The United States is often referred to as a nation of immigrants; indeed, since the 17th century, millions of colonists, slaves and migrants have crossed land and sea to make America their home. Today, the U.S. Census Bureau reports that 12.5 percent of the nation's population is comprised of people not born in America but lawfully residing within its borders. Of course, calculating the number of illegal immigrants is somewhat more challenging - educated estimates put that number around 11 million.
Illegal residents normally avoid seeking health care, and employers seldom provide them with the insurance avenues to do so. In the case of an emergency, however, an illegal immigrant may have little choice. What happens when 11 million undocumented U.S. residents need to go to the hospital? What happens is a program known as Emergency Medicaid. A subset of normal Medicaid, Emergency Medicaid reimburses hospitals for treating sudden illness or injury for people who don't have access to any other type of insurance, or cannot provide the documentation for emergency room workers to place them on a plan.
Emergency Medicaid is mostly used to cover the emergency health needs of the homeless, legal immigrants who don't have proper documentation or have been in the country less than five years, and undocumented illegal immigrants. Emergency Medicaid is a necessary expenditure, because federal law requires hospitals to screen and stabilize anyone who comes to an emergency room, without determining insurance or immigration status beforehand. It is therefore essential that a program is in place to pay for this treatment. However, plenty of people still balk at the idea of using federal tax dollars to fund the health care needs of people who are not legal residents of the United States and pay no taxes themselves.
With a recent report from Kaiser Health on Emergency Medicaid and illegal immigrants, and the Obama administration introducing important immigration legislation earlier this month, people and politicians on both sides of the issue are finding right now the perfect moment to express their point of view on Emergency Medicaid. Kaiser analyzed data from seven U.S. states with the highest estimated populations of illegal immigrants - California, Florida, Illinois, Arizona, North Carolina, Texas and New York. Investigators found that Emergency Medicaid covers around $2 billion in health care every year; and while some of those emergency room patients may be homeless, or legal but lacking proper documentation, most, according to Kaiser, are people who have entered the country illegally.
Kaiser also reports that the "lion's share" of this Emergency Medicaid funding goes toward delivering babies - a woman will show up to the emergency room in labor, and though she lacks identification or insurance, the hospital will of course help deliver her child. This health care procedure and spending rankles some Americans. Groups such as the Federation for American Immigration Reform (FAIR) fear that allowing patients to seek medical care without documentation and proof of insurance will just lead to more illegal immigrants.
In their 2010 report entitled "The Fiscal Burden of Illegal Immigration on U.S. Taxpayers," FAIR explains its belief that Emergency Medicaid or other health care funding for illegal immigrants will encourage pregnant mothers to cross the border and give birth, in order to ensure their child's status as a citizen of the United States. Then again, considering the fact that Emergency Medicaid's price tag of $2 billion is less than one percent of Medicaid's overall annual budget, some people think the program doesn't do enough. The National Immigration Law Center, for example, has stated the importance of considering Emergency Medicaid funding for a mother's pre-natal care as well as childbirth; after all, the child will be a U.S. citizen once it is born, and medical problems which have arisen during pregnancy will still need to be treated in infancy or childhood.
If Emergency Medicaid could be extended to general wellness care for a pregnant mother, regardless of her immigration status, it might mean less health care spending in the long run. Immigration and its effects on health care are also big news this week with a leaked White House proposal regarding upcoming immigration legislation. On February 17th, USA Today reported on some key points of that proposal, including a significant policy change that would allow currently illegal immigrants already residing in the United States to become citizens after eight years. A new visa for these "Lawful Prospective Immigrants" would be issued, and future citizenship would be based on English proficiency, knowledge of U.S. history and payment of back taxes. Importantly, these newly-lawful immigrants would immediately become eligible for health insurance; indeed, according to the rules of Obamacare, as legal citizens they would have a responsibility to be insured.
The idea of adding 11 million new people to state and federal health care plans has some politicians and employers calling out the White House on an oversized and potentially impossible immigration proposal. In his response to President Obama's State of the Union Address earlier this month, Florida Senator Marco Rubio called attention to the fact that under Obamacare, an immigrant does not need a green card to receive health insurance; he simply needs to be legally present in the country. Rubio commented, "That issue needs to be resolved because if Obamacare is available to 11 million people, it blows a hole in our budget and makes this bill undoable." It is extremely unlikely that the leaked White House proposal will pass both houses of Congress, or that the full plan as is will even make it onto a piece of legislation; what with the currently tense political atmosphere toward immigration, as well as Republican control of the House of Representatives. Members of Congress are already drafting their own immigration bills, and it's a good bet that as these proposals are written, debated and redrafted, the health care of people residing illegally in the United States will be an important consideration. In the meantime, Emergency Medicaid remains.