Action Needed Now On Anti-Immigrant Budget Provisions

[This guest post comes from Vicky Pulos of Mass Law Reform Institute, and Nicole Tambouret of Mass Immigrant and Refugee Advocacy Coalition. Both organizations are leading the effort to protect rights and opportunities for newcomers in Massachusetts.]

In the final days of the state budget-setting process, the conference committee must decide between two approaches to state involvement in immigration enforcement – study the costs and benefits before enacting legislation (House Section 55) or go forward with an Arizona-lite package of amendments without examining the consequences (Senate Amendment 172.1).

Now with time to take a closer look at what is in the Senate budget bill, it’s clear that there will be many unintended adverse consequences for health care if the Senate approach prevails.

We strongly urge everyone to immediately get in touch with their State Representative (look-up here) and ask them to sign on Rep. Provost’s letter to the Speaker and House conferees asking them to hang tough on the House approach.

It is particularly frustrating for health advocates to see fear of appearing to be soft on illegal immigration driving bad policy at the state level, because we’ve seen what this fear has done at the federal level. In 2006, a Congress cowed by fear of looking soft on “illegals” enacted legislation requiring all 50 state Medicaid programs to require that US citizens to provide documentary proof of US citizenship in the form of a US birth certificate and drivers license or other documents. Proponents were confident the savings from all the illegal aliens taken off the Medicaid roles would more than pay for the added administrative costs of 50 states reconfiguring computer systems, regulations, notices, training etc. to implement the requirement.

The law took effect in January 2006. With 4 years of experience we now finally have some data. A report (pdf) issued by the U.S. House of Representatives Committee on Oversight and Government Reform found that the verification rule caused eligible U.S. citizens to lose their coverage and increased costs to taxpayers by $16.6 million in six states, saving only 14 cents for every $100 spent. The increased verification requirements aided in identifying only 8 undocumented immigrants out of 3,655,500 Medicaid enrollees. A GAO report (pdf) was consistent with these findings. Despite what we’ve learned from the Medicaid experience, the Senate budget amendments will require that US citizens applying for unemployment compensation (and other benefits) supply added documents to verify US citizenship. (Section 294)

For laid off workers frustrated with current pace of processing applications for unemployment compensation, don’t look for relief any time soon if these requirements are added to the existing workload of DUA.

Public opinion surveys say the majority of voters think illegal aliens should not get public benefits, and the Senate bill duly provides that individuals applying for health benefits through the MassHealth application form must document lawful presence. (Section 145). Most providers and outreach workers are well aware of how restrictive existing Medicaid rules are for legal immigrants. Not only must they supply documentation to verify legal status, but legal status is not sufficient to meet Medicaid eligibility rules for immigrants. Most legal permanent residents who entered the US after 8/22/96 must not only be legally authorized to live and work in the US but must have had that status for 5 years before qualifying for federal Medicaid. Further, it’s not immigrants driving health care costs. On average immigrants use fewer health services, and that includes emergency room services, than native born. (see this 2009 study, Health Care Expenditures for Immigrants Are Lower than for Citizens).

However, federal Medicaid law requires states to provide emergency services to certain low income individuals regardless of immigration status—maybe because federal law prohibits hospitals from turning away emergency patients or delaying emergency care to check for insurance coverage or immigration status. Federal law also pays an enhanced rate for states that provide prenatal care to pregnant women regardless of immigration status and Massachusetts, understanding that $1 spent on prenatal care generates $8 in savings on postnatal care and associated social costs, has taken advantage of this program. The Senate language can be read as prohibiting MassHealth programs that now provide emergency Medicaid and prenatal care to those unable to document lawful presence. Not only is this bad health policy, but it violates the maintenance of effort requirements of the federal health reform law and could jeopardize all Medicaid and CHIP funding for the state. Do we think the drafters intended that result? Surely not, but it is one of many examples of how flawed the Senate amendments are.

It’s not just one or two of the Senate amendments that are badly drafted, virtually all are ill-conceived but explaining why takes more time than it does to ask, “What don’t you understand about illegal?” For example, one provision (Section 173A) would require the AG to duplicate an existing federal 24-hour hotline for reporting suspected immigration violations and charge her with investigating every anonymous and unsubstantiated tip with no added resources to do it. Another provision would require that all state contractors (Section 42), and all employers generally (Section 174), use the problem-plagued federal E-Verify system to determine if employees are authorized to work. The US Chamber of Commerce is suing Arizona for mandating E-Verify, and evidence from Arizona suggest that the requirement has driven some employers underground resulting in a loss of tax revenue to the state.

The bottom line, Massachusetts can’t afford to pander to ill-informed anti-immigrant sentiment.