Washington Post's Take on Illegals in Health Reform

By James R. Edwards, Jr. on December 27, 2009

A Washington Post editorial Saturday argues that illegal aliens should be allowed to purchase health insurance through the "exchange" created in both the House and Senate health reform bills. The argument is a familiar one in health policy circles. Having more people in the insurance pool means rendering less uncompensated care that burdens hospitals and other providers. The Post adds that illegal aliens tend to be younger and thus should amount to a net gain to the insurance risk pool; they'd pay premiums while seeking medical services relatively less often.

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The House bill allows illegal immigrants access to the exchange, while the Senate bill excludes them. And the House applies the individual mandate, requiring most people to have health insurance, to illegal aliens, while the Senate bill exempts illegals from the mandate.

The editors of Washington's liberal newspaper assume a lot. They assume illegal aliens want health insurance. The rates of uninsurance among illegal immigrants to date, compared with their remittances sent to relatives back home, indicate that obtaining health coverage may not be a high priority for a lot of illegal aliens. Many could (and do) find some form of affordable health insurance today if they were willing to buy it. But many would apparently rather spend their money on other things, including remittances of amounts about equal to the premiums of low-cost insurance policies or health savings accounts.

The Post assumes illegals don't have access to medical care without insurance. However, many receive medical services from "safety net" providers whenever they wish. The federal EMTALA law guarantees that anyone without insurance can demand "emergency" medical care, regardless of immigration status, insurance status, or ability to pay. And that can have dire consequences for everyone else in a community – such as bankrupting hospitals in Southern California and Arizona, and causing cost-shifting that increases the health care costs of responsible people who are insured. See examples of the burden of illegal immigration on American health care here, here, here, and here.)

Congress considered an amendment in 1996 to immigration reform that would have tied federal payment for illegals' uncompensated medical care to having the recipient hospitals and clinics to supply information on those illegal aliens to immigration authorities. The amendment was rejected when medical special interests weighed in that they wanted their candy without the spinach.

It's true the uninsured may not benefit from some preventive services or regular check-ups. But pretty much every medical screening and routine service is available to anyone, including illegal aliens, at no or nominal cost almost anywhere in America. Often, such services come from a private-sector medical provider. Seeking out such medical attention rests with the person who needs it and, again, this seems a lower priority to illegal aliens.

The Post also assumes that insuring illegal immigrants will amount to a net gain. It assumes these people will pay for insurance without the taxpayer subsidy created by the health reform bills. It assumes they will pay more without using more services. But research generally shows that medical care utilization rates rise as people gain health coverage. It's highly likely that newly insured illegal aliens will go to the doctor or clinic more often after they get coverage. See here and here.

In fact, a major concern in health care circles is whether the health system can accommodate all the newly insured and the services they're sure to demand. And anyone the least bit familiar with economics should warn the Post and Congress that increased demand and relatively reduced supply causes costs to go up, not down. That sets up the specter of the government, under the health "reform" regime, playing God: rationing care, choosing winners and losers, putting cost considerations above all else.

Post editors aren't much concerned whether illegal aliens receive taxpayer-funded subsidies in the exchange to pay their insurance premiums. Yet that subsidy, which the Senate makes some attempt to prevent from going to illegals, unjustly would force lawfully resident Americans to pay their own plus foreign lawbreakers' health premiums. Paying tax money for illegal aliens' emergency care already happens and remains unchanged in the legislation. That's bad enough. But forcing extra payment on the backs of people living here lawfully would unduly make illegal residents better off than they already are and in many cases better off than their American counterparts. It's effectively a reward for breaking immigration laws. It's unjust, unfair, and partial. And such "free" health care would increase even more the incentive to immigrate outside the law.