Need Medicaid? Show Your Passport - New York Times
The New York Times

January 5, 2006
Op-Ed Columnist

Need Medicaid? Show Your Passport
By
BOB HERBERT

Buried in the nearly 800-page federal budget bill is a nasty little
provision, ostensibly aimed at immigrants, that will make it difficult for
many poverty-stricken
U.S. citizens to get the health care they are entitled to under Medicaid.

Advocates believe that the provision, which will require Medicaid applicants
to document their U.S. citizenship (which means producing a passport or
birth
certificate), may be especially harmful to poor blacks, most of whom do not
have passports and many of whom do not have birth certificates.

There are no exceptions to this onerous provision, not even for people with
serious physical or mental impairments, including Alzheimer's disease.

The budget bill is scheduled for a final vote in the House on Feb. 1. The
Medicaid provision seems to have originated with a pair of Republican
congressmen
from Georgia - Nathan Deal and Charlie Norwood. The idea, Congressman Deal
told me, is to create a barrier against illegal immigrants who might slip
into
the Medicaid program by falsely claiming they are citizens.

You haven't heard much about this latest threat to the republic because
there is no evidence it is much of a problem. As the Center on Budget and
Policy
Priorities has reported, an extensive study by the inspector general's
office of the Department of Health and Human Services "found no substantial
evidence
that such false applications are actually occurring and [the inspector
general's office], accordingly, did not recommend making the change that is
included
in the [budget] agreement."

The problem will come when poor people who are ill get sucked into a
nightmare of documentation when their focus should be on their illness. The
center
noted: "Many individuals who require Medicaid coverage - such as people
affected by emergencies like Hurricane Katrina, homeless people or those
with mental
illness - may be unable to get Medicaid promptly when they need it because
they do not have such documents in their possession."

Many poor people live far from the cities or towns where they were born and
do not have ready access to their birth certificates. And, as the center
said,
a large number of African-American women, especially in the South, were
unable to give birth in hospitals because of racial discrimination. Many of
them
never received birth certificates for their babies.

A spokesman for the Senate majority leader, Bill Frist, who is a physician,
said the Senate went along with the House proposal because the "members did
not feel it was an unreasonable provision." He said applicants in serious
need of care would receive it, and that Medicaid officials could accept the
documentation
of citizenship later.

I wondered what would happen to individuals who were bedridden, destitute,
disoriented, enfeebled. They might receive care in theory. But would they
really?
Stepping on their care seems a heavy price to pay to address an issue that
very few people view as a serious problem.

I asked Abel Ortiz, who advises Gov. Sonny Perdue of Georgia on health care
issues, if he was aware of any studies that showed whether significant
numbers
of illegal immigrants in his state were getting Medicaid benefits. He said
no, although he added, "We have some cases that have happened."

The Congressional Budget Office has estimated that the new provision would
save more than $700 million over the next decade. But if illegal immigrants
crashing
the Medicaid program is not a big problem, where will the savings come from?
How about from the reduction in enrollment of sick or otherwise troubled
U.S.
citizens who are poor and less than savvy about the arbitrary workings of
the bureaucracy?

The budget bill is a good example of how the insiders and special interests
get what they want in Washington, while ordinary people, who are supposed to
be represented by the members of the House and Senate, get bludgeoned.

Some members of Congress wanted health care savings - if there were going to
be any - to be achieved by such measures as negotiating better rates with
large
drug companies and managed-care facilities. But that's not the sort of thing
that flies in this day and age. So the savings will be drawn like blood from
the sick and the poor.

Someday the pendulum will swing back, and the government of the United
States will become more representative and more humane. Meanwhile, as Lily
Tomlin
said, "We're all in this alone."

Posted by Miriam V.