto-enroll" in the new "exchanges" created by the health reform law. In some quarters, auto-enrollment is all the rage. As a report by the Robert Wood Johnson Foundation and the National Academy of Social Insurance points out, state exchanges are presupposed as screeners for automatically enrolling Medicaid-eligible persons in this welfare program (if not all comers in some health insurance program).

The dual nature of these obligations under the law is central to the success of program Medicaid/Exchange alignment. Exchanges are obligated, as a matter of federal policy, to play a role in Medicaid eligibility determinations, while Medicaid agencies are obligated to identify and electronically transfer into the proper "insurance affordability program" (including QHP [qualified health plan] enrollment with advance premium assistance and cost-sharing reductions) any individual who is ineligible for Medicaid but who appears to meet the standards of another program. The basis for this alignment is the ACA's [Affordable Care Act] intent to create an integrated eligibility determination process for insurance affordability programs while assuring that no premium tax credits are paid in any month in which an individual is eligible for other forms of "minimum essential coverage."

. . .

In both Medicaid managed care models, auto enrollment is a principal feature of the enrollment process. Auto enrollment is expressly contemplated under Medicaid managed care regulations, with an emphasis on auto-enrollment processes that weighs auto-enrollment assignment based on access standards, the strength and diversity of provider networks (including potentially the use of providers highly experienced in treating low income populations), and plan quality performance.

Obamacare must still pass muster with the U.S. Supreme Court, and the details to carry out the health law are still being written, should it remain in force. If initiatives like ROC-MD and the several loopholes that seem to be taking shape come about, then illegal aliens may end up rewarded for their immigration lawbreaking by the very health law that stifles Americans with an expensive individual mandate and the forcible subsidy of foreign lawbreakers.