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Insuring all kids: Let's mean ALL, including undocumented immigrants

January 12, 2009

Des Moines Register

Insure all kids: Let's mean ALL, including undocumented immigrants

JACK HATCH is chair of the Senate Health & Human Services Budget committee. JOE BOLKCOM is chair of the Senate Ways & Means Committee.

Last year, the Iowa Legislature passed landmark health-care legislation guaranteeing all eligible children health insurance by 2011. To back this bold plan, the Legislature appropriated $25 million over the next three years.

This year, it is time to ensure health-insurance coverage to a group of children left out of last year's legislation - the uninsured undocumented immigrant child.

There is opposition to this proposal. Opponents have asked, "Why should we spend tax dollars to provide health-insurance coverage to kids who are here illegally?" Years ago, this same question was asked about providing a public education to undocumented kids. In 1982, the U.S. Supreme Court upheld the right for undocumented immigrant children to receive public education.

In Plyler vs. Doe, the court argued, in part, that denying education to undocumented immigrant children unduly penalized this group, whose parents, and not their children, had broken the law. As stated in the ruling, "the deprivation of education takes an inestimable toll on the social, economic, intellectual and psychological well-being of the individual, and poses an obstacle to individual achievement."

As Justice William Brennan said, "It is difficult to understand precisely what the state hopes to achieve by promoting the creation and perpetuation of a subclass of illiterates within our boundaries, surely adding to the problems and costs of unemployment, welfare and crime."

The same logic holds true for health coverage. What does the state hope to achieve by promoting the perpetuation of a subclass of sick kids within our state, increasing the costs that are associated with disease and illness, all while putting our own kids at risk?

Let's not penalize these kids for their parents' actions. Studies have shown that allowing them access to primary-care health services is the best and cheapest way to keep them healthy. We need immigrant children healthy for their own development and so they do not spread illness and disease in our schools.

We are already providing health services to undocumented children in the emergency rooms of our community hospitals. This is the single most expensive venue to provide health-care services. It is far more cost-effective to provide care in an organized fashion. When our emergency-room doctors and nurses render primary care to undocumented children, it diverts these doctors from rendering emergent care to others in our community.

Moreover, emergency-room pediatricians often find themselves in an untenable situation when caring for an undocumented child who needs expensive, life-saving care. Their role as a physician and patient advocate leads to conflict between the need to provide care and the need of the health-care institution they work with to remain financially solvent. Significant ethical and public-health consequences result when we deny needed care to these children.

Through the proposal that will be presented this legislative session, we hope to join the ranks of other states that have decided to provide access to health-care programs to undocumented immigrant children.

There is no justifiable purpose in denying health-care coverage for these kids. We should not play politics when it comes to children. Whether children are citizens or undocumented immigrants, they deserve our support to make sure they grow up healthy.