Back to Basics

The Congressional Research Service has issued their report regarding the treatment of noncitizens in H.R. 3200. There has been a lot of debate over this topic, with the president and democrats saying illegals are not covered, while those opposed to the bill saying they are. A number of loopholes in the bill, including no provisions for checking immigrations status, prove illegal immigrants can and will be covered by the bill, at the taxpayers’ expense.  The Summary of the report is include below.  If you would like to read the entire report, please click on CRS Report.

August 25, 2009
Treatment of Noncitizens in H.R. 3200
Congressional Research Service

Summary

This report outlines the treatment of noncitizens (aliens) under H.R. 3200, America’s Affordable Health Choices Act of 2009. In particular, the report analyzes specific provisions in H.R. 3200, and whether there are eligibility requirements for noncitizens in the provisions. Within the bill, noncitizens are treated differently in several provisions. In 2008, there were approximately 37.3 million foreign-born persons in the United States. The foreign-born population was comprised of approximately 15.1 million naturalized U.S. citizens and 22.2 million noncitizens.

H.R. 3200 includes an individual mandate to have health insurance, with tax penalties for noncompliance. Individuals who do not maintain acceptable health insurance coverage for themselves and their children would be required to pay an additional tax. Some individuals, including nonresident aliens, would be exempt from the individual mandate. “Nonresident alien” is a term under tax but not immigration law. For federal tax purposes, alien individuals are classified as resident or nonresident aliens. In general, an individual is a nonresident alien unless he or she meets the qualifications under a residency test. Thus, legal permanent residents, and noncitizens and unauthorized aliens who qualify as resident aliens (i.e., meet the substantial presence test), would be required under H.R. 3200 to have health insurance.

In addition, under H.R. 3200, a “Health Insurance Exchange” would begin operation in 2013 and would offer private plans alongside a public option. The Exchange would provide eligible individuals and small businesses with access to insurers’ plans, including the public option, in a comparable way. Individuals would only be eligible to enroll in an Exchange plan if they were not enrolled in other acceptable coverage (for example, from an employer, Medicare and generally Medicaid). H.R. 3200 does not contain any restrictions on noncitzens participating in the Exchange – whether the noncitizens are legally or illegally present, or in the United States temporarily or permanently. Nonetheless, only aliens who could be classified as resident aliens would be required under the bill to have health insurance.

In 2013, under H.R. 3200, some individuals would be eligible for premium credits (i.e., subsidies based on income) toward their required purchase of health insurance. To be eligible for the premium credits under H.R. 3200, individuals must be lawfully present in a state in the United States, excluding most nonimmigrants (i.e., those in the United States for a specific purpose and a specific period of time). The exceptions for nonimmigrants who could obtain premium credits under H.R. 3200 would be trafficking victims, crime victims, fiancées of U.S. citizens, and those who have had applications for legal permanent residence (LPR) status pending for three years. It is expected that almost all aliens in these excepted nonimmigrant categories will become LPRs (i.e., immigrants) and remain in the United States permanently. Furthermore, unauthorized aliens would be barred from receiving the premium credit.

H.R. 3200 as reported from the House Energy and Commerce Committee (E&C) would extend Medicaid eligibility up to 133 1/3% of poverty for populations that previously were not covered (e.g., childless adults and many parents). This extension of benefits could mean an increase in the number of noncitizens who already meet the immigration status requirements for Medicaid eligibility who would be eligible for Medicaid. Also, H.R. 3200 as reported by E & C would make eligible for full Medicaid noncitizens who lawfully reside in the United States in accordance with the Compacts of Free Association between the Government of the United States and the Governments of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, and are otherwise eligible for such assistance. This report will be updated.

Under the title of Public Health & Workforce Development are a number of grants, scholarships and other programs, providing training, services and a whole new array of studies relating to health care – a lot of money being spent to support the expansion of government, special interests, illegal immigrants and labor unions, but little to help solve the health care issues.

The first expansion is the establishment of the Public Health Investment Fund, which requires deposits from the revenues of the Treasury in the amount of $88,700,000,000 over 10 years. This money is authorized to be appropriated by the Committee on Appropriations of the House and Senate for carrying out the activities under the designated public health provisions. These areas include Community Health Centers, National Health Service Corps Program, National Health Service Corps Scholarship and Loan Repayment Programs, Primary Care Loan Funds, Primary Care Education Programs, Nursing Workforce Development, The National Center for Health Statistics and the Agency For Healthcare Research and Quality.

