WHEN IT COMES to healthcare for immigrants, it’s hard not to think of Shylock’s famous lines from “The Merchant of Venice’’ by William Shakespeare: “If you prick us, do we not bleed? If you tickle us, do we not laugh? If you poison us, do we not die?’’
Do newcomers to America not get sick? Do they not fall off ladders, get struck by reckless drivers, break arms or collarbones or noses?
To judge by the way immigrants are denied access to health coverage in the current system, you’d think they were made of Kryptonite.
Earlier this week Governor Patrick cobbled together a last-minute fix for the 31,000 legal immigrants in Massachusetts who were facing the end of their healthcare coverage Sept. 1. CeltiCare of Massachusetts, a unit of the Missouri-based for-profit Centene Corp., has agreed to provide coverage - albeit less comprehensive coverage - and probably at a loss. The company’s offer is not entirely altruistic: it also hopes to gain a toehold in the Massachusetts healthcare experiment, seen as a model for national health reform.
Most people understand that the Massachusetts Legislature was faced with difficult choices when it cut $90 million from the $130 million needed to cover the immigrants. What many don’t realize is that the origin of this problem is not in Massachusetts. It is the bitter fruit of the 1996 welfare reform act signed by President Clinton, which, among its other better-known provisions, barred lawfully-admitted immigrants from getting many federal benefits for five years after their arrival.
Individual states were free to carry the full costs of healthcare (and initially, food stamps and disability payments) and several did, including Massachusetts. But the lack of federal reimbursement - at roughly 50 percent - makes the immigrants twice as expensive to insure as “real’’ Americans, and therefore more vulnerable during budget shortfalls.
And so began the carving out of one class of taxpayers as “other’’ - and not deserving of equal consideration under US laws. Forget the old chestnut about America being a nation of immigrants; including them in health insurance pools is smart economically and medically, as well as the right thing to do.
The health reform bills currently making their way through Congress offer a chance to correct this inequity. The bill produced in July by the late Senator Kennedy’s health and education committee lifts the five-year limit for legal immigrants to get access to subsidies to pay for insurance through new healthcare exchanges. Similarly, a bill combining the work of three House committees allows all legal immigrants access to so-called “affordability credits’’ without the five-year requirement.
Unfortunately, the Senate Finance Committee, which has jurisdiction over Medicaid, has not finalized its bill, and some on that committee are pushing for a restatement of the ban.
Sad to say, even some progressives who support healthcare reform are wary of this issue. Their hope is that healthcare inequities can be addressed through comprehensive immigration reform, which President Obama recently said might be taken up next year. But we know how the last attempt at immigration reform turned out.
The wariness is understandable, since few things rile up the demagogues more than the combination of government-run healthcare and illegal aliens ripping off the taxpayers. US Representative Paul Broun of Georgia, a medical doctor, said on the House floor in July that “Obamacare,’’ as he calls it, “is going to give every single one of those illegal aliens health insurance at the cost of taxpayers.’’
Never mind that Americans already pay for illegal immigrants through emergency room and charity care, which drives up the cost of insurance for everybody. The Senate bill already written clearly defines eligible individuals only as “citizens or lawfully admitted permanent residents.’’ The House bills include an explicit section titled “No federal payment for undocumented aliens.’’
What part of “legal’’ don’t the opponents understand?
“Fed with the same food, hurt with the same weapons, subject to the same diseases, healed by the same means,’’ immigrants are no different from the Jews Shylock was defending in a great drama 400 years ago. The country needs to stop pretending that they don’t also bleed.
Correction: In last week’s column I placed a townhouse explosion that killed members of the Weather Underground in 1969; it was 1970.Renée Loth’s column appears regularly in the Globe.