At a critical point during President Obama’s health care address to Congress two weeks ago he said, “There are also those who claim that our reform effort will insure illegal immigrants. This too is false. The reforms I'm proposing would not apply to those who are here illegally.” Immediately there was an interjection: "You lie," shouted Rep. Joe Wilson (R-S.C.) igniting a debate over both protocol and the substance of the accusation.

Cooler heads prevailed later, but only to an extent. The next day Sen. John McCain (R-Ariz.) said that he did not believe that the proposals for health care reform included illegal immigrants. Rep. Wilson, however, refused to back down other than to apologize to the White House for his outburst, but not for what he said.

The reason that Wilson felt that he was right was simple. When the proposed bill H.R. 3200 was in committee, Republican proposed amendments requiring verification of citizenship before applying for coverage were rejected by the Democratic majority.

So does that back up Rep. Wilson’s claim of dishonesty? It appears that all is not as simple as it might appear at first glance. The devil is in the details.

One major reason for the rejection is that, following a 2005 change to the law, Medicaid claimants are required to verify citizenship. According to The New York Times, a 2007 government review showed that this requirement increased the federal cost by $8.3 million. The benefit: Eight illegal immigrants were detected. More than $1 million for each person denied Medicaid.

A second reason was that many elderly people simply do not have the required original documentation to prove eligibility. This is unlikely to be such a concern for the new health care proposals, because younger people are far more likely to have documentation, but it was still a concern for Democrats.

Now maybe I should declare my interest in this. I am an alien… no, not that kind. I am an immigrant and, yes, I have permanent residency commonly referred to (inaccurately) as being a “green card” holder.

Under federal law I, as an immigrant, am unable to seek any kind of federal assistance for at least five years after arrival. Of course there are exceptions, including the granting of citizenship, but in general even legal immigrants are initially unable to rely on Federal programs.

On page 143 of the 1,103 page proposed bill is one sentence, in bold.  It says is “No Federal Payment For Undocumented Aliens.”  Earlier in the proposed bill is another paragraph.  In Section 242 it states, “IN GENERAL. — For purposes of this division, the term ‘affordable credit eligible individual’ means, subject to subsection (b), an individual who is lawfully present in a State in the United States”.

So we have established that those that are not entitled to receive federal assistance are disqualified from receiving credits towards health care under the proposed bill. In other words, if you are here illegally you cannot have money to help pay for your health care.  If this is the case, what is the fuss about?

Politics almost certainly plays a role. Because this health care bill is so important it is seen as the line in the sand for some Republicans. It gives them the opportunity to demonstrate their position on immigration to their constituents. Also to show that they are serious about not providing federal funding to those illegally in the country.

So Republicans want to see citizenship validated and Democrats believe that there can be no justification for increased costs just as we are trying to save money on health care. A Kaiser Foundation report in 2005 showed that despite the citizenship requirements for Medicaid, 46 states accepted a signed declaration as proof of status. Clearly the intent can be applauded, but, again, the devil is in the details.

Interestingly, there is no proposal or likelihood that there will be any changes made to the requirement that emergency rooms provide services to all, insurance coverage or not.  Hospitals do receive federal funding toward offsetting the additional costs incurred.

During the summer recess, it was widely reported that the Republicans were unhappy with the rejection of the proposed citizenship amendments. It took a very public stage to raise the debate over one point to the forefront of the health care debate. Some say that this was a planned outburst by Rep. Wilson, though he denied it.

The Obama administration would like the focus to be brought back to the broader points of the legislation, not the details of this sort of disagreement. Although, to date, there have been no tabled amendments addressing the citizenship issue, thus the real debate starts now. This is because the proposals, once passed by both houses, will need to be merged to create one document.

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