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Initially waved off, Hispanic advocates jump into health debate

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By Krissah Thompson
Washington Post Staff Writer
Thursday, November 12, 2009

After trying to carefully balance their interests in health-care reform and immigration, the nation's Hispanic lawmakers and largest advocacy groups are scrambling to develop a strategy to counter what they see as efforts to shortchange immigrants in health bills on Capitol Hill.

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They had tried to keep the two issues apart, concerned, they said, that immigration would distract from health care. But other lawmakers and activists have inserted the immigration issue into the middle of the health-care debate, causing a collision between what Hispanic leaders call their two top policy priorities.

Many of them believe that a health-care overhaul is vital to their community, which is disproportionately uninsured and suffers from a host of chronic illnesses. But with the current bills excluding more than a million Hispanics -- mostly legal immigrants -- the debate runs into the issue of immigrants' rights.

"In every policy debate, as long as immigration remains unresolved, there is going to be a question of what happens to immigrants in this country," said Jennifer Ng'andu, deputy director of health policy at the National Council of La Raza. "One of the reasons that there is so much concern is that our nation's leaders have not dealt with these issues."

Under the health bill passed in the House on Saturday, illegal immigrants would be allowed to buy insurance on a newly created exchange with their own money and without government subsidies. The bill expected in the Senate would bar illegal immigrants from the exchange altogether. In both the Senate and House, all legal immigrants are eligible for government subsidies to buy insurance on the exchange, but immigrants who have been in the country for less than five years would remain barred by existing law from enrolling in Medicaid and Medicare.

At a meeting in May with Hispanic groups and members of the Congressional Hispanic Caucus, activists pushed for dealing with immigration reform within the health-care debate, recalled Elena Rios, president of the National Hispanic Medical Association.

"They told us, 'Don't you dare,' " she said of lawmakers. " 'Don't distract. This is about health-care reform and eliminating health-care disparities.' I thought that was smart. We realized that wasn't the focus."

Now, however, she says she is worried that the health-care bills moving through Congress will not do enough to help immigrants and alleviate health-care disparities in the Latino community.

Similarly, a September meeting with White House policy advisers included a "warning" against confronting the health-care barriers immigrants face because of "fears that conservatives in the Senate could use the issue to kill the bill," Rios wrote on her Web site.

Immigration has become a major political hurdle, regardless.

"We assume the Republicans are prepared to offer any number of immigration-related amendments to slow down the process and score political points," said Jim Manley, a spokesman for Senate Majority Leader Harry M. Reid (Nev.).

The issue isn't clear cut among Democrats, either. Tensions have emerged between the Hispanic Caucus, the White House and Senate Democrats.


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