HR 3200 and Illegal Immigrants: Obama vs. Wilson

Wednesday night we witnessed what could only be deemed a masterful performance by President Obama stumping for his vision of health care reform.  During the speech many were stunned at the sudden outburst of Rep. Joe Wilson (R-S.C.), who blurted out “You Lie” when Obama stated that illegal immigrants would NOT receive government funded health care under H.R.3200.  Since that time Rep. Wilson’s presumptive challenger in 2010 has received $750,000 in campaign contributions from around the nation, while Mr. Wilson has taken in $200,000, a measure of the intensity surrounding the debate.   But the question remains, will H.R.3200 (and companion Senate bills) provide taxpayer funded health care for illegal immigrants, if so, for how many and at what cost?

On August 25^th the Congressional Research Service, a non-partisan branch of the Federal Government, released an analysis of the question.  Titled, “Treatment of Noncitizens in H.R. 3200” this work analyzed the text of the bill, though not its practical application.  As is so often the case, the devil is in the details, and these details will be determined in part by regulations as yet unwritten.  Proponents and critics alike have cited this report, which critiques the language of the bill with regard to illegal immigrants.

Indeed there are several sections of H.R. 3200 which address directly the implications for immigrants, both legal and illegal. They are dealt with separately below; but first, a consideration of the size of this issue.  The Center for Immigration Studies estimates that there are 6.6 million illegal immigrants currently without health insurance with incomes between 133% and 400% of the poverty level, who could potentially qualify for the proposed “affordable premium credits” through the National Health Insurance Exchange.  These credits are meant to allow low income Americans to purchase insurance through the new “exchange” by subsidizing premiums for those unable to pay.  Assuming ALL of these persons were enrolled and received premium payments (credits) from the government, a conservative estimate of the cost runs at $30.5 Billion dollars annually! This would be in addition to the sections which expand Medicaid eligibility from the current cut off to 133% of poverty level.  These astonishing costs would be borne directly by taxpayers as payments made on behalf of beneficiaries to purchase coverage, causing an explosion in the overall cost of the program.

What follows is a thorough discussion of the relevant sections of H.R. 3200 and the implications for reform. There is some legalese: such is the nature of legislation. I have attempted to make it short and concise, but also complete enough that the actual verbiage is present. Why? Because it is important the the reader know first hand the truth, not what someone tells you the bills says, but what it actually does say. All relevant sections are direct copy/paste from the text of 3200, no spin here, just the facts. While it may be difficult at times, please know that by the end of this single page you WILL know the truth about the issue. The entire bill may be found online at http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:

Sections 202

Section 202 specifically creates the national health insurance exchange through which private insurance plans and the new “public option” will be offered.  According to the CRS report, “H.R. 3200 does not contain any restrictions on noncitzens—whether legally or illegally present, or in the United States temporarily or permanently—participating in the Exchange”. Immigrants, both legal and illegal would be free to purchase insurance through the newly created exchange.  Who pays for this coverage is the primary issue of contention.

Section 242

This section creates the new entitlement; a subsidy of premiums for insurance granted to people between 133% and 400% of the federal poverty level ($88,000 annually).  Legal immigrants qualify for this subsidy as stated: Section 242(a)(1) makes eligible “an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act).”

This is in fact a fairly substantial change in existing federal law dating back to colonial times under a doctrine referred to as Public Charge which is designed to protect the country from importing people who would become a burden on society. The Public Charge doctrine was strengthened in 1996 as part of welfare reform whereby immigrant sponsors must now sign a legally enforceable affidavit of support.  Existing law holds that legal immigrants are not eligible for means-tested federal welfare benefits for a period of 5 years after immigration AND that sponsors of legal immigrants are responsible for their financial support for the same period of time.  By lifting these requirements, new LEGAL immigrants would become immediately eligible for financial subsidy in the purchase of insurance through the exchange.  Reaching far up into the middle class, with a cut-off of $88,000 annual income, the credits are available to sponsored legal immigrants and foreign-born sponsors themselves.

Section 242(a)(2) of the bill provides that “[e]xcept as the Commissioner may otherwise provide, members of the same family who are affordable credit eligible individuals shall be treated as a single affordable credit individual eligible for the applicable credit for such a family under this subtitle.”

As the CRS study points out, this suggests that if one member of a “family” is eligible for Affordability Credits, all members of the family could be presumed to be as well.  Since a US born child of illegal immigrant parents is a naturalized citizen at birth, this section would seem to confer eligibility on both parents, siblings and other relatives deemed part of that family unit.  In addition, mixed families where for instance one spouse is a citizen whilst the other is not would also be eligible.  This is a very significant issue.  The Pew research center estimates that there are over two million US families with illegal immigrant parents and US born children.  The number in other mixed situations is unknown but likely of similar magnitude. H.R. 3200 does not expressly address how such situations would be treated, leaving the determination of how these credits would be administered to the as yet unnamed Health Choices Commissioner (another Czar?).

