This op-ed originally appeared in the Houston Chronicle on October 5, 2018.
By Katy Caldwell
Texans, like the rest of America, don’t agree on much these days. But when it comes to the cost of health care, no matter income or political party, many believe it’s too expensive. Like Houston traffic, people just deal with it.
Which is why it’s odd the Trump administration recently announced a new rule that would make health care even more expensive for legal immigrants and that likely would limit care to some of the state’s most vulnerable residents. It’s not a rule that Legacy Community Health, the largest community health center in Texas, can endorse.
For decades, under “public charge” policies, legal immigrants have been able to utilize Medicaid and other publicly subsidized insurance plans if they did not have an employer-paid insurance. These insurance programs provide prenatal care to pregnant women and primary and preventive health care to working families.
The administration now believes documented immigrants — those in the country legally, who work and pay taxes — should have to risk their chance of qualifying for a work visa and citizenship if they make the responsible choice to sign up for health insurance through Medicaid or use a tax-funded prescription drug benefit. Those who decide to take care of their health could have that counted against their eligibility to remain in the country.
Which would you choose? Citizenship? Me, too.
The government’s rationale is that it wants immigrants to be financially “self-sufficient,” which means they’d better be able to afford health care. Many native-born Americans can’t even do that.
The Migration Policy Institute estimates almost 4 million Asian-Americans and 10 million Hispanics live in families where one member has used at least one public health service, including Medicaid and a prescription drug benefit, as well food stamps and housing vouchers.
As an economic matter, the administration’s new rule could hit Houston particularly hard, given our large immigrant population — 1 in 4 Houstonians is foreign-born — and sheer volume of medical institutions here.
The nonpartisan Kaiser Family Foundation has said the plan would likely lead to “broad decreases in Medicaid usage” among legal immigrant families.” A flood of Houstonians leaving Medicaid would have ripple effects across the overall health care system. (So would any large-scale withdrawal of children from the Children’s Health Insurance Plan, which isn’t currently part of the new rule but the administration says it could be.)
The uninsured rate — Texas’ has the highest in the nation — would go up, and those newly without insurance would likely flood hospital emergency rooms for primary care, which is the most expensive way to get medical care. Health care premiums and local taxes would go up. And taxpayers would feel it.
The administration admits its plan would “potentially impose new costs on individuals or companies” and that about $19 billion over 10 years would be lost from dis-enrollment or foregone enrollment in public benefit programs.
Let’s not forget the public health cost, which even the administration admits could lead to “worse health outcomes, including increased prevalence of obesity and malnutrition, especially for pregnant or breastfeeding women, infants or children, and reduced prescription adherence.” Without insurance, coupled with the general fear, perceived or real, that the government is “coming after” legal immigrants, health care needs will go unmet.
The mission of Legacy Community Health, like any safety-net provider, is to provide quality, affordable care to low-income patients, including many legal immigrants. Our goal is to provide preventive care to keep people out of the emergency room for non-emergencies, such as colds, or for treatment of chronic conditions. We’ve been doing this for decades in a fiscally responsible way and with bipartisan support. But this new rule would likely limit the amount of care we can provide, and it would be the same for many other Texas providers.
The 60-day public comment period on the proposed rule begins Oct.10. Go to the Federal Register and leave your opinion. Let’s not make our health care system even more expensive and less accessible than it already is.
Caldwell is CEO of Legacy Community Health, the largest community health center in Texas