President Trump could barely hide his glee when every one of his potential Democratic opponents shot up their hands at Thursday night’s debate when asked whether undocumented immigrants should be included in government health plans.
And for a clear reason. Extending public benefits to immigrants who are in the United States illegally has long been a fraught issue, even among Democrats. Nine years ago, the Democratic-led Congress banned such immigrants from the Obamacare marketplaces — even if they use their own money to buy a plan — and even the most liberal states have struggled to expand coverage to the undocumented population. Undocumented immigrants are excluded from the Medicare and Medicaid programs, with some exceptions for children and pregnant women.
It’s hardly the first time a Republican has pounced on a Democrat for appearing to support government health benefits to the undocumented. Many will recall the infamous moment in 2009 when Rep. Joe Wilson (R-S.C.) yelled, “You lie!” in the House chamber as President Obama told them health proposals wouldn’t cover undocumented immigrants.
Wilson was wrong — the eventual ACA did indeed exclude undocumented immigrants from health insurance expansions, as Obama had promised. But this is one of several issues on which the 2020 Democratic contenders are now moving quite a bit further leftward as they seek the presidential nomination. They’re certainly far from where the last Democratic presidential nominee — Hillary Clinton — stood on the issue.
In her 2016 health-care platform, Clinton would have allowed undocumented immigrants to buy marketplace plans, one step further than the ACA’s outright ban. But she would have still excluded them from getting the ACA’s income-based subsidies, increasing the likelihood undocumented immigrants still couldn’t find affordable coverage.
Rewind to two decades before that, to when Clinton as first lady was trying to get a health-care revamp passed from her perch at the White House. At the time, the first lady expressed concern that extending benefits to the undocumented could encourage more people to enter the country illegally.
“We do not think the comprehensive health-care benefits should be extended to those who are undocumented workers and illegal aliens,” Clinton told Congress in 1993. “We know now that too many people come in for medical care, as it is. We certainly don’t want them having the same benefits that American citizens are entitled to have.”
The Democrats onstage last Thursday sounded a lot different.
NBC moderator Savannah Guthrie posed this question to them after an extended discussion about the Medicare-for-all and public option plans they are proposing to offer Americans:
“A lot of you have been talking tonight about these government health care plans that you have proposed in one form or another,” Guthrie said. “Raise your hand if your government plan would provide coverage for undocumented immigrants.”
All the candidates — which included the two front-runners, former vice president Joe Biden and Sen. Bernie Sanders (I-Vt.) — raised their hands in response.
But Biden’s stance was notable, considering where mainstream Democrats used to stand on the issue. “You cannot let people who are sick, no matter where they come from, no matter what their status, go uncovered,” Biden said on the stage. “It’s just going to be taken care of, period … it’s the humane thing to do.”
Both Biden and South Bend, Ind., Mayor Pete Buttigieg noted that undocumented immigrants pay Social Security taxes if they have jobs and sales taxes when they purchase goods and services, arguing that’s another reason they should be included in public health-care programs.
“This is not about a handout,” Buttigieg said. “This is an insurance program. And we do ourselves no favors by having 11 million undocumented people in our country be unable to access health care.”
To Buttigieg’s point, there’s considerable evidence that helping people buy health insurance results in less spending in the long run. When hospital emergency departments care for uninsured patients, the hospitals end up passing along the costs to the insured patients, resulting in higher premiums for everyone.
Julian Castro, former HUD secretary under Obama, reiterated his support yesterday for giving health insurance to undocumented immigrants.
“What I’d like to Americans to know, right now, No. 1, undocumented immigrants already pay a lot of taxes,” Castro said on ABC’s “This Week with George Stephanopoulos.” “Secondly, we already pay for the health care of undocumented immigrants. It’s called the emergency room.”
That’s a reason California — home to about one-fifth of the country’s undocumented immigrants — recently passed a budget extending Medicaid to some of the undocumented. But it’s the only state to do so, and it chose the most limited, least-costly option.
Last week, Gov. Gavin Newsom (D) signed a $214.8 billion budget into law that extends California’s Medi-Cal program to undocumented adults ages 19 to 26. That measure also expands on the federal health-care law in a number of ways, reinstating its individual mandate to buy coverage — which Congress repealed a few years ago — and raising the income threshold for getting marketplace subsidies.
But the Medi-Cal expansion is only a shadow of what many state lawmakers wanted. The state’s Senate passed a bill also opening its door to undocumented immigrants over age 65, while the Assembly’s version would have opened it up to everyone. Newsom insisted on expanding coverage only to young adults, a much less expensive option estimated to cover 138,000 undocumented immigrants.
The political obstacles to such a move were evident back in 2010 when Congress was constructing the ACA and barred people in the country illegally from participating in any part of the law.
California took some steps in 2016 toward asking the federal government for permission to let undocumented immigrants buy marketplace coverage but withdrew its request over fears the young Trump administration might use the request to target immigrants for deportation. New York lawmakers have proposed similar legislation, but it hasn’t gained traction.
HENRY KOTULA 