President Barack Obama (WDCpix)

When President Obama showed up for a town hall meeting in New Hampshire on Tuesday, he heard more than just protests against health care.

“We don’t need illegals,” yelled a white-bearded protester into his megaphone outside the high school auditorium in Portsmouth, caught on video here. “Send ‘em all back. Send ‘em back with a bullet in the head the second time.”

If the threats of violence weren’t clear enough, the man goes on to say: “Read what Jefferson said about the Tree of Liberty — it’s coming, baby.” Thomas Jefferson’s actual quote was “The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants.”

Illustration by: Matt Mahurin

As the heat gets turned up on the health care reform debate, anti-immigrant activists are using the issue to whip up fear and anger toward immigrants, portraying them as a costly and burdensome drain on any taxpayer-supported U.S. health care system. Angry questions about illegal immigrants getting health care at town hall meetings across the country have put many lawmakers on the defensive.

At his town hall meeting in Pennsylvania, for example, Democratic Sen. Arlen Specter had to assure protesters that illegal immigrants would not be covered. House Speaker Nancy Pelosi (D-Calif.) has gone out of her way to make that point as well. Sen. Benjamin Cardin (D-Md.) faced similar shouted questions at his town hall forum on Wednesday, and repeatedly emphasized that illegal immigrants are not covered by the House bill. President Obama has also made the point, although it’s not clear that the anti-reform activists have heard it.

The protesters are spurred on in large part by immigration restrictionist groups who are using the health care debate to spread fears about immigrants. The restrictionist group Numbers USA, for example, has been posting video interviews online with unnamed “experts” warning that emergency rooms are overwhelmed by both legal and illegal immigrants, and that subsidized health care won’t be available for other low-income Americans because immigrants will be using it all up.

The Center for Immigration Studies in Washington, meanwhile, a non-profit research organization that says it’s “animated by a pro-immigrant, low-immigration vision,” is sponsoring a panel discussion next week in Washington called The Elephant In the Room: Immigration’s Impact on Health Care Reform. Steven Camarota of the center writes on the group’s web site that “one out of three people in the U.S. without health insurance is an immigrant (legal or illegal) or the U.S.-born child (under 18) of an immigrant,” and claims that immigrants and their children “account for one-fourth of those on Medicaid.” Yet “the enormous impact of immigration, both legal and illegal, on the health care system has generally not been acknowledged in the current debate.”

Immigrants’ advocates vehemently dispute the CIS statistics, and argue that immigrants — particularly illegal immigrants — are actually far less likely to use even emergency health services than American-born U.S. citizens are.

“We’re really concerned about what the anti-immigration community is doing to try and stop health care reform from moving forward,” said Jennifer Ng’andu, Deputy Director of the Health Policy Project at the National Council of La Raza. “We see it as those communities trying to stir the pot and create controversy. These are not folks who come to the table with solutions. They’re not looking to talk about a health care reform plan. They just assume that by creating anxiety about immigrants, that they’ll stop this debate.”

The protests have put lawmakers on the defensive. At town hall meetings focused on the health care debate, they’ve repeatedly been questioned about whether they support providing health care for illegal immigrants. Pelosi, Specter and Obama have all emphasized that illegal immigrants would not be covered under the current health care proposals.

The issue has gotten so heated that even the Congressional Hispanic Caucus issued a statement supporting health coverage only for “legal, law abiding” immigrants who pay their “fair share” for health care.

Under federal law, illegal immigrants are entitled to receive only emergency health care, although some states offer assistance to uninsured children. But conservative groups such as CIS and the Heritage Foundation complain that even emergency care for illegal immigrants is a big problem.

Immigrants’ advocates deny that that immigrants, legal or illegal, are driving up the costs of the health care system or disproportionately relying on government health services. And they point to a stack of studies showing that, on the contrary, immigrants actually use fewer health services than do American-born citizens.

A July 2009 article in the American Journal of Public Health, for example, found that insured immigrants had much lower medical expenses than insured U.S.-born citizens. And while recent immigrants constituted 5 percent of the nonelderly adult population, they were responsible for only 2 percent of adults’ total health care costs.

Meanwhile, a study by the non-partisan Kaiser Commission found that although noncitizens receive less primary health care than citizens, they are far less likely to use the emergency room.

The current House health care bill would not provide insurance coverage for illegal immigrants, and severely restricts coverage even for legal United States immigrants. Immigrant adults have to wait five years before becoming eligible for Medicaid or federal Children’s Health Insurance Plan benefits, for example. (CHIP covers pregnant women in addition to children.) That concerns both immigration and public health advocates.

“Legal immigrants might not achieve equitable access to health coverage in this health care reform bill, but they will be subject to the same requirements to purchase insurance,” said Ng’ara. “They pay the same taxes and will have to share in the responsibility of fixing our health care system, but they may be subject to waiting periods or restrictions before they qualify for many of the benefits.”

