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(CNN) - Democrats seeking the presidential candidacy have said they would support extending government health coverage to undocumented immigrants, a big change, since undocumented immigrants currently have little access to federal programs.
They do not qualify for Medicare, they are not eligible for federal subsidies from the Low Price Health Care Act, and they generally cannot enroll in Medicaid, which provides coverage for low-income people. Even many green card holders generally have to wait five years before they can enroll in Medicaid, and President Donald Trump has changed the immigration policy that could discourage even eligible immigrants to register.
What that means, today, is that many undocumented immigrants depend on emergency rooms, which are required by federal law to control and stabilize all patients who enter through their doors, when they get sick.
That ultimately costs the federal government billions in reimbursements to hospitals.
But Americans are divided about providing more comprehensive government-backed coverage to the approximately 11 million undocumented immigrants in the United States. About 59% of Americans say such coverage should not be available to undocumented immigrants, according to a CNN survey conducted in late June.
Among those who think it should be, there is a great disparity between parties. About 66% of Democrats support giving government coverage to the undocumented, but only 10% of Republicans feel the same.
The position of the Democrats has given Trump meat to attack his opponents.
"How about taking care of American citizens first?" He argued on Twitter after the first Democratic debate in June.
This is how undocumented immigrants access medical care now:
Some undocumented immigrants have insurance
About 45% of undocumented non-elderly people were uninsured in 2017, compared to 23% of legally present immigrants and 8% of citizens, according to the Kaiser Family Foundation.
Those who have coverage can get it in their jobs, through the employer of a family member or some state or local programs. They can buy individual policies, but not in the exchanges of the Law of Health Care at Low Price, as this coverage tends to be very expensive, the Foundation discovered.
Some states and local governments provide coverage
Certain states, cities and counties do provide non-emergency services to undocumented residents, particularly low-income people who would qualify for public benefits.
Six states, plus the District of Columbia, are using their own funds to expand their Children's Health Insurance Program (CHIP) to all children who meet income guidelines, regardless of immigration status.
California recently became the first state to extend Medicaid to undocumented low-income residents under 26. The authorities estimate that the plan will cover some 90,000 young adults and will cost the state $ 98 million in its initial year.
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Other local governments, such as Los Angeles, San Francisco and Harris County in Houston, also run programs that provide care for the undocumented. New York City recently expanded its efforts to connect uninsured residents with primary care doctors, regardless of immigration status.
Community clinics are another way, and they already receive federal support
Undocumented immigrants can also turn to the nearly 1,400 community health centers across the country, which generally provide primary care and specialized care and are often funded through federal grants and Medicaid.
"When you hear phrases like 'mosaic', you're not kidding," said Nancy Berlinger, a researcher at the Hastings Center, a group of experts that focuses on social and ethical issues in health care, science and technology.
Undocumented immigrants spend much less on medical care than US-born residents, partly because they are generally younger and healthier and partly because they face many barriers to treatment, said Leah Zallman, a Cambridge Health Alliance primary care physician, a Safety Net Health Care System in Massachusetts, which co-authored a review of studies on health care expenses for immigrants.
"In general, they use very little care," Zallman said.
The federal government also reimburses emergency rooms for the care of the uninsured
Emergency rooms often seek federal reimbursement for the treatment of people without insurance. A little-known program is called Emergency Medicaid, which spends around $ 2 billion annually to help pay for the treatment of approximately 100,000 people who would otherwise have qualified for Medicaid, but because of their immigration status, said Dave Chokshi, the chief of health of the population of New York. Health & Hospitals and co-author of a report on the program published in the medical journal JAMA earlier this year.
"It makes more moral and clinical sense, but it also makes more financial sense to take care of people before they are in crisis," Chokshi said. "The care we provide now is all too often emergency care, rather than primary care."
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It is a small part of the almost 577,000 million that the federal government and states spend on Medicaid. But most of the Emergency Medicaid fund is used to cover the care of the undocumented, with California receiving approximately half of the total, followed by New York, Texas and Florida, according to Chokshi.
Most of the expenses go to pregnancy-related treatments, but states may choose to extend the scope of what they consider emergency services to chemotherapy or dialysis, for example.
Still, some argue that policymakers should focus on citizens and legal residents.
"If you want to start covering people, you always want to start with those who follow the law and are supposed to be here," said Steven Camarota, director of research at the Center for Immigration Studies, which advocates reducing immigration.
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