This subsection, considering a variety of family situations, seems to indicate that the President’s plan, would in fact provide taxpayer subsidized credits for illegal immigrants to purchase insurance, despite his assurances to the contrary.

Perhaps Rep. Wilson was onto something after all.

Section 246

The CRS study notes reassuringly that Section 246 states: “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.” Such language is undoubtedly what President Obama had in mind when he asserted “There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I’m proposing would not apply to those who are here illegally.”  However, critics have pointed out that nowhere in the 1000+ page bill is there a mechanism to assure this intent actually prevails in practice. In fact there is very troubling evidence to the contrary.

Nearly all other means-tested programs of the federal government use a system known as SAVE (Systematic Alien Verification for Entitlements) to ensure eligibility, some 71 federal programs at this point in time. On July 16, an amendment offered by Rep. Dean Heller (R-Nev.) that would have required use of the SAVE program to prevent illegal immigrants from receiving the affordable premium credits was defeated by the House Ways and Means Committee on a party line vote. A similar SAVE amendment was defeated by party line vote in the Senate HELP committee.

If one is to believe that the intent is to limit a very generous taxpayer subsidy to US citizens and legal immigrants, there is no justification for refusing to include the standard SAVE language in HR 3200.  In fact Dr. James Edwards, author of “The Congressional Politics of Immigration Reform” describes section 246 as a “political Fig Leaf” and notes that the “glaring omission” of eligibility verification requirements coupled with the rejection of corrective amendments makes it “absolutely certain illegal aliens will receive government health coverage”.

So on the issue of covering illegal immigrants, one must conclude that Rep. Wilson again has a point.  While the language of restraint is present in H.R. 3200, it is toothless verbiage, and overt efforts by Congressional committee members to assure it remains so, calls into serious question the veracity of Obama’s claim.

Division B, Title VII, Section 1701

This section deals with the expansion of Medicaid eligibility to 133% of the poverty level.  Again, we see not merely a lack of serious efforts at verification, but willful attempts to circumvent such a process.

An amendment requiring the use of the SAVE process was proposed by Rep. Nathan Deal to check eligibility on immigration and citizenship status. It would apply the same verification standards and use the existing verification system that’s in the current Medicaid statute. Again the Deal amendment was rejected along party lines.  Instead the bill proposes a “Presumptive Eligibility” determination based solely upon income verification without regard to immigration status.  This section of the text (1702 (a)(ii)) states that the “State shall use the income-related information used by the Commissioner and provided to the State under the memorandum in making the presumptive eligibility determination to the maximum extent feasible”

Again we see an “enroll now, don’t ask questions later” regime, one guaranteed to result in large scale enrollment of illegal immigrants who do not meet the putative eligibility requirements of the legislation.  Here again Congress has created a system based solely on income verification and willfully ignorant of citizenship criteria.

Summary

While it is difficult to countenance the outburst of Rep. Wilson Wednesday night, the veracity of the President and the motives of Congressional committee members is very much in question.  The text of H.R. 3200 is opaque and full of legalese.  Yet upon reflection it is clear that in its’ current version, H.R. 3200 would indeed provide taxpayer funded health insurance to people here in contravention of the law.  Section 242(a)(2) would unequivocally provide such benefits to the illegal immigrant parents of US born children and could be construed as doing so for families of mixed legality as well.  Section 202 is mute as to participation in the Exchange, while Section 246 provides unenforceable prohibitions against granting these benefits.  Certainly the White House is aware of the amendments offered and defeated, amendments which would merely provide the same level of scrutiny present is 71 existing means-based welfare programs.  If the intent was to make 246 a meaningful section, there is no justification for omitting a strong enforcement mechanism to protect against the fraud and abuse that will drive the costs through the roof while providing a benefit to illegal immigrants the US public strongly opposes.

The reader must draw his or her own conclusions as to who is telling the truth. However, it is hard to believe politicians who speak simply and clearly while supporting legislation contrary to their statements. While President Obama calls the opposition’s objections “lies”, it seems it is really the proponents which are stretching the truth under the notion that “it is better to beg forgiveness than ask permission”. I believe they know full well the effect these passages will have in practice and are merely attempting to quash debate, to hide it from a public in strong opposition to their plan. While electorate voted for change last fall, it is hard to imagine this is what they had in mind.