Health Reform for Illegal Aliens

President Obama has been busy denying that illegal aliens would receive taxpayer-funded health care under pending legislation but the legislation on the table does, honest to goodness, effectively extend coverage to illegal aliens. That is a fact not a lie, as some would have you believe.

Take the premium subsidy in the House bill, H.R. 3200. This lies in the part of the legislation (Division A, Title II) that creates a Health Choices Administration, adds the infamous “public option,” sets up and runs the “exchange” clearinghouse for getting insurance, and controls a graduated premium subsidy program through allocation of “individual affordability credits.”

The subsidy, found in Section 242, will give a voucher to people earning between 133 percent of the official poverty level and 400 percent of that income level (or, up to about $88,000 a year for a family of four).

Legal immigrants certainly qualify under H.R. 3200 for this subsidy. 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)."

A political fig leaf purports to keep illegal aliens from receiving the subsidy. Section 246 says, "Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States."

However, reading the legislation as a whole, its glaring omission is any requirement to verify someone’s immigration or citizenship status. For instance, H.R. 3200 makes no reference to the verification system in current law that’s used for nearly all government welfare and other public programs. If lawmakers wanted enrolling agents, including bureaucrats at the new Health Choices Administration, to use the Systematic Alienage Verification for Entitlements (SAVE) system, the bill should include a reference and authorize SAVE’s application to this government program.

In other words, the silence of H.R. 3200 regarding SAVE and mandatory verification makes Section 246 just empty words. In fact, the Ways and Means Committee outright voted down an amendment by Rep. Dean Heller to require eligibility verification before qualifying someone to receive a taxpayer subsidy. Also, "lawfully present" covers a lot of ground. Does it include someone here under Temporary Protected Status, for instance? Again, the absence of eligibility verification requirements leaves open a lot of room for waste, fraud, and abuse.

A similar situation of setting up blinders occurs in H.R. 3200’s Medicaid provisions. Division B’s Title VII, Section 1701 expands Medicaid eligibility to those with incomes a third above the federal poverty level. This provision dictates that "the State shall accept without further determination the enrollment under this title of an individual determined by the Commissioner to be a non-traditional Medicaid eligible individual." In other words, the bill prohibits asking any further questions about new Medicaid enrollees.

Rather, the bill section promotes "presumptive eligibility" concerning Medicaid expansion. Read it for yourself, right from Section 1702(a):

(ii) PRESUMPTIVE ELIGIBILITY OPTION- Pursuant to such memorandum, insofar as the memorandum has selected the option described in section 205(e)(3)(B) of the America's Affordable Health Choices Act of 2009, the State shall provide for making medical assistance available during the presumptive eligibility period and shall, upon application of the individual for medical assistance under this title, promptly make a determination (and subsequent redeterminations) of eligibility in the same manner as if the individual had applied directly to the State for such assistance except 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. (emphasis added)

And, once again, the lack of any provision mentioning or requiring verification, mandatory use of the SAVE system under this part of the bill, or any other accountability requirement opens the process up to signing up illegal aliens for Medicaid.

In the Energy and Commerce Committee, a mandatory verification amendment was voted down when Rep. Nathan Deal offered it. A political figleaf amendment was added by voice vote, but the loopholes and potential for waste, fraud, and abuse remain wide open in the Medicaid provisions.

Whatever you think of health reform, a combination of things makes it certain that illegal aliens will receive government health coverage. The most obvious is the omission — heck, the outright rejection of corrective amendments — of eligibility verification requirements. The other factor is the designed ease of enrolling people in Medicaid, for "affordability credits," and the like.

Bottom line, the health legislation Congress is considering establishes an "enroll now, don’t ask questions later" regime. That’s a recipe for covering more people, but many of whom may not actually qualify. A huge number are almost guaranteed to be illegal aliens or legal immigrants still in their first five years in the country who are supposed to turn to their visa sponsor for financial support. And having more people in a public program translates pretty quickly into higher costs. In this case, we’re talking on the order of tens and hundreds of billions of dollars.