Now that the Senate Judiciary Committee has reported the major Senate immigration bill, S 744, out of committee and the full Senate is about to start debate on the measure, focus is beginning to turn to the House of Representatives. Getting a bill out of the House may be harder, mostly because the Republicans have a 233 to 201 majority there.
Media reports suggest that a major stumbling block may be the issue of access to health care. Under present law, undocumented immigrants do not have access to federally funded, non-emergency health care including Medicare, Medicaid, CHIP (Children's Health Insurance Program) and "Obamacare" (the Patient Protection and Affordable Care Act).
Many undocumented workers pay into Medicare through deductions from their paychecks, and all contribute, directly or indirectly, to the fiscal base for federal, state, county and local health care programs through the taxes they pay.
And remember that the work of the between 7 and 8 million undocumented workers in this country creates great fortunes for the companies big and small who employ them, and who are themselves under-taxed and thus are not supporting health care services at a fair rate.
Some undocumented workers have health insurance through their jobs, but most do not, and at any rate as Obamacare is implemented, we also see a pattern of employers stopping or cutting back on the provision of health care as an employee benefit.
When Obamacare was debated before being passed in 2010, there was discussion around exclusion of undocumented workers. The Republicans yelled that inclusion of undocumented workers would have amounted to a giveaway to criminals. The Democrats and the administration backed down, saying that pushing the matter at that point would undermine the chance of passing health care reform. The result of this is that today, undocumented immigrants are excluded from Obamacare to the extent that they are not even allowed to buy insurance through the federal and state exchanges using only their own money, with no federal subsidy.
Under proposed Senate and House legislation, they would probably be able to buy into the exchanges, but could not get federal aid for doing so.
In a number of states, arrangements have been made to cover the undocumented with Medicaid but only with money provided by the state government, not federal money. Also, in mixed-status families - those with some undocumented members and others who are U.S. citizens or permanent legal residents - the undocumented family members are excluded.
Now the fight in the House is about whether former undocumented immigrants undergoing legalization (in the status the Senate bill calls "Registered Provisional Immigrants") will have access to any kind of non-emergency health care paid for with federal money. The consensus seems to be "no," with the Republicans (as in 2010) yelling about giveaways to lawbreakers, and the Democrats (as in 2010) disagreeing but not wanting to insist for fear that pushing the health care access issue will scuttle the legislation.
The Democrats are saying that under federal law, undocumented immigrants undergoing legalization will still be able to go to emergency rooms for care. But Republicans such as Congressman Raul Labrador of Idaho point out that going to the emergency room generates costs which eventually are passed on to the general public. They say immigrants undergoing legalization should be forced to buy health insurance on the ordinary commercial market and/or pay their emergency room bills. Not having the income to afford this should lead to deportation, in these Republicans' view of things.
As the situation is, few undocumented workers can afford health insurance, so they either go to the emergency room immediately when sick, or wait until the illness has advanced to an emergency stage and then go to the emergency room. The reader can appreciate what this means for people ignoring, for example, early stages of cancer. Sometimes people go to the emergency room at an earlier phase of illness, which is better from a health point of view, but obviously not a good use of those "taxpayer funds."
There are also reports of hospitals themselves effectively "deporting" uninsured immigrant patients through a system euphemistically called "repatriation."
Though the undocumented immigrant population tends to be healthier overall than the general population, this is an obvious public health hazard. As it is, there are problems in this country with people who work in food service, home health care and other things but who have no health insurance or paid sick days (or any sick days), so come to work while suffering from infectious diseases, which endangers themselves and others. But for some it's a question of come to work sick or don't have money to pay the rent.
But our right-wing politicians appear not to believe in the concept of public health. Their concern is not the protection of the health of the public. They just like to yell about "costs to the taxpayers" and "handouts to criminals" as "gotcha" political tactics.
As the situation in the House stands, most Democrats seem to concede the point that undocumented immigrants undergoing legalization would not have access to non-emergency, federally funded health care. As the Senate bill keeps these "Registered Provisional Immigrants" in this limbo status for 10 years, and the House will probably do something similar, this means that for 10 years the current unsatisfactory situation of health care for the undocumented will continue, with the added twist of possible deportation if one gets sick.
This is another essential fight, for the immigrant workers and their families and for the well-being of the whole U.S. population.
Photo: This boy marches with his family at a recent Chicago demonstration for comprehensive immigration reform (PW/Winona Albano Bachtell).