In his article, “The Democrats’ Gamble on Health Care for the Undocumented” at The Atlantic, Ronald Browstein writes:
Anxiety spiked among many centrist Democrats when all 10 presidential candidates at a recent debate raised their hand, as if pledging allegiance, to declare they would support providing health care to undocumented immigrants…Led by Senator Bernie Sanders, nearly a half-dozen 2020 Democrats have embraced a clear position of offering full access to health-care benefits. Others, including former Vice President Joe Biden, the nominal front-runner, oppose full benefits, although that wasn’t apparent at the debate. The latter group would allow undocumented immigrants to purchase coverage through the exchanges established by the Affordable Care Act, but only with their own money. That approach would cover far fewer people, but also potentially create much less exposure to Republican counterattacks.
Regarding the scale of the actual problem, Brownstein notes:
This debate affects millions of people. The Kaiser Family Foundation, using census data, has estimated that 47 percent of the country’s roughly 11 million undocumented immigrants are uninsured, compared with one-fourth of legally present immigrants and about one-tenth of American citizens. Similarly, the Urban Institute places the number of uninsured undocumented immigrants at nearly 4.9 million , or about one-sixth of the total population of uninsured people in America.
There is a strong case for insuring immigrants, as Brownstein explains:
The case for expanding their health-care access rests on financial, public-health, and moral arguments. Supporters contend that it’s cheaper to provide access to medical care up front, rather than deal with health crises in emergency rooms; that allowing the undocumented to go untreated increases health risks for legal residents who come in contact with them; and that it is unjust to let people face health threats without care, regardless of their status.
Put another way, contagious diseases don’t care about your citizenship status. But health secuirity for immigrants is not an easy sell, As Brownstein observes:
Emergency rooms must provide aid to all who need it. But polls have consistently found that most Americans resist offering public benefits to the undocumented beyond that. In a recent CNN survey, Americans by a solid 3–2 margin said that “health insurance provided by the government” should not be available to immigrants here illegally. The idea faced resistance across a wide array of constituencies, including several that Democrats rely on: Just over half of college-educated white voters, half of young adults ages 18 to 34, and more than two-fifths of nonwhites said they opposed providing coverage for the undocumented. At the same time, three-fifths of voters who identified as Democrats or lean Democratic said they support the idea.
Brownstein highlights the moderate approach outlined by some Democratic presidential candidates, which may be the safest position for Democrats who want to win the support of persuadable voters:
Three years later, the current slate of candidates seem to have significant differences in how they would treat the undocumented, even if, as a group, they have moved beyond the Obama administration’s more cautious position on the ACA. Biden and Senator Michael Bennet of Colorado, both of whom raised their hand at the debate last month, are taking a similar position to House Democrats’ in 2009 and Clinton’s in 2016: In addition to opening the ACA exchanges to the undocumented, they would also allow them to buy into the new public insurance option they would create through an expanded Medicare system. But they would still deny the undocumented any public assistance. Biden, in his CNN interview, put greater emphasis on expanding federally funded community-health clinics as a means of delivering more health care to undocumented immigrants than he has on offering them insurance.
Other presidential candidates, however, are making cases for complete coverage for undocumented immigrants in the U.S.:
At the other pole of the debate is Sanders’s Medicare for All proposal, which would entitle the undocumented to the same health-care services as anyone else in America. The actual language of the bill is less definitive: It says that while “every individual who is a resident of the United States is entitled to benefits for health care services under this Act,” the federal government will promulgate regulations for “determining residency for eligibility purposes.” But in response to a health-care questionnaire from The New York Times, Sanders unequivocally included the undocumented in his system: “Medicare for All means just that: all. Bernie’s plan would provide coverage to all U.S. residents, regardless of immigration status,” his campaign wrote.
In response to my questions, the campaigns of Senators Kamala Harris of California, Elizabeth Warren of Massachusetts, and Cory Booker of New Jersey said they would provide full benefits to the undocumented; so would former Housing and Urban Development Secretary Julián Castro.
South Bend, Indiana, Mayor Pete Buttigieg made a passionate case for covering the uninsured during last month’s debate, but his campaign would not specify his exact plan for doing so, particularly whether he would subsidize coverage with public dollars. Former Representative Beto O’Rourke of Texas likewise would not nail down his position on that point.
There is no doubt that the Republicans will demogogue the issue to portray all Democrats as spendthrift politicians who are ‘soft on illegals.’ Democratic candidates, not just presidential hopefuls, but all candidates for the Senate and House, should get to work on soundbites, tweets and short comments to support their positions on health care for undocumented immigrants, and portray the GOP as irresponsible advocates of public health chaos. Meanwhile, now would be a good time to collect data showing that health care protection for these immigrants would be a cost-effective investment in protecting the public as a whole from unnecessary illnesses.