To avoid adding additional costs to immigration reform, House Republicans are considering mandating undocumented immigrants purchase health insurance plans. Regardless of their concern for the deficit, this proposal is nonsensical given that undocumented immigrants are most likely to be poor, will not receive subsidies, and are barred from accessing state health insurance exchanges under the Affordable Care Act.
The Republican argument is that these immigrants need to show a bit of individual responsibility to earn their citizenship. Yet responsibility is the same reason Democrats used to justify the individual mandate in the Affordable Care Act. Without a mandate, they argued, there would be a "free rider problem" in which people would abuse the system and buy health insurance only when they became sick. Hence, the mandate in the Affordable Care Act ensured everyone was responsible for their health. If one is viewing this from the perspective of individual responsibility, one must support both mandates, making the Republicans look hypocritical.
There is still another problem with this proposal, though. It is highly unlikely most undocumented immigrants could afford a health insurance plan. Many of them earn meager salaries and need to spend most of it on housing and food. Further, the Affordable Care Act bars any benefits to undocumented immigrants like subsidies or participation in the state health insurance exchanges. Nor is there an enforcement mechanism to ensure they do purchase a health insurance plan. The federal government is not going to imprison them for not buying a plan. At worst, it will inhibit those who don't abide by the mandate from becoming citizens anytime soon. This upsets the whole point of immigration reform if there are even more barriers in the pathway to citizenship.
Of the 11 million undocumented immigrants in the U.S. in 2010, 7 million of them did not have health insurance. Taxpayers already pay for some of their health services because the Emergency Medical Treatment and Active Labor Act of 1986 requires hospitals to accept all people for emergency care. Although undocumented immigrants are technically responsible for the bill, they are often unable to afford it, so the costs are passed on to the hospital, other health consumers, and taxpayers. Ostensibly, mandatory health insurance would shift the costs of these services on to the undocumented. In reality, the majority of them could not afford to purchase it.
It was a foolhardy to decision to bar undocumented immigrants from the benefits of the Affordable Care Act in the first place. These immigrants tend to be younger and healthier than the overall population, so they would more likely contribute than take out of the system. Furthermore, unhealthy undocumented immigrants can have negative effects on citizens. Without insurance, they are less likely to purchase vaccines or antibiotics, risking the possibility of spreading illness to other people. Current fear of deportation discourages them from accessing these health services. Finally, barring them from benefits only incentivizes employers to hire undocumented workers because they don't require health care coverage.
The House Republican's proposal for a health insurance mandate on undocumented immigrants would be acceptable if they received any benefits under the Affordable Care Act. However, they don't, so it becomes an unenforceable, pointless addition to immigration reform. Although House Democrats may oppose this provision, they are in the. Nothing similar to this currently exists in the bipartisan bill in the Senate, and it is doubtful this addition would stay after the two bills are merged. It is certainly fair to require immigrants to meet certain requirements before they can become a citizen, but a health insurance mandate would be impossible to uphold.