Need Medicaid? Show Your Passport

By Bob Herbert of The New York Times
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?

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