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A Project of The Annenberg Public Policy Center

Romney Didn’t OK New Benefits for Illegal Immigrants

Texas Gov. Rick Perry is claiming that Mitt Romney “OKd health care for illegal immigrants” by signing Massachusetts’ 2006 health care overhaul law. But the law didn’t give illegal immigrants anything new. It merely continued and renamed a state program that had long allowed low-income, uninsured residents, including those in the country illegally, to get care at community health centers and (as in all other states) hospital emergency rooms.

Perry’s campaign seized on an Oct. 23 Los Angeles Times story that said the law Romney signed “includes a program known as the Health Safety Net, which allows undocumented immigrants to get needed medical care along with others who lack insurance.” The Times noted that the Health Safety Net “built on a previous program.” But the story did not make clear that the old program, called the Uncompensated Care Pool, did not treat illegal immigrants any differently than the newly named Health Safety Net.

We spoke with two former commissioners of the Massachusetts Division of Health Care Finance and Policy, which oversees the hospital reimbursement program — one official under the Romney administration and one under current Gov. Deval Patrick’s administration — and both told us there is no difference between the pre-health care law program and post-law program as it relates to illegal immigrants.

Romney has made Perry’s treatment of illegal immigrants a major issue in the presidential campaign. He has been hammering Perry for allowing illegal immigrants to pay in-state tuition at Texas colleges. In the Oct. 18 debate, the former Massachusetts governor made the shaky claim that the program was a “magnet to draw illegals into the state.”

Now, Perry is criticizing Romney for the health care law that he signed in 2006. Perry’s website, however, falsely claims that “Romneycare – includes provisions that allow illegal immigrants to receive full health benefits for free,” according to the Los Angeles Times. That goes well beyond what the newspaper said, and that’s not what the law does. Instead, low-income uninsured people can get necessary health care at hospitals — just as they can in any other state — or, in Massachusetts, in community health centers, and those institutions can receive reimbursement through the state program, which is funded largely by an assessment on hospitals and insurers.

Sarah Iselin, president of the Blue Cross Blue Shield of Massachusetts Foundation, was the commissioner of the state Division of Health Care Finance and Policy from 2007 to 2009. She told us there were no substantive changes in the way the Health Safety Net versus the old Uncompensated Care Pool affected illegal immigrants. The state health care law did add “much stronger accountability provisions” to the safety net, and it required hospitals and community health centers to screen for eligibility for Medicaid or subsidized insurance through the new state exchange, she says.

But “absolutely” care for illegal immigrants was paid for by the Uncompensated Care Pool, just as it is now by the Health Safety Net, Iselin says.

Amy Lischko, an associate professor of public health and community medicine at Tufts University School of Medicine, was commissioner of the DHCFP during the Romney administration. She also confirmed, via email, that there’s no difference between the Uncompensated Care Pool and the Health Safety Net concerning illegal immigrants. “Several changes were made to the Health Safety Net beginning in 2008,” she says. But not as it relates to immigrants. Changes were made to the payment system — the new one is “based on Medicare principles” and does away with the old “block grant” payments to hospitals — and, as Iselin mentioned, “new program integrity features were added to ensure that people were enrolled into the coverage they were eligible for before they were permitted to use the Health Safety Net,” says Lischko, who is also a senior fellow at the Pioneer Institute, a think tank in Massachusetts.

And, of course, the name was changed. But the program existed long before Romney took office.

“The Uncompensated Care Pool goes back to the 1980s,” Brian Rosman, research director for the advocacy group Health Care for All, told us via email. “The HSN is the same thing, with a new name.” In a phone interview, Rosman said his colleagues still refer to it as “the pool.” Health Care for All posted a blog item on the Times‘ story, adding context on the Health Safety Net.

The situation is similar in other states. “Every state, even Texas, has programs that acknowledge people show up for care,” Iselin says. “Hospitals have obligations under federal law to take care of people when they show up with a broken leg” or other ailments. “You can’t leave hospitals holding the bag.”

In Texas, public hospital districts provide care for illegal immigrants, and the Texas Emergency Medicaid program pays hospitals for providing emergency care.

In Massachusetts, the safety net program also reimburses community health centers. It’s not free health insurance for the people seeking care; rather, it’s payment for the hospitals and health centers that provide treatment. “This is a program for financing care that many of these institutions, either by virtue of their nonprofit mission or federal law, have to provide,” Iselin says.

Iselin, Lischko and Rosman all told us that, overall, the Massachusetts health care law didn’t give anything new to illegal immigrants that they didn’t have before.

The Romney campaign has responded to this issue by blaming Romney’s successor, Gov. Patrick. Spokesman Eric Fehrnstrom told MSNBC: “To the extent that illegals are receiving some kind of care under the Health Safety Net program, that would be a function of what the current governor, Deval Patrick, has put into place.” He noted, correctly, that federal law requires hospitals to provide emergency care to anyone, regardless of immigration status. But Massachusetts’ program, which was highlighted in 2004 by the Commonwealth Fund as one of several innovative state programs, allows access to care at hospitals and at community health centers, where it’s often cheaper, and it was started in 1985.

Fehrnstrom, MSNBC, Oct. 24: There’s nothing in the law that permits illegal immigrants to receive care that they’re not entitled to. Now, federal law requires that illegal immigrants get care in emergency settings. If they’re getting anything beyond that, that would be because of rules that were written by Deval Patrick, not by Mitt Romney.

Iselin and Lischko told us that there were no changes made by Patrick that gave illegal immigrants more benefits. Says Iselin: “As it related to how we treated undocumented folks in terms of the eligibility to get care [that was] billed to this program, we didn’t make any changes. None.”

Lischko says the Patrick administration “could have promulgated regulations that restricted care more.” But no regulations were written that would give illegal immigrants additional benefits. “Changes were made, true, but the program is more or less the same as it was before the reform.”

There isn’t solid information on how many illegal immigrants may in fact receive medical care paid for by the safety net, says Lischko. “The program has always garnered attention in the state since a bulk of the funding comes from insurers and providers,” she says. “There is not a lot of state funding in the safety net.”

Rosman doesn’t recall any major debate over whether the pool should continue to cover care for illegal immigrants when the legislation was being written. “It was part of the landscape here,” he says.

— Lori Robertson