Should immigrants lacking permanent legal status arriving in Chicago in big numbers get free health care paid for by the state?
It makes sense to provide at least basic medical services to refugees and others in need. Immigrants lacking permanent legal status often are refugees with children who have undergone arduous journeys and have few resources at their disposal. Paying attention to preventive care in the present often prevents expensive emergency room visits and other costly interventions down the road. And refugees deserve a humane welcome to the state.
Nobody in an advanced society wants to deny a sick child medicine. Nor should they ever do so.
But U.S. health care mostly relies on a system of private insurance, something that immigrants lacking permanent legal status typically do not have. And health care in this nation is wildly expensive. That explains why Gov. J.B. Pritzker announced Friday some limitations on what had been closer to a carte blanche for migrants’ health care needs.
The Illinois Department of Healthcare & Family Services announced Friday that it was, in essence, in danger of exceeding its budget for its programs for immigrants lacking permanent legal status, which was careening out of control.
Back in February, Pritzker had pegged the cost of the program, popular with open-border progressives, at $220 million, but that proved unrealistic to say the least. Three months later, cost estimates for health care for immigrants lacking permanent legal status had risen to a stunning $1.1 billion, threatening other parts of the budget, especially sums earmarked for early childhood education. This came, of course, alongside the end of federal COVID bailouts and other revenue reductions.
In 2020, the state’s ruling Democrats had said immigrants over 65 who were lacking permanent legal status now would get Medicaid-style coverage, even though they did not qualify for the federally funded program. That program was twice expanded (first from the age of 55) and currently covers persons 42 and older, although many on the left of the party want it extended to everyone, whatever their age and whatever the cost to taxpayers. If that were to happen, even the $1.1 billion would not be near enough.
But in the Springfield budget deal announced last month, state health care spending on immigrants lacking permanent legal status was reduced to $550 million, not the potential $1.1 billion that had been discussed. Both figures represent a huge amount of taxpayers’ money; the majority of that saved $550 million was earmarked for spending on education.
The Friday news was, in essence, a road map on how the state plans to get to that reduced figure. It’s one thing to declare an intention to spend less money. It’s another to reveal where the pain points will be.
The state now says it will walk back its expansionist ideas and close new enrollment in Illinois’ Healthcare Benefits for Immigrant Adults program for those under 65, effective July 1, unless enrollment in the program exceeds more than 16,500 before then, in which case it will close earlier. That will leave just the Healthcare Benefits for Immigrant Seniors program up and running.
Additionally, there now will be reimbursement limits and new copays for emergency room visits and inpatient services for those immigrants lacking permanent legal status for whom the federal government is not paying the bills.
Pritzker, generally a favorite of progressives, took it on the chin. The actions were variously called “immoral” and “inhumane,” and the City Council’s Latino Caucus said it was “outraged” by the decision.
That rhetoric was absurd. Insurance copays are a fact of life for citizens, even those with low-income levels, and it makes no sense to privilege immigrants lacking permanent legal status over those with low incomes who have followed the rules.
Obviously, the state’s financial angst over these programs plays right into the hands of the Republican governors who have sent migrants to Chicago and argued that the city’s open-arms welcome was only possible because it was not seeing the numbers of migrants seen in border states. It’s one thing to offer full health care benefits to immigrants lacking permanent legal status, they said, but another when any such commitment potentially could bankrupt the state. Clearly, they have a point.
We don’t approve of those unethical bus rides and chartered aircraft using migrants looking for a better life as political pawns. It is a poor substitute for a coherent national immigrant policy. And we also think someone who arrives in Illinois in an ill condition should always find medical help, regardless of their age or financial status.
But that doesn’t mean that it’s all right to pretend that the U.S. has a single payer, government-run health care system akin to Britain’s National Health Service, offering free care to all. That is not the system our democratically elected government has put in place, and the states cannot fully take its place.
Behold the absurdity of our intractable immigration crisis: a federal government and a state government operating as polar opposites, one welcoming and motivating immigrants lacking permanent legal status with free health care and the other officially discouraging them and thus deeming them ineligible for benefits. To say that this sends mixed signals to potential migrants abroad is an understatement. It cannot continue.
Pritzker probably erred in some of his preaching about immigrants lacking permanent legal status and their right to free health care, statements made when he thought the bill to the state was going to be lower.
Nonetheless, he was right to put in some controls when the fiscal situation left him no choice: The state cannot fund free health care to massive numbers of immigrants lacking permanent legal status, especially when it makes no comparable offer to impoverished citizens. Charitable and mission-based organizations, with help and cooperation from the state, must be part of this effort to attend to the urgent needs of migrants.
The state cannot just write huge checks to medical offices, for-profit hospitals and Big Pharma. There are other needs.
