A potential block to reform

Opponents of healthcare reform argue that Congress would give illegal immigrants health insurance at taxpayer expense. The claim stirs a lot of resentment, particularly in border states struggling to cover the costs that undocumented immigrants impose on hospitals, schools and other public services. And although there may be valid reasons to improve the healthcare services these immigrants receive, it’s a step lawmakers can’t take without jeopardizing the reform effort as a whole.

Authors of the House bill (HR 3200) recognize how explosive the issue is and have tried to defuse it. One section :ih:965 of the bill unequivocally declares that illegal immigrants cannot receive taxpayer funds to help buy coverage. Critics say the proposal doesn’t provide a way to enforce the ban, so illegal immigrants are sure to find a way around it. Although that’s not a compelling argument, the insurance-buying exchanges created by the bill aren’t likely to be more resistant to fraud than Medicare and Medicaid are.

The more difficult issue is whether illegal immigrants should be eligible for subsidized insurance. Some immigrant activists contend that insuring them would improve public health and reduce costs. Like the uninsured generally, immigrants without coverage tend to forgo care until they need expensive emergency treatment. One of the main goals of healthcare reform is to reduce this sort of inefficiency, which drives up private insurance premiums and the medical costs covered by local governments.

Although illegal immigrants are disproportionately uninsured, they account for an unusually small share of healthcare costs. A recent study published by the American Journal of Public Health found that per-capita costs were significantly lower for immigrants -- even those with insurance -- than for native-born Americans. They’re less likely to suffer from chronic illnesses such as diabetes and heart disease. And, according to the Kaiser Family Foundation, noncitizens are significantly less likely than citizens to go to an emergency room.

On the other hand, the prospect of subsidized health benefits would raise the incentive for illegal border crossings. That’s one reason insurance coverage for illegal immigrants should be addressed in the context of comprehensive immigration reform, not an overhaul of the healthcare system. Here’s another reason: The healthcare debate has already become so politicized, it’s well-nigh impossible to have a rational discussion of the problems and solutions. The economic and public-health effects of extending coverage to noncitizens are worth exploring, but not at the expense of reforms that are vital to millions of Americans.