Health Care Debate Focuses on Legal Immigrants - NYTimes.com

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By JULIA PRESTON

The debate over health care for illegal immigrants continues to percolate in Congress despite the Obama administration’s efforts to put it to rest, with lawmakers in both houses also wrangling over how much coverage to provide for immigrants who have settled in the country legally.

Some Republicans favor excluding immigrants who have been legal permanent residents for less than five years, as well as all illegal immigrants. Democrats broadly agree that illegal immigrants should be excluded, but many want all legal permanent residents to be able to participate in proposed health insurance exchanges and receive subsidized coverage if they qualify.

Latino leaders, worried that Congress might quietly cut back benefits for legal immigrants, have started an 11th-hour campaign to eliminate waiting periods for them in the proposed legislation and to cancel the existing five-year wait for Medicare and Medicaid programs.

Under some plans being considered by Congress, more than one million legal permanent residents and about seven million illegal immigrants who currently have no health insurance would be excluded from coverage, according to a study by the Migration Policy Institute, a nonpartisan research group in Washington.

Any proposal under discussion would leave California with the largest population of uninsured residents, as many as 1.4 million legal and illegal immigrants, according to a study by the Center for Health Policy Research at the University of California, Los Angeles. California’s health system has been crippled by the soaring costs of caring for 6.8 million residents with no insurance, a figure that includes about 4 million American citizens.

Large numbers of immigrants in Florida, New York and Texas would also remain without coverage under the proposals.

While generally ceding the fight to gain coverage for illegal immigrants, groups like the American Hospital Association, the United States Conference of Mayors, and the Catholic Health Association, among others, have urged Congress to eliminate any waiting periods for legal residents in future programs and for Medicare and Medicaid. Such exclusions, they say, tend to defeat the cost-saving purposes of universal coverage.

“You can either keep those immigrants healthy now, or exclude them and wait until they get really sick, then pay for it down the line,” said Prof. Steven P. Wallace, associate director of the U.C.L.A. research center. “If you don’t pay now, you’re going to pay for them later.”

Republicans argue that maximizing restrictions on legal and illegal immigrants will save money and prevent health care benefits from becoming a magnet that draws new migrants to the United States. The five-year wait for Medicare and Medicaid was first imposed on legal permanent residents as part of the federal welfare overhaul in 1996.

Under all plans under consideration, immigrants who are excluded from new programs, including illegal immigrants, would still be required to buy health insurance.

In September, Representative Joe Wilson, Republican of South Carolina, caused a furor during a joint session of Congress when he accused President Obama of lying about whether Democratic health proposals would cover illegal immigrants. Since then, battles over health care for immigrants have been waged less openly, in closed-door negotiations and dueling amendments in committee. With Democratic leaders in the House and Senate pushing to move bills to the floor in coming days, lawmakers from both parties are working to line up immigration amendments for full debate.

There is broad agreement in Washington on barring illegal immigrants from taxpayer-financed coverage. White House officials have also said that illegal immigrants should be excluded from buying coverage through insurance exchanges that are proposed to increase competition.

Instead, the debate has been over measures to verify applicants’ citizenship status. Both the Senate and House bills now call for relatively simple proof of identity, like a driver’s license or Social Security card, lawmakers said.

Representative Nathan Deal of Georgia, the senior Republican on the House Energy and Commerce Subcommittee on Health, said he would try to offer an amendment to require a second document to verify immigration or citizenship status. Mr. Deal accused the House speaker, Nancy Pelosi of California, of leaving loopholes that would allow “illegal aliens to slip in through the cracks.”