To make these programs even more appealing is the stipulation that “Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget solutions for fiscal years during which appropriations are made from the fund.” More spending without any concern for balancing the budget or controlling the country’s deficit. We don’t have it, but let’s spend it!

The first program – Community Health Centers – will obtain increased funding in the amount of $38,800,000,000.

The National Health Service Corps is being amended allowing the Secretary to issue waivers to individuals who enter into a contract for obligated service to pay for their education. It further raises the loan repayment amount from $35,000 to $50,000 and will be adjusted thereafter to reflect inflation. Additional appropriated funds for this program are $796,000,000 over the next 10 years. Additional funding is authorized in the amount of $3,171,000,000 over 10 years to cover the National Health Corps Scholarship and Loan Repayment Programs.

The Frontline Health Providers Loan Repayment Program will be established to address unmet health care needs in certain areas, populations, or facilities as designated by the Secretary. Individuals participating in this program must agree to serve for a period of 2 years in a health professional needs area specified in the program. This program has a clause that if there are an insufficient number of applicants for the program, then all excess funds from the program will be transferred to the National Health Service Corps to recruit more people to take advantage of this fund.

The Secretary shall establish a primary care training and capacity building program consisting of grants and contracts to plan, develop, operate or participate in accredited professional training in the field of family medicine, general internal medicine, general pediatrics or geriatrics. Funds for this program are from the Public Health Investment Fund in the amount of $3,023,000,000 for 10 years and will include the following:

• Capacity Building in Primary Care – grants to specialties of family medicine, general internal medicine, general pediatrics or geriatrics, with preference given to entities that train individuals who are from underrepresented minority groups or disadvantaged backgrounds.
• Training of Medical Residents in Community-Based Setting – a program established for the training of medical residents in community-based settings, with preferences given to entities that support teaching programs addressing the health care needs of vulnerable populations or are a Federally qualified health center or rural health clinic, as well as preference to those training individuals from underrepresented minority groups or disadvantaged background.

• Training for General, Pediatric or Public Health Dentists and Dental Hygienists – grants and contracts to plan, develop, operate or participate in an accredited professional training program or oral health professionals, with preference given to individuals who are from underrepresented minority groups or disadvantaged backgrounds.

Grants for Health Professionals Education – Advanced Education Nursing Grants is being amended, including increases in dollar amounts for the Nurse Faculty Loan Program. Funding for this program is $1, 450,000,000 over 10 years.

The Public Health Workforce Corps is being amended and expanded by the following: Creating the Public Health Workforce Scholarship Program, Public Health Workforce Loan Repayment Program, Enhancing the Public Health Workforce, and Preventive Medicine and Public Health Training Grant Program. Appropriations for these programs total $642,000,000 over 10 years. The Enhancing the Public Health Workforce even includes provisions for veterinary medicine! I’m not sure how veterinarians will provide quality health care to people or decrease health care costs, but it’s nice to see even our animals will be included in the grant programs.

Under the Subtitle “Adapting Workforce to Evolving Health System Needs” there are a number of grants and programs including:

• Health Professionals Training for Diversity, which includes scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistant in health professions regarding individuals from disadvantaged background.

• The Nursing Workforce Diversity Grants is being amended and adding the Coordination of Diversity and Cultural Competency Programs.

• The Secretary will establish a cultural and linguistic competency training program for health care professionals, including nurses, consisting of grants and contracts to develop and implement models of cultural and linguistic competency training. Preference will be given to entities that address cultural and linguistic needs of the population and health disparities, and placing health professionals in regions experiencing significant changes in the cultural and linguistic demographics of populations, including communities along the United States-Mexico border. Obviously this program will benefit all the illegal immigrants coming from Mexico to obtain free health care.

Appropriations for these programs total $1,138,000,000 over 10 years.

Grants and contracts are given to develop training programs to promote the delivery of health services through interdisciplinary and team-based models, with preferences given to entities that demonstrated training to the greatest number of health professionals who serve in underserved communities.

