From a purely economic standpoint, insuring illegal immigrants makes a lot of sense—and not just for them, but for everyone.
Consider a few statistics. According to a July article in the American Journal of Public Health, immigrants typically arrive in America during their prime working years and tend to be younger and healthier than the rest of the U.S. population. As a result, health-care expenditures for the average immigrant are 55 percent lower than for a native-born American citizen with similar characteristics. With the ratio of seniors to workers projected to increase by 67 percent between 2010 and 2030, it stands to reason that including the relatively healthy, relatively employable and largely uninsured illegal population in some sort of universal health-care system would be a boon rather than a burden. “Insurance in principle has to cover the average medical cost of all the people it’s serving,” explains Leighton Ku, a professor of health policy at George Washington University. “So if you add cheaper people to the pool, like immigrants, you reduce the average cost.” More undocumented workers, in other words, means lower premiums for everyone.
The actuarial advantages don’t end there. As it is now, undocumented workers (and others) who can’t pay their way receive free emergency and charitable care—a service that costs those of us with health insurance an additional $1,000 per year, as Obama noted. But if illegals were covered, this hidden tax would decrease, further lowering our premiums and “relieving some of the financial burden on state and local governments,” says Harold Pollack, a University of Chicago professor who specializes in poverty and public health. What’s more, employers currently have a clear economic incentive to hire undocumented immigrants: they don’t require coverage. A plan that mandates insurance for native workers but not their illegal counterparts actually makes life harder on the blue-collar Americans competing for jobs (and railing against immigrants) because it means that hiring them will cost more than hiring a recent transplant from Mexico City. As The Washington Post’s Ezra Klein recently explained, “If you’re really worried about the native-born workforce, what you want to do is minimize the differences in labor costs between different types of workers. A health care policy that enlarges those differences—that makes documented workers more expensive compared to undocumented workers—is actually worse for the documented workers.”
At this point, you’re probably wondering whether taxpayers would have to foot a bigger bill for these newly insured illegals. Not necessarily—at least in theory. As Obama said in Wednesday’s speech, “Like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects” to fund whatever care it provides. Given that many undocumented workers leave the country before they’re old enough to require much medical care, says Phillip Longman of the New America Foundation, “you could set up the system in a way that that they wind up contributing as much or more than they receive” in low-income subsidies, especially when the “offsetting savings of lower emergency-room use” are factored in.
As Romano notes, coverage of undocumented immigrants is politically impossible, even though it makes sense. (Via Ezra.)
None of the above seems to acknowledge that HR 3200 as currently written appears to mandate that people buy insurance regardless of their immigration status, but only provides subsidies and the like for people who are legal residents. In other words, those prime-working-years illegal immigrants can and do get insurance through the private sector (especially if they work for an employer who provides insurance at affordable premiums), and I think a few states use their own funds (distinguished from federal funding) to provide Medicaid/CHIP as well.
So we pretty much already get the benefit of having, in American insurance pools, the illegal immigrants who would be most likely to be able to contribute premiums without requiring a lot of services (i.e. those whose presence lowers everyone’s premiums without requiring taxpayer subsidy).
The ER argument is much better, though some of these rightwingers are getting kooky enough to demand that we revoke the emergency treatment law and require that anyone showing up in an ER have proof of legal residence in the U.S. Since rightwingers consider driver’s licenses so easily forged, I’m going to have to start carrying my SS card and passport (“Hey, shouldn’t we take this woman who’s bleeding on the sidewalk to the hospital?” “Hmm, she’s unconscious so we can’t hear her accent; she’s brown; and I’ve rifled her purse and can’t find proof of citizenship. Better leave her there.”).
As The Washington Post’s Ezra Klein recently explained, “If you’re really worried about the native-born workforce, what you want to do is minimize the differences in labor costs between different types of workers. A health care policy that enlarges those differences—that makes documented workers more expensive compared to undocumented workers—is actually worse for the documented workers.”
Whaaa? I normally respect Klein’s analysis, but this quote of it at least sounds downright goofy. Employers can’t overtly distinguish between workers with the knowledge that one is legal and the other not legal to work, because employing illegal immigrants is illegal. Most employers get away with it due to under-enforcement and plausible deniability (“he showed up with a SS# and I’d get in trouble with anti-discrimination law if I turned away a guy who didn’t speak much English, so I *had* to hire him”).
