We Should Insure Undocumented Immigrants

Andrew Romano writes in Newsweek:

The current House bill makes it very clear that “individuals who are not lawfully present in the United States” will not be allowed to receive subsidies. To wrangle assistance, illegal aliens would have to commit identity fraud, something that rarely happens in our current public-health-care system (a.k.a. Medicare). And Democratic senators have just announced that they’ll require those who participate to show proof of citizenship. So it’s a nonissue.

But let’s just assume, for argument’s sake, that we all live in [Joe] Wilsonville, where Obama is the lying liar his critics allege him to be—the sort of psycho who has chosen to sacrifice his political future on the flaming pyre of anti-immigrant sentiment by concocting a secret scheme to cover the nation’s estimated 11.9 million illegals. Would that really be so bad?

Of course, insuring undocumented workers is ethically murky and politically impossible. Some people argue that if we’re hiring illegals to, say, shingle our roofs, we have a moral obligation to care for them if they fall off. But more people, it seems, simply want them out of the country. Given that illegal immigrants have, by definition, broken our laws, it makes sense that large numbers of upstanding citizens oppose any measure that would encourage more foreigners to sneak into America or make their lives easier once they’re here.

The only problem? From a purely economic standpoint, insuring illegal immigrants makes a lot of sense—and not just for them, but for everyone.

Consider a few statistics. According to a July article in the American Journal of Public Health, immigrants typically arrive in America during their prime working years and tend to be younger and healthier than the rest of the U.S. population. As a result, health-care expenditures for the average immigrant are 55 percent lower than for a native-born American citizen with similar characteristics. With the ratio of seniors to workers projected to increase by 67 percent between 2010 and 2030, it stands to reason that including the relatively healthy, relatively employable and largely uninsured illegal population in some sort of universal health-care system would be a boon rather than a burden. “Insurance in principle has to cover the average medical cost of all the people it’s serving,” explains Leighton Ku, a professor of health policy at George Washington University. “So if you add cheaper people to the pool, like immigrants, you reduce the average cost.” More undocumented workers, in other words, means lower premiums for everyone.

The actuarial advantages don’t end there. As it is now, undocumented workers (and others) who can’t pay their way receive free emergency and charitable care—a service that costs those of us with health insurance an additional $1,000 per year, as Obama noted. But if illegals were covered, this hidden tax would decrease, further lowering our premiums and “relieving some of the financial burden on state and local governments,” says Harold Pollack, a University of Chicago professor who specializes in poverty and public health. What’s more, employers currently have a clear economic incentive to hire undocumented immigrants: they don’t require coverage. A plan that mandates insurance for native workers but not their illegal counterparts actually makes life harder on the blue-collar Americans competing for jobs (and railing against immigrants) because it means that hiring them will cost more than hiring a recent transplant from Mexico City. As The Washington Post’s Ezra Klein recently explained, “If you’re really worried about the native-born workforce, what you want to do is minimize the differences in labor costs between different types of workers. A health care policy that enlarges those differences—that makes documented workers more expensive compared to undocumented workers—is actually worse for the documented workers.”
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