Beware of long adjectives. “Comprehensive” immigration and “universal” healthcare are joined at the hip, and the bond is something called presumptive eligibility.
The concept of presumptive eligibility was introduced in the Omnibus Budget Reconciliation Act of 1986 as a short-term measure to allow low-income pregnant women to receive “free” healthcare immediately — before completing the qualification process.
In 1996, Congress decided that legal immigrants would not be eligible for Medicaid coverage until they had lived in the United States for five years. At the same time, illegal-immigrant pregnant women were being presumed eligible for free healthcare.
The following year, the Balanced Budget Act of 1997 (PL105-33) created the State Child Health Insurance Program (SCHIP). The Federal government authorized funds to the States to enable them to initiate and expand child care assistance to uninsured low income children, who would be presumed to be eligible for healthcare and Head Start programs.
In 1999, Medicaid was extended to “undocumented aliens.” Then in 2000, Congress enacted legislation consolidating Medicare, Medicaid, SCHIP, and various sections of the Social Security Act appropriations, which included presumptive eligibility provisions for low-income pregnant women and children.
In 2005, a Department of Health and Human Services internal evaluation found no problem with allowing applicants for Medicaid and SCHIP simply to self-declare to be U.S. citizens. “Presumed eligible” had evolved into “eligible if you say so.” This allowed illegal aliens to receive coverage in healthcare, social, and welfare programs.
That same year, Maryland under Gov. Robert Ehrlich, R-Md., eliminated state-funded Medicaid for legal-immigrant pregnant women and children who had not been in the country five years. Immigrant advocates sued, arguing that denial of coverage and benefits increases the spread of communicable diseases, injures pregnant women, injures newborns, and actually increases costs to the taxpayers. Maryland’s cost-saving measure was overturned.
In 2006, conservative members of Congress pushed through a law requiring states to ensure that Medicaid enrollees provide documentation of citizenship. In practice, though, documentation remained questionable. Fraudulent driver's licenses or some other photo identification card unfortunately are easily obtained. Alien smugglers often include such documents in the cost of their services.
In 2007, Congress weakened the citizenship requirements for SCHIP and Medicaid and indirectly for other health and social benefits, choosing to ignore cost-saving measures.
Today, cost-saving measures also are absent in the proposed Obamacare or, as the president has come to call it, health insurance reform. The Democrat-dominated Senate and House are divided on which parts of the various healthcare bills will make it to Conference Committee, where select senators and representatives will perform the final surgery, combining the best or the worst parts of the bills passed by each chamber.
As with immigration legislation, Congress for decades has altered, amended, tweaked, technically adjusted, and mucked-about healthcare legislation, rendering it open to "Alice in Wonderland" interpretation. The Obamacare bills (three in the Senate and five in the House) are being drafted in the midst of congressional bickering and bungling which does not bode well for the electorate.
The Pelosi-Waxman healthcare bill (HR 3200), which members of the public actually have read, includes a presumptive eligibility section and a government option. Endorsed by the Obama administration, despite opposition by a majority of U.S. citizen-voters, the government option is socialized medicine in disguise. If enacted, it has the potential to force out private insurers, thus becoming the nation’s prime healthcare insurer. The government option could still make its way into the healthcare bill that comes out of conference.
Healthcare services for illegal aliens, which Obama declares will not be part of “health insurance reform,” already are covered under presumptive eligibility. Obamacare will cost untold billions of dollars in the first years and is fated to grow exponentially with each wave of illegal aliens that “free” healthcare draws to the United States.
At this point, no one knows what the final conference “health insurance reform” bill will contain. No one knows whether U.S. citizen-voters will be allowed to read the bill before Congress votes on it. Democratic senators oppose posting the final bill for public view and public comment on the Internet or elsewhere. President Obama has not delivered on his campaign promise of transparency, including public posting of all bills for 72 hours of review before a final vote.
What provisions will the awaited “health insurance reform” bill have for legal and illegal aliens? The final bill may declare no free healthcare for aliens, legal or illegal, just as Section 246 of the Pelosi-Waxman bill does. Like the Pelosi-Waxman bill, however, the final bill probably will have sections that prohibit discrimination, that leave determination of eligibility to Obama bureaucrats, and that include presumptive eligibility. If contested, litigators for presumptive eligibility will cite the Equal Protection Clause of the U.S. Constitution to assure access to Obamacare for legal and illegal aliens.
The Pelosi-Waxman bill, section 205 (e)(3) (B), not only recognizes presumptive eligibility but also calls for its maximum use, stating: "The State shall provide for making medical assistance available during the presumptive eligibility period and shall, upon application of the individual for medical assistance under this title, promptly make a determination (and subsequent redeterminations) of eligibility in the same manner as if the individual had applied directly to the State for such assistance except that the state shall use the income-related information used by the Commissioner (Health Choices) and provided to the State under a memorandum in making the presumptive eligibility determination to the maximum extent feasible."
The Senate and House healthcare bills are about to be amalgamated into one Senate bill and one House bill, which then will go to conference. Odds are that the conference bill will lack any provision for verification of citizenship as a requirement to receive Obamacare. Efforts of Republican senators and representatives to include verification of citizenship have been voted down resoundingly.
Claims to the contrary notwithstanding, the majority of U.S. citizen-voters are against the healthcare bills being floated, and they strongly oppose illegal aliens' qualifying for Obamacare. The Democratic majority in Congress, along with the Obama administration, appear to be turning a deaf ear to the electorate.
Presumptive eligibility, as set forth in the Pelosi-Waxman healthcare bill, probably will appear in any final Obamacare/health insurance reform bill. Liberal Democrats insist that all services for U.S. citizens also be provided for immigrants, be they legal or illegal. Open borders and the subservience of the United States to all comers may prove to be the means to the end the radical left seeks: the end of U.S. sovereignty and the Republic form of government.
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