Michele Waslin, Senior Policy Analyst at the Immigration Policy Center, made the point in a recent blog post that including immigrants in any health insurance plan would actually help reduce the costs for everyone else. “An important function of health insurance is to pool risks and use premiums collected from the healthy to pay for the medical care of those who need it,” says Waslin. “It is common sense that the more people who pay into the health care system, the more the risk—and thus the costs—are spread out over the entire population.”

What’s more, she argues, public health improves the more people receive regular health care, including preventive services. “It’s also very expensive when people do not receive regular health care and wait until they are very sick to receive care,” she said.

The Center for Science in the Public Interest has concluded that “Comprehensive prevention programs are the most economical way to maximize health and minimize costs.”

The economics of health care may not be what’s actually motivating the controversy, however. The move to bar even legal immigrants from receiving any support to purchase health insurance is consistent with a broader rise in anti-immigrant sentiment that experts who track hate groups are noticing.

A new report from the Southern Poverty Law Center released this week, for example, noted a dramatic rise over the past decade of right-wing militia movements. The group attributes the phenomenon in part to “high levels of non-white immigration and a decline in the percentage of whites overall in America,” which has made race a much larger focus of its anti-government “Patriot movement.” The result, says the law center, has been that even “ostensibly mainstream politicians and media pundits have helped to spread Patriot and related propaganda, from conspiracy theories about a secret network of U.S. concentration camps to wholly unsubstantiated claims about the president’s country of birth.”

A mountaintop mine in West Virginia (NRDC photo)

For environmentalists in the Appalachians, it was a roller-coaster week.

Just one day after the Environmental Protection Agency announced plans to reassert its powers to protect mountain streams from the ravages of mountaintop coal mining, the U.S. Army Corps of Engineers approved the broad expansion of such a project without EPA input.

Illustration by: Matt Mahurin

Many environmentalists are scratching their heads over the seemingly contradictory events. On the one hand, they are cheering the promise of a newly empowered EPA under the Obama White House, while also wondering when that vow will surface as policy. At stake are hundreds of miles of Appalachian streams that could be buried with pollutant-laden debris if scores of pending mining permits are approved as is.

The episode presents tough choices for the young administration, pressured to deliver the environmental protections it’s promised while taking care not to hobble the powerful coal industry — an important economic engine in the Appalachian states — in the middle of a deepening recession. It also highlights the tensions between environmentalists trying to wean the country from a reliance on coal, which generates more than half the country’s electricity, and industry defenders who hope to maintain its importance.

The recent saga began last Monday, when the EPA sent letters to the Army Corps of Engineers in Huntington, W.Va., recommending that the Corps either deny or alter proposed projects in West Virginia and Kentucky because agency studies show that the two mountaintop mines would have serious water-quality consequences. A day later, the EPA vowed to review hundreds more backlogged permit requests to assess their effect on streams.

Environmental groups embraced the developments as a sharp break from the hands-off EPA policies of the Bush administration, which left mine-permit decisions almost exclusively to the discretion of the Army Corps.

“What EPA is doing is reasserting the primacy of science,” said Jim Hecker, environmental enforcement director at Public Justice, a public interest group. “The Corps has never cared about science.”

On Wednesday, however, the Corps’ Louisville district approved a 1.5-square-mile expansion of a mountaintop mine in Southeast Kentucky with no input from the EPA. The expansion of the International Coal Group’s Thunder Ridge mine allows the company to fill four valleys with debris, burying nearly two miles of streams that drain into the Middle Fork of the Kentucky River. That river supplies drinking water to more than 700,000 people — roughly one-sixth of the state’s population.

The permit approval, according to many environmentalists, directly contradicts the EPA’s vow to play a larger role in the permit process.

“It’s just completely outrageous, especially in light of the EPA’s announcement just 24 hours before,” said Judy Peterson, executive director of the Kentucky Waterways Alliance, which filed suit in December 2007 to block the Thunder Ridge expansion. “It’s basically a slap in the face for the EPA. They said they were going to be reengaged in this issue, and they were nowhere in sight.”

EPA spokeswoman Enesta Jones gave a terse “no comment” when asked about the Thunder Ridge permit approval. But Ron Elliott, spokesman for the Corps’ Louisville district, was happy to talk. Elliott said the Corps presented the EPA with Thunder Ridge’s expansion proposal several years ago when the application was submitted, and again in January of this year when approval was imminent. The new administration “had plenty of time” to weigh in on the permit, he said, but didn’t do so.

“They chose not to comment,” Elliott said. “That’s why we thought there wasn’t any need to coordinate. The silence is interpreted as concurrence.”

