Undocumented Immigrants: Include, Exclude, Ignore?

According to the Oregon Center on Public Policy, an estimated 128,000 to 150,000 undocumented immigrants resided in Oregon in 2006.* Two years later that number has likely increased, yet would still possibly represent around 4 percent of the total population in Oregon.** While this group is a small segment of the entire population, it could play a divisive role in a push for universal health care coverage.

Two committees of the Oregon Health Fund Board (the Health Equities Committee and the Eligibility and Enrollment Committee) have held discussions on the topic and are in the process of issuing recommendations to the Board. Both Committees focused on humanitarian, public health, and cost-shift issues related to either ignoring undocumented Oregonians or creating a bureaucracy to actively exclude this group. The Committee members see their primary charge as advancing the goals of the Healthy Oregon Act by covering Oregon’s uninsured population. They do not want to enter into enforcement of federal citizenship requirements.

The Health Equities Committee recommends:

It is a long held Oregon value that all Oregon residents have equal opportunity to support their families, pay taxes, and contribute to the State’s economy. To maintain the health of that workforce, it is fair, wise and in the State’s economic interest that the Oregon Health Fund program shall be available to all Oregon residents.

As consistent with current practices in the private marketplace, no citizenship documentation requirements will be in place to participate in the Oregon Health Fund program.

To implement these recommendations, the Committee believes that the Oregon Health Fund Board should consider various policy implementation options. The Committee’s preferred option is:

Establish an ‘Oregon Primary Care Benefit Plan’, or alternatively a health care pool, within the Oregon Health Fund Program for non-qualified [legal immigrants who have been in the U.S. under 5 years, and individuals without documentation] Oregon residents who are unable to afford purchasing health care without a subsidy. Financing for this portion of the program could be structured so that industries employing non-qualified Oregon residents are directed to contribute through the “play or pay” requirement of the employer mandate.

What do you think the Oregon Health Fund Board should include in its consideration of this potentially hot button issue? How should undocumented immigrants be treated within a plan for universal health coverage in Oregon?

*Data based on reports from the Pew Hispanic Center and the former Immigration and Naturalization Service (now the U.S. Citizenship and Immigration Services Bureau).

**Additional information on immigrants and health care is available from a recent report by the Kaiser Commission on Medicaid and the Uninsured.

Comments

[Robert Brown]

SB 329 states pretty clearly that the system to be created must be available to all Oregonians. "All individuals must be eligible for and have timely access to
at least the same set of essential and effective health services." Therefore, I agree with the Committee's recommendation.

That said, I believe the eligibilty of undocumented people will be an issue as the recommendations work their way through the legislative process in 2009. This is an issue that is worth fighting for: if there is any segment of the population that is not covered by any health care reform proposal, we will be back in the same place we are in now. We will have that population without accesss, going to emergency rooms for routine care when all that is needed is access to basic services. This is a humanitarian issue. Those that will fight for this provision must have data to support this claim. Data includes cost to provide services and cost to not have available services, where cost must include more than dollars.

[Marwift]

I like the idea of everyone having reasonably priced access to health care. But what happens, down the line, when people start coming to Oregon because of the health care?

I have friends in healthcare in Arizona who have definately seen an increase in the number of people moving into the state because of their heath care availability. How do we provide health care for all Oregonians without having a huge influx of unemployed or undocumented persons into the state? Who will make determinations of eligibility. What is the definition of a "resident"?

These questions (and others like them) must be answered before a new program is instituted. These are NOT hypothetical situations. They are situations other states/countries have faced. For once, let's try to learn from other's mistakes.

[jen]

According to Drug Availability Steering Committee Reports, Oregon is the 4th in indoor productionin the US. We also rank 10th in overall production of marijuana. It is a $116 Billion dollar industry nationwide.

Marijuana is the top cash crop in the Oregon, yet is completely unregulated, untaxed, and controlled by criminals. If you want to pay for universal healthcare for all Oregonians,you need to legalize, regulate and tax marijuana for adult use regardless of medical condition.

It would reduce your public safety budgets, by focusing police resources where they are needed: on meth, heroin and violent crime.

It wil create revenue that will make treatment for people with real drug problems more available.

It would free up needed jail space - no sense locking up tax-paying pot growers.

But most importantly, we wouldn't have to fear the influx of new residents, or try to come up with qualifications to keep new people out of the system, because we would have a way to pay for it.

It would also reduce overall healthcare costs. Many medical marijuana patients are able to reduce doctor visits, hospital stays, and pharmaceutical medications by using marijuana instead.

[Lurelle]

I am in complete agreement. We must Include all undocumented residents. We must do the right thing which is to provide a system for every resident that allows for equal access and equal coverage. It needs to allow every resident the right to choose the type of care and service provider for their prevention and health program; to include but not be limited to care providers such as Naturopaths, Chiropractic, Acupuncture to name a few.

The eligibility of undocumented persons may become an issue of discussion but we must remain committed to all the reasons we believe care should be available for everyone. It is the humanitarian and moral thing to do.

We should not create a system that has special sub sets of people. All residents deserve the same service, keep it simple.

Just like education, those of us who can pay, pay and those who can not still get education and deserve the opportunity to be healthy.