But if the benefits at this workplace get reviewed and a bureaucrat says, “Hey, why do you think you don’t need to cover all these folks nor pay into the government fund for each of them you’re not covering?” and the employer says, “Because some of them are illegal immigrants!” that’s a really damn stupid employer whose ass is getting very heavily fined. (And checking up on employers’ provision of benefits is a lot easier than checking up on the employees’ immigration status. The names and SS#s provided by illegal immigrants often are real ones, just not actually the possession of said immigrants but instead bought/ stolen from a legal resident or citizen of the U.S.)
How can you cover them? Once you know they are illegal they should be deported. If you don’t know then it doesn’t matter anyway.
*And yes the should be deported, they can come here legally if they want have no problem with that. But doing it illegal is not fair to those who do it the right way*
dyet,
You can cover them if you don’t know one way or another whether or not they are illegal; i.e., if you don’t try to find out. Just like we can provide police services without regard for the legality of anyone’s status.
I recently read an article that stated that the large teaching hosptial in Zurich will no longer be providing non-emergent medical care to US-Americans visiting Switzerland. How do people who are arguing against including immigrants (legal or otherwise) in the health care plan feel about that?
I could care less what Switzerland does with Swiss money and resources, that’s how I feel.
I could care less what Switzerland does with Swiss money and resources, that’s how I feel.
If you could care less, then presumably you care greater than zero now.
/ pedant.
Forgot to say that even if the economic effect of covering illegal immigrants was neutral or slightly positive, that effect may only exist when analyzed in the sphere of health care. There are other issues. Incentives, for example (does providing more services create added incentives for illegal immigration?) and morality (even if it saves money, do we want to provide benefits to people who are breaking the law?) among others.
Regarding Switzerland: you mean they were providing free health care to visiting non-citizens? It certainly doesn’t bother me to know it is no longer available. Why were they doing it in the first place?
When I was in the UK for two weeks in 2004, I wound up in the emergency room with a urinary tract infection. They treated me for free as a “temporary resident.” I paid 6 pounds for a prescription. The cab ride there and back cost more.
A similar bacterial infection (this time of my ear, rather than my urethra) cost me $80 for an uninsured doctor visit and $60 for the cheapest generic I could get at Walgreen’s, not two weeks earlier in the US.
Why would the UK do this? Maybe because they knew if my condition dragged on and on, and went into my kidneys, or turned into sepsis, and I was picked up in the street where I fell by an ambulance and treated with far more expensive interventions, their chances of collecting from me were maybe even odds at best, so they’d rather treat me for free early on using existing infrastructure already paid for by taxes (the A&E was nearly empty when I went, so I used up very little resources other than some disposable medical equipment and maybe some lab supplies), rather than have me become a bigger drain on the system later on.
Or maybe they just decided human suffering isn’t worth it.
In general the UK does charge for treatment for nonresidents – the guidelines are here http://www.dh.gov.uk/en/Healthcare/Entitlementsandcharges/OverseasVisitors/Browsable/DH_074374 . Your exemption may have been because the treatment was wholly within A&E.
One difference between the UK and, say, Canada, is that the former doesn’t have any system of insurance cards or the like for those who are entitled to free treatment. Thus it’s comparatively easy for those who aren’t to nonetheless receive it, since the system isn’t built around verifying eligibility. I recall the issue receiving some press attention in the past, don’t know if things have been tightened up since then.
I work at a hospital in a community that has a large number of undocumented immigrants. I would say that the proportion of undocumented immigrants who come to the ER for health care is much larger than that in the overall population. This is because these people, who have no insurance and therefore no primary care physician, have no other option than to come to the ER when they need treatment.
Some of these patients arrive in the ER with problems that could be treated outside of the hospital for much less money than it costs for them to be treated in the ER. Others have problems that are directly related to the lack of regular, accessible health care. Small problems that would have been easily detected and treated by a PCP become large ones that need expensive treatment.
The hospital has to treat everyone who comes to the ER for treatment, as it should. But when undocumented immigrants are treated there and can’t pay, the hospital has to absorb the costs. The entire hospital population – patients and employees – suffer when this happens.
Because undocumented immigrants are human beings, they require health care. When they come to our hospital, we have a legal and moral obligation to give it to them, regardless of whether they can pay. Denying undocumented immigrants federally funded health care won’t change the fact that these immigrants are receiving health care anyway, and won’t change the fact that SOMEONE has to pay for it. At this point, it’s either the government or the hospital.