The episode could prove to be a wakeup call for the EPA, which, despite its vow to review pending permits, has also emphasized that it’s “not halting, holding or placing a moratorium on any of the mining permit applications. Plain and simple.”

Some environmentalists maintain that last week’s announcement will effectively delay the permit process. Matthew Wasson, director of programs at Appalachian Voices, an environmental group, said the EPA is not only reviewing the permits, but also working on new standards to govern the process. “There won’t be any new permits until that’s resolved,” he said.

Some others, however, worry that the EPA reviews will do little good if the Corps begins approving controversial permits before the EPA can weigh in. “If the Corps is going to take these kinds of egregious actions,” Peterson said, referring to the Thunder Ridge decision, “maybe EPA does need to put holds on these permits.”

Under the Clean Water Act, the Corps handles most permit decisions, but the EPA can step in to delay pending permits — or veto those already approved — if the agency has reason to believe the disposal sites will harm water supplies or ecosystems.

The controversy swirls around mountaintop mining — a process in which companies blast the tops off of mountains to reach the coal seams within, creating moonscapes within the eons-old Appalachians. The process produces enormous amounts of debris, which is disposed by pushing it into adjacent valleys, some of which contain streams. The technique has grown popular — particularly in Virginia, West Virginia and Kentucky — for its efficiency: Companies can retrieve nearly all of the coal within the seam, and they can rely more on explosives and machines than manual labor.

Defenders of the coal industry, including a number of powerful lawmakers, argue that the practice generates much-needed jobs in some of the most destitute areas of the country. The National Mining Association issued a statement last week calling the EPA’s announcement “incomprehensible” and “especially troublesome from an administration that with one hand proposes enormous fiscal stimulus to put Americans back to work and with the other hand takes their jobs away.”

Many lawmakers representing the coal producing states have weighed in with similar warnings. “Every job in West Virginia matters,” Sen. Robert Byrd (D-W.Va.) said in a statement. “Everyone involved must act swiftly in concert and cooperation to remedy any problems that threaten coal jobs and the people who live in the local communities where coal is mined.”

Yet critics of mountaintop mining are quick to point out that it creates far fewer jobs than other extraction methods. Indeed, the reason the companies choose to blow the tops off of mountains is to reduce labor and save costs. “This is a jobs issue,” said Sierra Club spokesman Oliver Bernstein, “but they’re on the wrong side of it.”

Opponents also say the jobs aren’t worth the flooding, water pollution and general decimation of local communities that often accompany the mining operations.

“The loss of community and the loss of culture is the real story here,” said Cindy Rank, who chairs the mining committee at the West Virginia Highlands Conservancy.

The issue is timely because hundreds of permits have been backlogged awaiting a court ruling on the Corps’ authority to issue permits without more extensive environmental impact studies. Overturning a lower court’s ruling, the 4th U.S. Circuit Court of Appeals, based in coal-friendly Virginia, found last month that the Corps does indeed have the power to issue mountaintop permits without broader reviews.

Adora Andy, spokeswoman for the EPA, said there were between 150 and 200 permits on backlog awaiting the 4th Circuit decision. If approved, those projects would impact at least 211 miles of streams in West Virginia and Kentucky, according to Margaret Janes, senior policy analyst for the Appalachian Center for the Economy & the Environment, who analyzed 102 of the permits.

Peggy Noel, spokeswoman for the Corps’ Huntington district, said the EPA’s recent letters don’t change the task or the direction of her office, where it’s “just business as usual.”

“We are a neutral agency,” Noel said. “We’re not for [the mines]; we’re not against them. We’re just here to evaluate and approve permits.”

Yet with the conclusion of the 4th Circuit case, many observers fear that a wave of approvals is soon to follow. “There’s a sense of urgency with these permits waiting in the pipeline,” said Bernstein, of the Sierra Club. “They’re ready to go.”

The urgency hasn’t been lost on some lawmakers. Last week, Sens. Lamar Alexander (R-Tenn.) and Ben Cardin (D-Md.) introduced legislation aimed at eliminating mountaintop mining by restricting what companies can dump into adjacent valleys. The idea is that if it becomes too expensive to truck the debris off the site, then companies will abandon the practice altogether.

“Coal is an essential part of our energy future,” Alexander said in a statement, “but it is not necessary to destroy our mountaintops in order to have enough coal.”

Companion House legislation, introduced earlier this month by Reps. Frank Pallone (D-N.J.) and Dave Reichert (R-Wash.), has 135 co-sponsors.

Yet in the face of opposition from some powerful congressional lawmakers — including Byrd and Senate Minority Leader Mitch McConnell (R-Ky.) — the legislation has a difficult road ahead. Environmentalists and other mountaintop mining critics are hoping the White House will step in to restrict the practice.

“Politically,” said Hecker, of Public Justice, “it’s easier to get the Obama administration to do it themselves.”