As promised, I have been reading H.R. 3200, and this is my summary of the private option established by the Health Insurance Exchange. I apologize for the length of the article, but feel to report the information as accurately as I can I could not leave anything out. I will again state that I am not a lawyer, so if you have questions about anything please contact your local representatives.

This is just ONE section of the bill, establishing only the Health Insurance Exchange. It expands the government and thus government spending. In this section alone it adds one committee and three new government positions, as well as support departments. You must also factor in the overhead and administrative costs in support of these new positions. Those costs have to be recovered somehow either in the form of higher taxes or included in the cost of insurance premiums offered. I don’t know how spending more produces lower costs. Since insurance policies are currently brokered in the true private sector, why would it now require the creation of a government agency to do the same thing? If this isn’t a government takeover then why not leave it in the hands of the private sector without government interference and provide a means of expanding it there?

I do not usually watch mainstream television and therefore may not ever see the propaganda being pushed in the ads for Obamacare, but I’ve heard about them. So I watched it on the internet. On the surface it all sounds wonderful, the utopia everyone is looking for. EVERYONE will be covered by insurance, NO ONE will be denied, EVERYONE will have access to health care. LOWER out-of-pockets costs. But at what cost?

They claim everyone will be covered by insurance. Not true. This legislation is estimated at only adding 16 million to the ranks of the insured, leaving another 29 million still uninsured. The rest will be insured, not by choice, but because it will become law. How many people still drive a car without auto insurance? Yet everyone will purchase health care insurance – very doubtful. If you do not obtain acceptable coverage then you will be taxed 2.5% for failing to do so. That tax still doesn’t insure those people, it just imposes a penalty for not getting insurance. Illegal immigrants fair even better because the 2.5% tax cannot be imposed on them. They still remain uninsured with no penalties.

Insurance coverage costs money. That is why many people don’t obtain it now! By adding the uninsured to the mix, the cost of insurance will increase, not decrease. Many of these people will be receiving affordability credits from the government – meaning the taxpayers get to foot the bill in the form of higher premiums and additional taxes – free services to one group means someone else has to pay for it. Still, millions of people will remain uninsured, at the taxpayers’ expense, continuing to drive up health care premiums and medical costs.

What if the plan required everyone to obtain health care insurance and the government would not subsidize a dime? Would it still look as good as advertised?

No one can be denied. How can you deny someone from obtaining insurance when you make it a law to have it? If you are one of the people with a pre-existing condition then you may feel this is the only option open to you. Think again. Other bills are being developed that will also make sure you can obtain insurance coverage without the government raping the system.

Everyone will have access to health care. Sure you may have access but will you be able to get in. What will that care be once you do get to see a medical professional? Access does not equal quality. If the government has a fixed amount of money to spend (and in many parts of the bill that is a fact) and the cost of providing service to the people wanting or needing care exceeds that amount, how do, or do you, cover those expenses? It will result in increased premiums and taxes the following year – it states that in the bill. If the service is in one of the areas that cannot go over budget, then there is only one option – either deny service or reduce care to those in need of it. So to treat your condition your medical professional might recommend one procedure, but because of budgetary reasons you may be given something else, less affective, because it costs less. That’s not quality care – that’s rationing of care.

Lower out-of-pocket costs are promised. Well that depends on if you are insured now and what your current coverage is. The bill does set annuals limits – 4 times what my current annual limits are. That’s not lower costs – that’s HIGHER. Once you reach the new government limits, then what happens? Will you continue to receive care or will that care be “postponed” until the following year when you get to start paying out again? Treatments get delayed for all sorts of reasons. When the government mandates and rewards “efficient” care, keeping you in check with low cost options until you can pay in again might become a real medical standard.

Look at who is behind the push in sponsoring these new ads. One major contributor is the drug companies – they have everything to gain and nothing to lose. People who have health insurance typically spend more money on drugs than those who don’t. Guess who’s going to benefit – the drug company! Just look in Wikipedia at one of the major pharmacy and brokerage companies. Of course they’d back this legislation, look at their track record!

So while it may look like a pretty package, beware! Before you drink the Kool-Aid and enter the land of utopia, look at the ingredients. There’s a snake in there just waiting to bite.

