From the genesis of the health care debate, immigrant communities such as new lawfully residing and unauthorized immigrants were excluded from any benefits of health care reform. The Administration’s perception was that the exclusion of undocumented immigrants from any benefits and the continuation of the current policy that forces new legal immigrants to wait five years before being eligible for federally funded programs such as Medicaid would guarantee the support of conservative Democrats, sway the votes of moderate Republicans, and appease public ‘outrage.’ Alas, this strategy did not accomplish the desired results and instead went into a spiral.  

On September 9, 2009, President Obama addressed a joint session of Congress on health care reform. This speech sought to provide a boost to Congress to act swiftly on health care reform and garner support from the general public. However, President Obama’s speech is most remembered by an inappropriate outburst by Congressman Joe Wilson (R-S.C.). Congressman Wilson shouted ‘You lie!” in response to Obama’s affirmation that health care reform would not provide coverage to undocumented immigrants.

The infamous Joe Wilson episode made Administration officials increasingly anxious about this issue and triggered the inclusion of more restrictive language in the Senate bill. Unlike the House proposal, the Senate bill excluded undocumented immigrants from purchasing unsubsidized private health coverage in the Exchange¹ and did not eliminate the five-year waiting period for legal immigrants  before qualifying for Medicaid. The concessions by both Democrats and the Administration proved to be futile because at the end of the day, not a single Republican voted in favor of health care reform. Furthermore, anti-immigrant groups continued to spread myths that health care reform delivers an array of benefits to undocumented immigrants. The political decision made by the Administration failed at its goals and was also a devastating public policy proposal.   

The strategy that Administration officials took narrowed the debate to immigrant issues and missed the main reason for enacting health care reform; as the late Senator Edward M. Kennedy (D-MA) said, “What we face (our broken health care system) is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”² This is the heart of the argument behind comprehensive, inclusive, and affordable health care reform, rather than that it should be enacted in part because it excludes immigrants.

It is estimated that 45,000 people die in the United States each year in large part because they lack health insurance.³ This figure includes immigrants. A video that CHIRLA produced with stories of immigrants featured Mari Campos, a native of Los Angeles, student at the University of California Santa Cruz, and daughter of immigrant parents that naturalized in 2008. It narrates how her father struggled with cancer and at times did not seek services because of fear of the cost associated with treatment. Mari’s father died in March of 2009.⁴ Another story comes from Rosa, an undocumented immigrant; she has worked all her life and was diagnosed with diabetes. At times, she is unable to pay for her medications and has taken part in experimental treatments to receive free treatment for her illness. These are the human faces and experiences of immigrants that lack health care coverage, and turning a blind eye on them goes against the moral premise of enacting health care reform.

To ignore and exclude immigrants neglects the needs of state and local governments with large immigrant populations. These populations are healthier in comparison to native citizens, but account for 24% of the overall uninsured.⁵ California, a state with one of the highest populations of immigrants, provides Medi-Cal to lawfully residing immigrants with state funding. Thus, if they had been included in health care reform, the state budget would have benefited because the federal government would have contributed to the cost. Although undocumented and lawfully residing immigrants will remain uninsured, at some time they will require medical care. Their only alternative will be the emergency rooms, which are more costly to states and local governments.

Excluding immigrants also has a negative effect on native citizens. They will pay more for their health insurance as a result of a smaller pool of people who are required to be insured, and the cost of emergency rooms will continue to be passed along to all tax payers. U.S-born children in mixed families will continue to be exposed to financial insecurity because one of their parents will continue to lack health insurance and will be a step away from financial insecurity if an accident occurs.

Health care reform became a reality, at last, but at what cost? This reform falls short in including immigrant communities. In order to avoid making this achievement a Pyrrhic victory, Congress and the President must commit to fix the current bill in the near future.

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