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The Affordable Care Act And Illegal Immigrants

It was politically unfeasible at  the time the Affordable Care Act  (ACA) passed to have expected Congress to include all immigrants in the Act’s provisions, but politics are changing–rapidly.  Many people recognize that the ACA was merely a first step.  Now that the Supreme Court has upheld the constitutionality of all but one part of the ACA, pundits are urging politicians to take the next steps, even big steps, like moving to a single payer system, and providing health care to all immigrants.

Current State of The ACA Act

Right now, the ACA provides limited benefits to legal immigrants and practically no protection for illegal immigrants.  The ACA includes provisions for those here legally that match what a US Citizen can expect (though legal residents remain subject to existing Medicaid restrictions, including a five-year-or-more waiting period).   But undocumented immigrants are limited to getting emergency room care or seeking non-emergency health services at community health centers or safety-net hospitals.  This was true both before and after the ACA passed.  Congress basically left this  political third rail out of the equation.  Undocumented immigrants aren’t eligible to participate in the new health care exchanges, and even though many pay taxes, they aren’t eligible for the premium tax credits or cost-sharing reductions provided for in the Act.

Of course, many people will find this state of affairs anything but shocking.  After all, if someone is here without authorization, why should we encourage their continued presence by providing them benefits?  Moreover, providing benefits might even encourage increased undocumented migration. The problem with this logic when it comes to health care is that we end up providing these individuals health care anyway, but at the highest possible cost to the taxpayer.

The ACA attempted to cover as many people as possible–to stop so-called “free loaders”–those whose get all their health care at an emergency room and then often leave the taxpayer holding the bag for the extraordinary costs of such care.  Why use the ACA to stem just those free-loaders with documents (by offering them coverage under the Act)?  Why not stop all free-loading within our borders (by offering the undocumented in our country coverage under the Act)?   If it saves us money and takes non-emergency care out of the emergency care system, why wouldn’t we all want that?  We could then use the money we save to  address undocumented migration directly, freeing our nation’s policy-makers from having to use health care as an immigration policy tool.  If health care decisions can be made without concern for their impact on immigration, those decisions will be more likely to solve our health care problems, particularly rising costs.

If affordable health care  is on life support, and I believe it is, then let’s not be satisfied with a band-aid solution like the ACA.  Let’s have the full-on, life-saving overhaul that will once and for all provide health care as a right, not a privilege.  Unless and until every human being is covered, health care will remain merely a privilege and the ACA will be good only for expanding that privilege.  Progress, sure.  But with the prevailing Zeitgeist, we should be demanding a revolution.  And we just might get it.