After reading more and more of H.R.3200, it is becoming very apparent that this is not health care reform at all and would be better title “The National Health Care Welfare Expansion Program.” This bill should be burned and ANY attempt at true health care reform should start with a fresh slate. It creates a new health care system running concurrently with the Medicare program with expanded services to cover those areas typically not covered by Medicare. In creating this system it permitted an expansion of the welfare system, an invasion into the Internal Revenue Service, Social Security, Medicare, Medicaid programs and personal lives of everyone. In order to fully understand the implications of the bill, you not only have to read H.R.3200 and the amendments, but also must reference the Internal Revenue Tax Code, the Social Security Act, Medicare and Medicaid laws and the Public Health Service Act. Throughout these sections obscure references are made to amend those bills, so unless you are reading the affected sections you are not getting the true ramifications of the bill.

The bill is like a cancer that is spreading through our government, out of control. An attempt at amending the bill would be like doing surgery on one tumor but leaving thousands of others still at bay to do their damage. There is NO WAY to save this patient, and taking the lead from the bill itself “the value of the bill to the American public is not worth the money required to try to save it.” Take the policies you are trying to shove at the rest of us and apply them to your own bill. LET IT DIE!

This bill is being advertised as a means to make sure everyone is insured. Yet they left open one of the biggest drains on our health care system – the illegal immigrants. There is reported to be 12 million illegals in this country at a cost of $11 million dollars a year for medical care. If you do the math we obviously have a revolving door policy of illegals coming into the country, receiving free medical care, and then a good number of them returning to their own country. NO where in the bill are there provisions to stop this abuse of our medical system.

While reading through the bill here is what was uncovered.

Although I could not find anything related directly to the purchase of a policy on the National Exchange, I did find a reference under Affordability Credits, Section 246 No federal payment for undocumented aliens, states that “Nothing in this subtitle shall allow federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.” (Page 143 of the bill.) But under Subtitle C for Individual Affordability Credits it states “Commissioner shall establish effective methods that ensure that individuals with limited English proficiency are able to apply for affordability credits.” (Pages 129-130 of the bill.)

The bill requires all individuals to purchase health care insurance or be penalized. Section 593 Tax on Individuals Without Acceptable Health Care Coverage states “(a) Tax Imposed – In the case of an individual who dos not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of…” (page 167 of the bill.) Further in this section it states “(2) Nonresident Aliens – subsection (a) shall not apply to any individual who is a non-resident alien.” (Page 170 of the bill.)

So, although it states individuals who are not lawfully in the United States should not receive affordability credits, there was nothing I could find to ensure they do not get them. No additional safeguards are in place to verify their legal status, so we would continue on the same path we are on granting handouts to illegals. Further, it requires citizens to obtain insurance or pay a penalty, but non-resident aliens are not subjected to the same penalty. Then NO WHERE in the bill could I find that care could be withheld if one did not obtain insurance. So illegals could continue to visit our emergency rooms without insurance and obtain free service as they are today. Nothing is in the bill to stop that, and they would not have to pay the tax penalties for not having insurance. This leaves an open door for anyone to enter this country illegally, obtain medical services at the taxpayers’ expense, and have no monetary responsibility. How does this solve one of the major problems of the increasing cost of health care?

Sec 2511 establishes a school-based health clinic program awarding grants supporting the operation of these programs. It gives preference to areas with a high percentage of children and adolescents who are uninsured, underinsured or eligible for medical assistance under Federal or State programs. Under this bill, in theory, since it is a requirement of everyone to obtain health insurance then no child or adolescent should be uninsured. Further, since the government sets the standards for coverage for insurance plans then no child or adolescent should be underinsured, unless the government is approving policy standards that are not adequately providing medical coverage. So one could conclude that these programs are implemented to serve those who are eligible to receive service under the Federal or State programs and ILLEGAL IMMIGRANTS – they are the only ones who do not have to purchase health care insurance.

Throughout the bill there are references to Culturally and Linguistically Appropriate Services and Communications, reducing health disparities (including racial, ethnic and other disparities) and individuals with limited English proficiency.

The bill amends the Social Security Act making it a requirement to provide interpreters for patients who do not speak English, free of charge to the patient. It also appears to penalize providers under Medicare if they fail to substantially provide language services to limited English proficient beneficiaries enrolled in the plan.