The main topic of discussion for the past few months has been health care, so I might as well take it on as my first topic. I am someone who will greatly benefit from health reform. Like 80% of the Class of 2009, I graduated without an immediate job prospect. So in June I went to my final doctor, dentist, and eye appointments before being dropped from my parents health insurance. Unfortunately, my doctors appointments didn't turn out routine and it became clear I was going to have to follow up for a while. Now saddled with a pre-existing condition, I was left with few options. Obtaining my own insurance that would allow me to move to Washington D.C. and pursue a career while addressing my health concerns became a near impossibility. Even if I could get a plan approved, the premiums would be incredibly expensive and as noted before, I am unemployed. That's how I ended up at community college two months after completing my Bachelor's degree. In order to remain on my parents insurance plan, I had to enroll as a full time student. So here I am, sorting out some health issues but not able to move fully forward with my life.
Seemingly uncontroversial reforms such as banning rejections based on pre-existing conditions and dropping people once they get sick are extremely important to any reform plan. But there are many, many other components to be discussed and considered. I will not tackle them all in one single post. Instead, today I will focus on the most recent controversy: Rep. Joe Wilson's "You Lie!" interjection during President Obama's recent address to Congress.
I am not going to discuss the appropriateness of his comment (I believe it was incredibly inappropriate and disrespectful), nor the political expediency of his actions. I think Fox News and MSNBC have covered those aspects enough in the last two days. Instead, I got myself the CRS report "Treatment of Noncitizens in H.R. 3200," and looked at the facts behind the "lie." I will assume as a member of the House, Congressman Wilson was referring to his knowledge of H.R. 3200 and for now disregard that the President was proposing HIS ideas for reform, not the House Energy and Commerce Committee's. Interestingly, this CRS report made me think more about immigration reform than health care reform.
H.R. 3200 would mandate that people carry insurance. This is because one of the hidden costs those with insurance pay in their premiums comes from the uninsured whose expensive emergency room visits get spread out and paid for by the rest of us. The individual mandate is enforced through tax code provisions, enforced by the IRS. As stated in the CRS report, for tax purposes, noncitizens are classified as resident or nonresident aliens. But because these IRS terms do not exist in the Immigration and Nationality Act, an illegal alien may either be a resident or nonresident alien. Thus, a Legal Permanent Resident (a person who has a Green card but has not yet been naturalized as a citizen) may have the same tax status as an illegal immigrant. Because this bill requires resident aliens to obtain insurance, it appears to require some illegal immigrants to acquire insurance. It is important to understand this does not mean the government is required to supply these people with insurance, only that they must purchase it. Tonight, the White House clarified that in the President's proposal, undocumented immigrants would not be able to purchase insurance in the new exchange, but would have to do so on the non-exchange private market like some do now.
This brings us to the subject of tax credits and subsidies for those who cannot afford insurance like the mandate requires. H.R. 3200 explicitly states the term "affordable credit eligible individual" to mean "an individual who is lawfully present in the United States." According to CRS, illegal immigrants "would be required to have health insurance, but would be ineligible for the credits under the bill." Thus, it would appear the President was not lying. The federal government and the taxpayers that support it will not pay for the health insurance of illegal immigrants. Mandating them to acquire it is seen as a cost-saving measure because it would cut back on unpaid emergency room visits.
But how are we to enforce this provision if we can't even control illegal immigration as it is? Republicans are concerned there is no enforcement provision to make sure illegal immigrants do not obtain health care credits. CRS acknowledges there is no specific enforcement mechanism to do so, though the bill does give the Health Choices Commissioner responsibility for determining eligibility for credits. Tonight, the White House expressed its desire for an verification system of legal status. They gave the existing SAVE program (Systematic Alien Verification for Entitlements) as an option, though Congress has already defeated efforts to put that in place.
The President did not lie in his address to Congress. His proposals do not include illegal immigrants. Furthermore, H.R. 3200 includes language to specifically exclude illegal immigrants from tax-funded subsidies. The fact that there is a lack of enforcement speaks to a different issue: immigration reform. To be honest, immigration reform is not an issue I have carefully studied. But it seems to me enforcement of immigration laws has been an issue that leads to resentment among American citizens. Perhaps part of the problem is that the IRS and the Immigration and Naturalization act classify noncitizens differently? If a program, such as the the new health insurance exchange, is to be put in effect through tax law, wouldn't it make sense to have tax codes match up with immigration definitions? A legal permanent resident should not have the same tax status as an illegal immigrant who meets the substantial presence test (an individual who has been present 31 days during the current year and at least 183 days during the current and previous two years). Sound confusing? It is.
Republicans will continue to find loopholes in the current health care reform proposals because they want to stop the Democrats plans at all costs. Rep. Wilson's "You Lie!" helped to expose such a loophole. This is not a provision the Democrats placed in the bill to secretly cover illegal immigrants. Instead, it arose from trying to bring much needed health care to as many people as possible. Unfortunately, our tax codes classify both legal immigrants and some illegal immigrants under the same name. Under these circumstances, it will be nearly impossible to amend tax credits and subsidies without illegal immigrants filling up the loopholes.
Looks like immigration reform will be a topic I'm going to have to learn much more about!
CRS Report: Treatment of Noncitizens in H.R. 3200
http://opencrs.com/document/R40773/
WH on health care, illegal immigrants
http://firstread.msnbc.msn.com/archive/2009/09/11/2065287.aspx
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