Initially waved off, Hispanic advocates jump into health debate
Effort centers on ensuring reform doesn't shortchange immigrants

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.

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.

After Rep. Joe Wilson (R-S.C.) shouted "You lie!" when President Obama pledged that the reforms he proposed "would not apply to those who are here illegally," the White House promoted language barring undocumented immigrants from the exchange, which was adopted by the Senate Finance Committee.

Members of the Hispanic Caucus balked, saying that rule was more restrictive than current policy. According to the Pew Hispanic Center, about 40 percent of illegal immigrants have some form of health insurance.

"I am not going to vote for a health-care bill that includes provisions that exclude people using their own money to go to the exchange regardless of their immigration status," said Rep. Luis Gutierrez (D-Ill.). "It is silly and stupid. If we do not allow them to purchase it, their communities will suffer. Their children will suffer."

On Saturday, House leaders worked to satisfy the concerns of Hispanic lawmakers after a majority of their 22-member caucus pledged to vote against a bill that did not allow all immigrants access. Leaders of the caucus have also met with the White House and Senate leadership in recent days to outline their concerns.

In the Senate, advocacy groups are looking to Sen. Robert Menendez (D-N.J.), who pushed in the Senate Finance Committee to allow undocumented immigrants to buy health insurance on the exchange without taxpayer subsidies. But he has not decided whether to introduce similar amendments when the Senate's floor debate begins, an aide said.

Several Republicans in the committee, including Sen. Charles E. Grassley (R-Iowa) and Senate Minority Whip Jon Kyl (R-Ariz.), introduced immigration-related amendments. The Federation for American Immigration Reform, an advocacy group that supports limiting immigration, is encouraging them to push for barring illegal immigrants from the exchange and denying tax subsidies for health care to legal immigrants who have been in the country for less than five years.

"The Senate is going to have to deal with these red hot issues right at the start of their process, otherwise it is going to dog them during the debate," said Bob Dane, a spokesman for the group. "We see the health-care bill as having been hijacked and reshaping immigration policy."

Some Hispanic activists believe their early cautious stand may have backfired, and they are turning up their advocacy, said Lillian Rodriguez Lopez, president of the Hispanic Federation.

Recently, the largest advocacy groups, including the Federation, La Raza and League of United Latin American Citizens, launched a lobbying campaign focused on removing the five-year ban for legal immigrants and on getting coverage for all families, even families in which the children are legal immigrants and the parents are illegal.

The groups applauded the House's passage of its bill last week, but stressed that they want more coverage for the 4.2 million legal immigrants who are uninsured, according to a study by the Migration Policy Institute, and consideration for the estimated 7.2 million illegal immigrants who do not have health insurance.

"We feel that our community is not being fully represented in the conversation and needs to be more aggressively represented," Rodriguez Lopez said.

Letter of concern

Ten Hispanic organizations sent a joint letter to members of Congress on Wednesday to express their concern about pending health-care legislation. Led by Hector Barreto, who served as a chief of the Small Business Administration under President George W. Bush, the groups said the bill passed Saturday by the House would place unfair mandates on Hispanic small businesses and families.

Barreto, now chairman of the Latino Coalition, said in a statement that "the House vote illustrated Congress's refusal to come up with a bipartisan solution on real health-care reform. We will not support a bill that creates an inefficient and ineffective government-run health care system for America."

Other groups that signed the letter include the Virginia Hispanic Chamber of Commerce, U.S.-Mexico Chamber of Commerce and the Hispanic Alliance for Prosperity Institute.

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