Health Reform Loopholes for Illegals

Well, does it or doesn’t it?

Advocates continue to insist that health reform legislation doesn’t cover illegal aliens. Lawmakers, special interests, journalists, even the president assert this with seeming confidence.

Some of them imply that anyone saying illegals would get “free” health care under proposed legislation is uninformed or a kook.  

They point to the House bill’s Section 246, relating to Affordability Credits for the taxpayer-funded premium subsidy, and Section 1783, relating to Medicaid and the Children’s Health Insurance Program.  These provisions ostensibly keep these benefits from going to those “not lawfully present in the United States.”

The Senate HELP Committee bill contains similar words.  Section 162 of the Affordable Health Choices Act designates as eligible for the “public option” any “alien lawfully admitted to the United States for permanent residence or an alien lawfully present in the United States.”  That last clause about “lawfully present” breathtakingly opens up coverage to millions of immigrants who otherwise would have to turn to their visa sponsors.

Another HELP program, the “Right Choices” program, makes eligible not only the “lawfully admitted” but also any alien “otherwise residing in the United States under color of law.”  That phrase means coverage for all but the least “documented” of illegal aliens.  This program is aimed at people not eligible for Medicaid, SCHIP or several other government-run health care programs.

But just like the House legislation, the HELP bill has no teeth.  It lacks any verification requirements of citizenship or immigrant status.

Thus, many people continue to be skeptical.  We contend that illegal aliens would receive Medicaid and other government-run health care, because existing supposed checks on individuals’ eligibility contain loopholes.  

Let’s be clear:  H.R. 3200 would definitely make illegal aliens the beneficiaries of taxpayer-funded health care.  It and the HELP bill would effectively result in illegals’ receipt of these benefits, through institutionalized willful ignorance.

This all is in addition to the “free” (to them) emergency care illegal immigrants already receive.  Proposed health reforms don’t affect the current law that requires medical providers to render care at emergency rooms, regardless of the patient’s ability to pay or immigration status.

Why such certainty, against all the voices of denial?  For one thing, I read the legislation.

Second, previous actions of this Congress undermine the loud assertions.  Earlier this year, H.R. 2 was enacted to revise the SCHIP program.  The Children’s Health Insurance Program Reauthorization Act, or CHIPRA, gutted the previous eligibility verification requirements.

Section 211 of the SCHIP reauthorization bill gave states, which administer this entitlement, a less robust way of verifying someone’s eligibility for SCHIP or Medicaid.  States check a Social Security number and a U.S. place of birth.

The obvious problem, legislative sources point out, is that this “verification” scheme does nothing to verify the identity of the person proffering a given Social Security number.  Thus, an illegal immigrant today can sign up for Medicaid, present someone else’s SSN and get coverage under someone else’s name.  That’s a recipe for massive identity fraud.

H.R. 2 weakened effective citizenship verification requirements.  The 2005 Deficit Reduction Act mandated that those applying for Medicaid produce proof of citizenship.  Before DRA, states could accept an applicant’s self-declaration of U.S. citizenship.

Third, the health reform legislation widens CHIPRA’s wink-wink-nod-nod loophole.  Only the Senate Finance Committee bill contains language requiring that applicants’ immigration or citizenship status be confirmed.  

Fourth, two House committees outright rejected attempts to add meaningful eligibility verification to H.R. 3200.  Ways and Means rejected an amendment by Rep. Dean Heller that would have required verifying eligibility by citizenship and immigration status.  The Heller amendment applied to the premium support subsidy program, which the proposed Health Choices Administration would run.  Energy and Commerce by a single vote killed an amendment by Rep. Nathan Deal that would require citizenship-status verification of Medicaid and SCHIP applicants.

Absent meaningful, bonafide verification requirements, every expansion of health care access will stimulate gross waste, fraud and abuse by ineligible foreign-born applicants.

Fifth, H.R. 3200’s Section 1702 mandates presumption of eligibility for Medicaid and SCHIP enrollees, no questions about immigration or citizenship status asked.  State agencies would be barred from performing the same verification measures taken in most other means-tested programs.  This amounts to a gaping loophole.

Those who read the legislation, understand it as a whole, and recognize loopholes built in on purpose, as happened in CHIPRA, will come to one, single, inescapable conclusion about health reform:  This legislation ensures that taxpayer-funded health care will benefit immigration lawbreakers.