Health care reform was approved by Congress and signed by the president more than a year ago. Yet the most important and expensive parts of the law won't take effect for another three years. As Congress and the president work out ways to cut billions from current and future federal budgets, it seems an easy target for future cost cutting should be health care benefits for illegal immigrants.
President Barack Obama's vision of health care access for all Americans makes that care available by expanding Medicaid, government-subsidized health care for America's poor. Illegal immigrants are technically barred from Medicaid. Permanent residents must pay into the system for five years before they can buy health insurance through it, so one can safely presume legal immigrants pay their own way to access affordable care.
It's an entirely different story for those here illegally. By some estimates, 60 percent of illegal immigrants already have health care provided by their employers who believe those workers are in the United States legally. But once the government starts to subsidize care to make it more affordable, it will be cheaper for employers to end health care coverage for their employees, and force them onto government subsidies.
Immigration reform advocates want a path to citizenship for the 12 million or-so people living in the U.S. as undocumented workers that they say is tough, fair and practical. They want to enforce borders and stop employers from hiring illegal workers. At the same time, they want the government to offer those people a way to become legal citizens down the road. In so doing, they add costs to future budgets that will quickly become unsustainable.
The Center for Immigration Studies, a think tank that seeks lower levels of legal immigration and a "warmer welcome" for legal immigrants, estimates that if or when people in this country illegally are granted legal status, the costs to provide them health insurance under the new health care law will exceed $30 billion per year. That's almost as much money as Congress and the president are trying to save in the current budget. Neither the president nor Congress is considering the fiscal impact of illegal immigration on health care reform as a possible venue for budget cuts. But that is a very good way to prevent future budgets from spiraling even further out of control. Here is how it might work. The most expensive part of health care reform will be the government-supported subsidies designed to make health care affordable for all Americans. Those benefits will first be offered in 2014. The regulations governing who receives those subsidies and who doesn't, have yet to be written.
The Congressional Budget Office told Congress last month health care subsidies will average $4,600 per person per year in the first year of the program (2014) and billow to more than $5,000 on average in the second year. Congress is already cutting some important domestic programs designed to alleviate poverty and improve the nation's environment. Last week's budget compromise included $600 million in cuts to community health centers programs, $414 million in cuts to grants for state and local police departments, and a $1.6 billion reduction in the Environmental Protection Agency budget, almost $1 billion of which would come from grants for clean water used by local groups and Native American tribes.
One way to head off future deep cuts is to keep future increases in check. It seems an easy fix to prevent employers from cutting health insurance for illegal immigrants, whom the vast majority of Americans including legal immigrants, do not want to subsidize with taxpayer funds.
But the path to citizenship will do just the opposite. At times like these, with unemployment still close to 9 percent, and a historic amount of federal debt, we should be comfortable denying health care subsidies to people who violated our nation's laws to come live here. In a world of tough choices, this one should be easy, but apparently it is not.
Bonnie Erbe is a TV host and writes for Scripps Howard News Service. E-mail bonnieerbe@CompuServe.com.