Two Latino men are stricken with similar gunshot wounds by the shooter at the Pulse nightclub in Orlando, Florida. Both are rushed to local emergency rooms and treated for their injuries. Both require additional physical therapy, rehabilitation, mental counseling, and perhaps additional surgeries to be restored to full health.
Both make the same amount of money, but only one can afford the additional mcedical bills after the tragedy. That’s because one of the Latino men had health insurance coverage, and one doesn’t. The man with coverage is considered a U.S. citizen, and the man who doesn’t is an undocumented immigrant. And that fact sets them on two different courses as a result of Omar Mateen’s hail of bullets.
This is the current law of the land in 49 states. Undocumented immigrants cannot access health insurance coverage on the Obamacare exchanges, even if they can pay for it entirely with their own money. They can purchase directly through an insurance carrier, but with the advent of Obamacare those options have dried up and become more expensive. There aren’t many forms of discrimination left against particular classes of people for purchasing goods and services. You can’t stop someone from eating at a lunch counter or drinking from a water fountain. But you can stop someone from buying health insurance coverage to afford medical care, simply because of where they were born.
Outside of a few exceptions, under federal law an undocumented individual can only get affordable health care at a qualified community health center, or more likely the emergency room. This causes a host of market distortions in areas with high concentrations of immigrants. It turns the ER into primary care centers and makes it harder to treat true emergencies in the community. It makes the people who cook our food, build our houses and care for our children sicker, because they are less able to access preventive care. It stresses the patchwork “health care safety net” of community health centers and public hospitals, which must cater to millions of additional patients and which often cannot find the resources to care for them. And it increases costs in our health care system, with expensive ER care delivered to patients who might otherwise benefit from a cheaper option.
There’s a pretty simple solution for this, and California will hopefully move it out to the nation. Governor Jerry Brown just signed a bill allowing undocumented immigrants to use their own money to buy private health insurance on the Obamacare exchanges. Under the new law, California can request a waiver from the federal government on restrictions against extending the exchanges to the undocumented. They will not receive any subsidies or any taxpayer dollars. The law just ends the discrimination, which makes sense for practically every resident in the state.
This could help as many as 390,000 immigrants in California obtain health insurance coverage. $600 million in taxpayer assistance for uncompensated care would be either reduced or cancelled as a result of the law. And that’s the dollars we can see: the costs of having sick people in your lives unnecessarily when they could be treated is less calculable.
The law is another step in years of work in California to secure truly universal health care, not a universal system in name only that leaves 31 million people on the sidelines. In 2015, the state extended Medi-Cal, its version of Medicaid, to 170,000 undocumented children. Two big cities, San Francisco and Los Angeles, have experimented with universal care systems that provide treatment regardless of immigration status. HealthySF gives San Franciscans primary care inside the city limits. Healthy Way LA Unmatched does something similar for Los Angeles. Overall 46 of California’s 58 counties now have programs in place providing non-emergency services for undocumented immigrants.
Slowly but surely, California is narrowing the uninsured population by giving the undocumented an actual choice, one without the fear of deportation that comes with revealing their immigration status (federal law bars Immigration and Customs Enforcement from accessing health records). That creates a healthier population, one that is more productive economically as well. It also, paradoxically, improves health coverage, by taking the undocumented out of the emergency room and unclogging that vital part of the system.
Very few other states have such a setup. The District of Columbia has a public primary care program for the undocumented called DC Healthcare Alliance. And a handful of states allow immigrant children to get covered through Medicaid or the Children’s Health Insurance Program. But by and large, states deny the undocumented access. They also cannot access Medicare, even if they pay for it through their employer. From 2000 to 2011, undocumented workers paid $35 billion into the Medicare Trust Fund without ever receiving benefits.
The Orlando shooting example provides only the most stark instance of this inequity. Sickness does not pick and choose based on immigration status. And we all have an interest in a healthier community, rather than one where illnesses can breed from lack of access to medical care. Moreover, we have an interest in universal coverage from the simple standpoint of cost. The more individuals in a risk pool, the cheaper it costs to cover them. Adding millions of new enrollees would drive costs down.
Indeed, this is a case of segregation. The uninsured population has dropped because of Obamacare. But that has only increased the percentage of the uninsured who are not in this country legally. Our government is more inclined to ignore the undocumented inside our borders. They are the subject of persistent demonization, which as I’ve said is self-defeating. Solutions like California’s provide hope that these neighbors and community members will not be completely forgotten. But if you’re wondering why you should care, run that thought experiment about the Orlando shooting again, and ask yourself if it’s fair that an assassin’s bullet could be life-altering for one person and not another, simply because of what it says on their immigration papers.