Anti-Immigration Activists See Opportunity in Health Care Debate

August 14, 2009 | Last updated: July 31, 2020

President Barack Obama (WDCpix) 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 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.”