Undocumented Immigrants and Health Care


The way the issue of undocumented immigrants has been wielded as a weapon in the health care debate is an indicator of how far this country has backslid on the immigration issue since the giant immigrants’ rights marches of 2006 and 2007. All we hear and see is the Republicans claiming that undocumented immigrants will, too, be covered by the Democrats’ health insurance plans, and the Democrats responding that, no, they will not be covered.

Who is standing up for sick immigrant workers and their families?

There is an unstated subtext of agreement on both sides that undocumented immigrants do not deserve, and should not have, health insurance. Even some progressive commentators, eager to defend the Obama administration’s health care reform from the attacks of the paranoid ultra-right, get a little too enthusiastic in their celebration of the fact that sick undocumented immigrants won’t be covered unless they somehow have the money to pay for private insurance out of their own pockets.

They talk and write as if not covering the undocumented were a self-evidently a good thing.

There are many reasons to find this state of affairs worrying and even repugnant. The first is the ethical one, of subjecting fellow human beings of the torment of having nowhere to turn when they get sick. On principle, undocumented workers and their families should be covered. Even brutal criminals in state and federal penitentiaries have their health care needs provided (not consistently well, but that’s another matter – nobody actually argues that people in jails and prisons should not be treated when sick but rather should be allowed to die in agony in their cells). Yet undocumented workers, whose only crime is to work themselves half to death so as to be able to feed their families, do not merit this?

There are also practical arguments.

As undocumented immigrants tend to be younger and healthier than the general population, one might think that they would be an asset to any insurance program, since they would pay premiums like everybody else, while using the program significantly less. However, undocumented immigrants also tend to be poor, which means that they would, if they were not undocumented, be eligible for subsidies built into the various plans to allow lower income people to buy health insurance. But all factions in Congress say that they will exclude undocumented immigrants (and perhaps some legal immigrants, i.e. those not here on permanent resident visas or who have been here less than five years*) from at least the subsidies. (True, various plans say that undocumented immigrants would also be exempt from the legal requirement that they buy insurance or be fined – a small mercy).

Undocumented immigrants live and work in this country. They contribute to the society through the wealth they create for their employers and through the taxes that they pay. Yes, their taxes, for even if they are working “off the books” for cash, they still pay sales and property taxes (the latter either directly or through their rent) which support most local services. And some manage to work “on the books” which means that they are also paying federal and state income taxes, and also Social Security and Medicare taxes.

They are not here and undocumented by some sort of whimsical choice or a perverse desire to annoy us, but because trade and other policies pursued by the US government and corporations have made it impossible to live in their countries of origin, and US immigration policy makes it impossible for them to get visas to come here legally.

And they are not going to “self deport” because they can’t get health care, or even because of the state of the US economy. Though things are bad here, they are infinitely worse in their countries of origin, which have been hit even harder by the current crisis than the United States has. Mexico, for example, will see at least a seven percent drop in its Gross Domestic Product for 2009, with a proportional loss of jobs, yet food prices continue to rise.

If undocumented immigrants are forced to resort to emergency rooms for health care, because they don’t have other resources, we must not delude ourselves that this is somehow a free service, either for the patients or the society. Most observers agree that using emergency rooms for primary care is economically inefficient, and that if the immigrants and other working poor people who use them in this way can’t pay, other patients and the society as a whole end up paying. And emergency room attention is not free; the hospital will go after you for the money if you don’t have insurance.

Nor is it understood, apparently, that even if employers, landlords and social service workers are forced to demand proof of legal status from their workers, tenants and clients, the H1N1 “swine flu” virus has no such scruples. It does not ask for “papers”, just infects any warm human body. The expected fall outbreak of this disease is a clear case of an urgent public health reason for covering everybody. People without money or health insurance will delay going to doctors when they have seemingly minor symptoms. Then if the symptoms get worse, it may be too late for them, and their circulating in public during the early stages of the infection, when it is most highly contagious for others, will have negative or even tragic results.

