With Republican presidential frontrunner Donald Trump and other conservatives stoking the flames of anti-illegal immigrant sentiment, state and local governments are struggling with the question of how far to go in providing health care and prescription drugs to the estimated 5 million undocumented immigrants who lack health insurance.
While the 2010 Affordable Care Act and subsequent executive orders were written to preclude illegal immigrants from qualifying for subsidized health insurance coverage, many states and local governments have stepped in to try to fill the void. They reason that it would be cheaper in the long run to provide the necessary medical and preventative health care services through community clinics than for the government to pay far more to reimburse hospitals for emergency room care for seriously ill illegal immigrants.
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But critics charge that it’s an outrage for millions of illegal immigrants to take advantage of free, taxpayer provided health care services, as well as taking the jobs of low-income Americans or others living legally in the U.S. And on Thursday, The Wall Street Journal rekindled the controversy with a front-page story documenting the pervasiveness of local governments handing out hundreds of millions of dollars’ worth of free health care services annually to illegal immigrants.
According to the newspaper’s survey of the 25 counties with the highest concentrations of illegal immigrants, 20 of them provide inexpensive or free medical services, vaccinations, lab tests, surgeries and prescription drugs. The recipients are assured their immigration status isn’t a problem – and they won’t run into trouble with the INS-- as long as they can demonstrate that they live in the county or jurisdiction.
Immigrant advocates see this as a fiscally sensible and humane approach to addressing the problem of uninsured immigrants. The number of immigrants treated annually by county governments across the country varies widely, from as many as 135,000 in Los Angeles County, 115,000 in Dallas County, Texas, 103,000 in the Boston area and 71,000 in Queens County, New York, to as few as 54,000 in Santa Barbara, Calif., and 25,000 in Montgomery County, Maryland.
“If federal programs exclude people who live here and get sick here, then someone has to care for them,” George Leventhal, a Democratic Montgomery County council member, told the Journal. “We all pay anyway.”
But critics don’t see it that way.
“These are kind of self-inflicted wounds on the parts of these localities that make themselves as attractive as they possibly can be to illegal aliens and then they force everybody else to bear the costs,” Ira Mehlman, communications director for the Federation for American Immigration Reform, which favors a crackdown on illegal immigrants. “These are the kind of counties that created sanctuaries and offer all kinds of benefits and services.”
“As you have more people coming in who lack health care and lack the means to pay for health care, then it becomes a burden on the rest of the community,” he said in an interview Friday.
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County officials argue that it is less costly and “safer and easier to give basic health services to immigrants who can’t get insurance” than to treat them in county hospital emergency rooms where hospital staff members are obliged by federal law to at least screen and stabilize any indigents who seek emergency treatment. Medicaid spends about $2 billion a year to cover emergency-room treatments, according to a 2013 report by Kaiser Health News. The total annual cost of treating uninsured illegal immigrants in emergency rooms and community health clinics has been pegged as high as $4.3 billion in some studies.
In recent years, state and local officials have sought ways to skirt the federal government’s ban on providing medical services to immigrants who don’t qualify for Obamacare. California and New York, in particular, have been experimenting with ways to provide far ranging health care coverage for illegal immigrants and others with temporary work visas, according to media reports. But the patchwork efforts by state and local governments fall short of addressing the long-term costs of health care coverage for immigrants.
What’s more, even as critics complain that these types of health care services are unnecessarily draining government, studies have shown that illegal immigrants actually pay billions of dollars of state and local taxes annually.
A recently updated 50-state study of the budgetary and fiscal implications of massive illegal immigration by the Institute on Taxation and Economic Policy found that roughly 8.1 million of 11.4 million undocumented immigrants pay more than $11.6 billion in state and local taxes annually, even while living illegally in this country.
