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Does Joe Wilson Have A Case On Health Care, Illegal Aliens?

(AP Photo/Harry Hamburg)
Rep. Joe Wilson, who shouted "You lie!" at President Obama last night, may have been rude. But was he right?

Let's look at the facts. CBS News has posted the transcript of the president's speech, which says: "There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms -- the reforms I'm proposing would not apply to those who are here illegally."

What the Obama administration is proposing is something of a moving target -- just look at the varying opinions about whether last night's speech abandoned the "public option" -- but the White House health care page offers a reasonable summary. Nowhere does it talk about illegal immigrants.

In an interview in July with CBS News, Obama said he didn't want to include illegal immigrants but indicated that American taxpayers could be required to pick up some health care bills for their children. That's not the same as all illegal immigrants, which is what Wilson, the South Carolina Republican, was talking about.

So that brings us to to the House Democrats' proposal, aka H.R. 3200. It's true that one portion, Section 246, limits "federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States." But H.R. 3200 is a large and complex bill and Section 246 is limited in scope; the overall bill contains far more moving parts than just affordability credits.

The Congressional Research Service, the legislative branch's research arm, took a close look at H.R. 3200 in a report dated August 25. It concludes that the bill's individual mandate to have health insurance (with tax penalties for non-compliance) would apply to legal residents and illegal aliens alike.

When the legislation's "Health Insurance Exchange" offering private and government-run plans would begin operation in 2013, CRS concluded would be no restrictions on illegal aliens buying government-offered insurance: "H.R. 3200 does not contain any restrictions on noncitzens participating in the Exchange -- whether the noncitizens are legally or illegally present, or in the United States temporarily or permanently."

Now, there are reasonable arguments for and against allowing illegal immigrants to buy government-sponsored insurance. On one hand, they'd be covering much of the cost of their routine medical care and perhaps reducing unnecessary use of emergency rooms; on the other, if illegal immigrants require more expensive care than U.S. citizens and legal immigrants, Americans who play by the rules would end up subsidizing those who didn't. (Someone will be sure to dub this the "illegal immigrant tax," and depending on how the numbers work out, that might even be correct.)

If Democrats wanted to eliminate allegations such as Joe Wilson's, they could simply rewrite H.R. 3200 to say: No illegal immigrant can shop at the Health Insurance Exchange.

Rep. Dean Heller, a Nevada Republican, offered precisely that amendment during a House Ways and Means committee vote in July. It said that to "utilize the public health insurance option, an individual must have had his or her eligibility determined and approved" through two existing verification programs already used by the federal government. One is called SAVE, and checks immigration status, and the other is called IEVS, which is used in conjunction with Social Security.

In a party line vote, Democrats rejected Heller's amendment. After the vote, Heller said in a statement that: "If the majority party insists on moving forward with government-run healthcare plan, Congress should do everything within its power to curb abuse. Requiring citizenship verification for enrollment would ensure only citizens and legal residents receive taxpayer funded healthcare." (Here's a YouTube video of Heller.)

One likely reason why Democrats shot down Heller is that they're under pressure from the left to include -- or at least not explicitly exclude -- illegal immigrants. That would mean rejecting any requirement that applicants' eligibility as citizens or legal immigrants be verified.

Jennifer Ng'andu, deputy director of the National Council of La Raza's Health Policy Project, recently told the Associated Press that she believes any plan without coverage of illegal immigrants won't last. (Her group is the largest U.S. advocacy organization for Hispanics, especially Mexicans.) "If we don't talk about integrating communities that have been traditionally shut out, we're going to be talking about health care reform again in 15 years," Ng'andu said.

Added Elena Rios, president of the National Hispanic Medical Association: "We can't have the status quo. It's just a disgrace."

Which is why pointing only to H.R. 3200's section 246 -- which groups such as Factcheck.org have done -- is a bit misleading. Even the generally pro-immigration Los Angeles Times warned last month that: "The prospect of subsidized health benefits would raise the incentive for illegal border crossings. That's one reason insurance coverage for illegal immigrants should be addressed in the context of comprehensive immigration reform, not an overhaul of the healthcare system."

At least in Washington circles, this became a relatively high-profile debate last month, which is probably why Obama felt the need to respond to it yesterday. One example: Rep. Lamar Smith, the Texas Republican, wrote an opinion article for The Hill newspaper saying the National Council of La Raza and the Congressional Hispanic Caucus were responsible for blocking the verification amendment. "The Democrats' bill in the House, H.R. 3200, contains gaping loopholes that will allow illegal immigrants to receive taxpayer-funded benefits. And these loopholes are no accident," Smith wrote.

Republicans also pointed out over the summer that House Energy and Commerce Committee Democrats killed a GOP proposal requiring states to keep illegal aliens off of Medicaid. Rep. Nathan Deal of Georgia said afterwards that the "reason for the amendment is that the underlying bill would require millions of people to be automatically enrolled in Medicaid without any guarantees that these new enrollees are United States citizens or legal residents."

The Congressional Research Service says that as of early 2008, there were approximately 37.3 million foreign-born persons in the United States, including legal and illegal immigrants. The foreign-born population was divided into about 15.1 million naturalized U.S. citizens and 22.2 million non-citizens. Some estimates put the number of illegal non-citizens at 11 million; Texas estimates illegal immigrants cost its hospitals $1.3 billion in 2006, and California put the figure at $1.4 billion in 2004.

For his part, after apologizing in a phone call to the White House, Wilson stuck to his critique of H.R. 3200 on Thursday. (See my colleague Charles Cooper's article on the political fallout.)

This brings us back to Obama's speech last night. It's true that the Democrats haven't explicitly called for illegal immigrants to be covered by H.R. 3200, but by voting down two amendments that would have verified participants' legal status, they seem to have implicitly allowed it. It's no crime in Washington to say one thing and do another, especially when you're under pressure from influential special interest groups, but it should still be a bit embarrassing for politicians discovered to be doing it.

So while Joe Wilson may not have chosen the best way to express it, he did have a point. As the president might have said, the Republican politico's outburst has turned into one of those teachable moments.


Declan McCullagh is a correspondent for CBSNews.com. He can be reached at declan@cbsnews.com. You can bookmark the Taking Liberties site here, or subscribe to the RSS feed.
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    Declan McCullagh is the chief political correspondent for CNET. You can e-mail him or follow him on Twitter as declanm. Declan previously was a reporter for Time and the Washington bureau chief for Wired and wrote the Taking Liberties section and Other People's Money column for CBS News' Web site.