This brings me to the topic of immigration reform. During the 2008 election campaign and on several occasions since then, President Obama committed himself to supporting a reform of immigration laws that would encompass new mechanisms of border and internal enforcement, but also a “path to legalization and citizenship” for the estimated 12 million undocumented immigrants in this country. So far, we have seen only new enforcement crackdowns. True, factory raids have not continued as under Bush, but the Department of Homeland Security under Secretary Janet Napolitano has been cracking down in other ways, and unfortunately has continued the Bush policy of criminal prosecutions of undocumented immigrants (instead of just removing them from the country). Crackdowns against companies employing the undocumented do not help the undocumented workers in any way, but rather leave them without any way of earning a living. This is why all US labor and the immigrants’ rights movement opposes these “employer sanctions.”

We don’t know when immigration reform will take place, if ever. When he met with the other heads of NAFTA governments in Guadalajara, Mexico, recently, President Obama said that he has too much on his plate to deal with immigration now, and that he would get to it in the first half of 2010. The problem with that is that it means that immigration reform legislation will be on the table smack in the middle of the 2010 election campaign, and the Congressman Wilsons of this country will be baying like bloodhounds after anybody who dares to present a progressive immigration reform proposal.

To protect themselves against this certainty, some Democratic politicians are trying to prove that they, too, are capable of immigrant bashing “lite.” Senator Charles Schumer, D-N.Y., is supposed to be the point man in the Senate for immigration reform legislation, since the illness and death of Teddy Kennedy (a true friend of immigrant workers). He says he will introduce legislation in October, but meanwhile calls on undocumented immigrants and their allies to admit that their coming here without papers was “wrong.” He also calls for the supporters of immigration reform to stop using the word “undocumented” and go back to calling these folks “illegal immigrants” instead. Yet Schumer is considered one of the immigrants’ rights movement’s best friends in the Senate. No doubt he is taking these positions on the use of language as a protective measure against attacks from the ultra-right. In doing so, he is protecting himself and his Democratic colleagues, not the immigrants. He is saying to the anti-immigrant lobbies “see, I can meet you half way on the illegal immigration issue, I’m reasonable about this.” But for people like this writer and you, the reader, to accept this would be to make an ideological concession to the selfsame immigrant bashers (the Lou Dobbs crowd) who have so much poisoned the atmosphere that many electoral politicians think that they can not touch the issue of immigration reform with a ten foot pole. It is a vicious cycle of concessions and retreats, a road on which we must not set foot.

We need to keep pushing the following demands:

*Health care reform with everybody covered, via a strong publicly run program. To include the fiv percent of households which include one or more undocumented immigrants in this will improve the program, not harm it.

*Comprehensive immigration reform that includes legalization for the undocumented and adjustments in visa programs to reflect the reality of continued immigration of workers and farmers from Mexico and other poor countries.

*While immigration reform is worked on, a moratorium on enforcement actions by Homeland Security, except those which target criminals, drug dealers and real terrorists who threaten our people’s security. If the government wants to crack down on employers who brutally exploit undocumented workers, it should do it via the Department of Labor, and focus on violations of wages and hours, child labor, and occupational health and safety laws. Abusive employers abuse undocumented workers by committing violations in these areas, not just by the mere act of giving them jobs. And if the undocumented were no longer undocumented, i.e. had the legal rights of other workers, this kind of exploitation would be much more difficult.

None of this is easy. But who ever said it would be?


*Current US law excludes legal immigrants who have been here less than five years from some government benefits. The theory is that the person who sponsored you as an immigrant should be paying your bills if you lose your job, which they committed to do when they filled out and signed the sponsorship documents. There have even been efforts to deny Pell grants and student loans to immigrant youth on this basis, on the theory that either the sponsors should pay the tuition, or these young folks should not go to college if they can’t pay it themselves. Fortunately, these efforts have not been successful. How this relates to proposed health care policies is a matter of doubt. If anybody sponsoring a legal immigrant must be prepared to pay potentially hundreds of thousands of dollars for some catastrophic illness because the immigrant’s insurance company weaseled out of paying, for instance nobody would dare offer themselves as a sponsor, except billionaires.