If Obama extends his health care plan to undocumented immigrants, the cost of health care will come down. I guarantee it. Primary health care, particularly that which focuses on preventive measures, is much less expensive than our current system of allowing immigrants to line up at the ER when they have no other option.
Madeline,
This is because these people, who have no insurance and therefore no primary care physician, have no other option than to come to the ER when they need treatment.
While the majority of illegal immigrants who lack insurance coverage don’t have the money to pay directly for care, some do. Also, non-ER federally funded health centers assist people without insurance and charge for care on a sliding scale based on income; so far as I know, they do not inquire about immigration/ citizenship status.
The hospital has to treat everyone who comes to the ER for treatment, as it should.
I am not sure that is correct. EMTALA says that any patient who “comes to the emergency department” requesting “examination or treatment for a medical condition” must be provided with “an appropriate medical screening examination” to determine if he is suffering from an “emergency medical condition.” If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute’s directives. If the patient does not have an “emergency medical condition”, the statute imposes no further obligation on the hospital. And an “emergency medical condition” is defined as
madeline says:
I presume that madeline also would include immigrants who HAVE documents but whose documents don’t include permission to stay in the U.S., as well as people who come to the U.S. to work as, for example, migrant workers but who intend to return to their country of origin at some point and thus cannot be properly described as immigrants. Many of whom will likely need healthcare while they are here, it’s true.
Hm. No, there’s a third alternative.
As I read through this thread it occurs to me that we have this all wrong. Illegal aliens are covered under a healthcare plan. It’s just that it’s not an American healthcare plan.
And what’s wrong with that? Why should they be? If, for example, someone is in this country illegally from Mexico, they are a citizen of Mexico and should be covered under Mexico’s healthcare plan. Let them then provide the appropriate information to the hospital and let the hospital send the bill to the Mexican authorities.
Everyone keeps saying that all the other industrialized countries have nationalized healthcare. I presume that includes Ireland, Poland and other countries that have citizens present illegally in the U.S. It seems from a cite in another thread that this is soon to include Mexico. On that basis the whole premise of this thread is wrong. Illegal aliens ARE covered under healthcare plans. There shouldn’t be duplicate coverage for them in our health care plan. There’s no need to cover them again. Let’s just start having them use the coverage they already have. If I don’t submit my bills to my healthcare carrier I don’t expect the government to pay my bills instead. Why should they be any different?
RonF – I’m not aware of any national healthcare plan that provides people with comprehensive coverage when in other countries and for which citizenship (rather than residency) is the important criterion. The only vaguely similar things I can think of are reciprocal healthcare agreements (such as in the EU) which only cover temporary emergency care for travellers. Generally if you’re not living in your country of citizenship then you’re not covered by their scheme. Which seems logical enough – you probably aren’t paying any taxes there either. Thus it seems highly unlikely that many people living illegally (or, indeed, legally) in the US are entitled to any medical care (particularly not from American healthcare providers) under the scheme of their country of citizenship.
Jebedee,
Actually, some countries (like the U.S.) have worldwide taxation, in which you owe income tax obligations to your nation of citizenship even if you do not reside there and are earning your income elsewhere. This can be offset by the taxes you’re paying in the country where you reside if that country has a tax treaty with the U.S., but you still need to send a form to the IRS.
PG – true, but I think the point stands wrt to healthcare – IIRC such countries are in the minority (had heard the US was almost unique in that respect), and under normal circumstances (i.e. your income is primarily from the country where you live and the taxation rate for that income isn’t massively higher in the US) the bulk of your taxes are going to go to your country of residence, so covering people living abroad would make little sense (administration difficulties aside). In principle I suppose it might be cost-effective for a country with worldwide taxation and very high tax rates to cover expats’ health, but I’m not aware of any examples.
If someone is (1) here illegally, (2) not here for reasons of asylum, and (3) a resident of a country which offers some level of nationalized health care, then it makes no sense at all to use the “don’t let them suffer” morality for anything other than emergent or temporary maintenance care. And humanitarian transport.
I.e. if they would get health care in the U.K., where is our moral obligation to give them health care here? We might have some obligation not to strand them in a place without health care, so we might have to pay to deport them to the UK. But if they choose to stay here illegally and have no health care, that’s their choice.