What’s Missing From the Health Care Bill

In the spring of 2010, President Barack Obama passed a momentous health care bill. Said bill dominated most of the political discourse during his first year; to date it constitutes one of the president’s most substantial achievements.

In dealing with the issue of health care, Democrats faced a choice of whether to concentrate on cutting costs or extending coverage to the uninsured. For better or worse they chose to focus on the latter. Due to this choice, the health care bill is estimated to extend health care insurance to 32 million out of a total 55 million uninsured people.

This leaves, however, some 23 million people who will not benefit from health care reform. Some of these individuals will opt-out of buying health insurance voluntarily; for instance, young people may decide to pay a fine rather than buy government-mandated health insurance.

There is, however, a substantial population – numbering something like six to eight million people – who were unilaterally denied the right to health care. These people are some of the most despised in the United States, living in constant fear and harassment. They are almost all poor, disadvantaged, and denied the opportunity to advance in American society. Even a straight-A college graduate belonging to this population is confined to menial labor.

The Obama administration has also been antagonistic with this group of people. Indeed, Mr. Obama’s health care bill explicitly prohibits undocumented immigrants from participating in the government programs it sets out. This is both terrible policy and naive politics.

Let’s start with the politics. The Obama administration decided not to include undocumented immigrants in order to win political support from Republicans – who are strongly opposed to undocumented immigration. If Democrats had included undocumented immigrants, Republicans would not have voted for the bill, and conservatives would not have supported health care reform.

Oh wait – that’s right, conservatives didn’t support the health care bill anyways, and not a single Republican voted for the final version. In fact, conservatives did absolutely everything they possibly could to oppose health care, whether it included undocumented immigrants or not. In effect, the Obama administration naively sacrificed one of the most abused groups in the United States to gain Republican support that did not exist in the first place.

That leaves the policy side of the equation – is insuring undocumented immigrants good policy? In fact, right now undocumented immigrants are insured; they are just done so in an extremely inefficient manner. This insurance is called the emergency room. There is little need to explain how using emergency room visits to treat undocumented immigrants causes soaring costs; immigrants without insurance delay treating illnesses until the last second, when things are far worse (and more expensive) than they otherwise would be. Then they cannot afford to pay, making costs go up for the hospital and therefore everybody else.

The solution is to provide health insurance to undocumented immigrants. This stops them from being a burden on government services – which ought to make conservatives happy – and lowers costs. It is also, by the way, the right thing to do. A shame that the Obama administration did not have the courage to do that.