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… And Health Care for All: Immigrants in the Shadow of the Promise of Universal Health Care

Published online by Cambridge University Press:  06 January 2021

Adrianne Ortega
Adrianne Ortega*
Affiliation:
Boston University School of Law, Boston University School of Public Health, Northeastern University
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Extract

President Obama’s ambitious universal health care plan aims to provide affordable and accessible health care for all. The plan to cover the estimated 46.5 million uninsured, however, ignores the over thirty million non-citizens living in the United States. If the United States passes universal health care coverage, Congress should repeal the prohibitions of the Welfare Reform Act, extend Medicaid coverage to non-citizens, and allow non-citizens to purchase employer-based insurance coverage.

President Obama’s plan follows the lead of state universal health care legislation by retaining private, employer-sponsored insurance coverage and expanding the eligibility requirements of the Medicaid program. This strategy will not aid uninsured immigrants or overburdened states and hospitals, though, because current law excludes most non-citizens from nonemergency health care services.

Type
Article
Information
American Journal of Law & Medicine , Volume 35 , Issue 1 , March 2009 , pp. 185 - 204
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2009

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References

1 Barack Obama & Joe Biden, Barack Obama & Joe Biden's Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage for All (2008), http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf [hereinafter The Barack Obama Health Care Plan].

2 Kaiser Family Foundation, The Kaiser Commission on Medicaid and The Uninsured, The Uninsured: A Primer 4 (2007), http://www.kff.org/uninsured/upload/7451-03.pdf(noting that as of 2002, 34.5million foreign-born people lived in the United States); see also Steven A. Camarota, Center for Immigration Studies, Immigrants in the United States, 2007: A Profile of America's Foreign-Born Population, http://www.cis.org/articles/2007/back1007.pdf (noting that as of 2007, 37.9 million foreign-born people lived in the United States).

3 See The Barack Obama Health Care Plan, supra note 1, at 5-6; Eric Benson, States Lead the Way on Health Insurance Reform, 35 J.L. Med. & Ethics 329, 329 (2007) (stating that Massachusetts and California expanded coverage under Medicaid).

4 See infra Part I.

5 See infra Part I.

6 See infra Part I.

7 See Plata v. Schwarzenegger, No. C01-1351 TEH, 2008 WL 4847080, at *5 (N.D. Cal. Nov. 7, 2008). Prisons must provide care to comply with the Constitution's prohibition on cruel and unusual punishment. A U.S. District Court in California required the state to expend funds on the prison health care system because it was otherwise incapable of complying with the ban on cruel and unusual punishment.

8 See infra Part II.

9 See Kaiser Family Foundation, The Kaiser Commission on Medicaid and the Uninsured, The Role of Employer-Sponsored Health Coverage for Immigrants: A Primer 5 (2006),http://www.kff.org/uninsured/upload/7524.pdf (stating that 78% of the uninsured are native or naturalized U.S. Citizens).

10 Kaiser Family Foundation, The Kaiser Commission on Medicaid and the Uninsured, Immigrants and Health Care Coverage: A Primer 1 (2004), http://www.kff.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=44857; see also Michael Hoefer, Nancy Rytina, & Christopher Campbell, U.S. Department of Homeland Security, Office of Immigration Statistics, Estimates of the Unauthorized Immigrant Population Residing in the United States: January 2006 1 (2007), available at http://www.dhs.gov/xlibrary/assets/statistics/publications/ill_pe_2006.pdf.

11 Kaiser Family Foundation, The Role of Employer-Sponsored Health Coverage, supra note 9, at 1.

12 See id.

13 See id.

14 See id.

15 Id.

16 Id. at 2.

17 Id.

18 Neda Mahmoudzadeh, , Love Them, Love Them Not: The Reflection of Anti-Immigrant Attitudes in Un-documented Immigrant Health Care Law, 9 Scholar 465, 481 n.82 (2007)Google Scholar (referencing 8 U.S.C. § 1601(2)(B) (2000)) (“It continues to be the immigration policy of the United States that … the availability of public benefits not constitute an incentive for immigration to the United States”); see also Michael E. Fix & Jeffrey S. Passel, The Urban Institute, The Scope and Impact of Welfare Reform's Immigrant Provisions 3 (2002), http://www.urban.org/UploadedPDF/410412_discussion02-03.pdf (“At the time of welfare reform's passage, some researchers contended that the availability of public benefits was increasingly influencing immigrants’ migration decisions ….”).

19 8 U.S.C. § 1601(6) (2000).

20 See generally Mark L. Berk et al., Health Care Use Among Undocumented Latino Immigrants, Health Affairs, July-Aug. 2000, at 51, 56.

21 Id.

22 See id. at 56.

23 Id.

24 See id. at 51.

25 Id. at 56.

26 Dana Canedy, Hospitals Feeling Strain from Illegal Immigrants, N.Y. Times, Aug. 22, 2002, available at http://query.nytimes.com/gst/fullpage.html?sec=health&res=950DE6DB133CF936A1575BC0A9649C8B63.

27 See Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193, 110 Stat. 2105.

28 Shawn Fremstad & Laura Cox, The Kaiser Commission on Medicaid and the Uninsured, Covering New Americans: A Review of Federal and State Policies Related to Immigrants’ Eligibility and Access to Publicly Funded Health Insurance ii (2004), http://www.kff.org/medicaid/7214.cfm.

29 See id. (noting that California, New York, Florida, Massachusetts, Maryland and Virginia all provide state-funded coverage to immigrants).

30 See Deborah Sontag, Immigrants Facing Deportation by U.S. Hospitals, N.Y. Times, Aug. 3, 2008, at A1, available at http://www.nytimes.com/2008/08/03/us/03deport.html?ref=us.

31 See id.

32 See id.

33 See Francine J. Lipman, , Taxing Undocumented Immigrants: Separate, Unequal and Without Representation, 59 Tax Law. 813, 816 (2006).Google Scholar

34 See id.

35 Mahmoudzadeh, supra note 17, at 484 (citing Eduardo Porter, Illegal Immigrants Are Bolstering Social Security With Billions, N.Y. Times, Apr. 5, 2005, at A1, available at http://www.nytimes.com/2005/04/05/business/05immigration.html).

36 See Lipman, supra note 33, at 816.

37 Laurence C. Baker & Linda Shuurman Baker, Excess Cost of Emergency Department Visits for Nonurgent Care, Health Affairs, Winter 1994, at 162 (charges for emergency room visits were two to three times more than other visits ….); see also Jim Yardley, Immigrants’ Medical Care Is Focus of Texas Debate, N.Y. Times, Aug. 12, 2001, at A18, available at http://query.nytimes.com/gst/fullpage.html?sec=health&res=9E01E1DB103FF931A2575BC0A9679C8B63 (quoting an estimate that emergency care could cost “four to ten times” as much as routine medical care).

38 See id.; Alan Zarembo & Anna Gorman, Citizenship Often Determines Who Gets Medical Care, L.A. Times, Oct. 29, 2008, available at http://www.latimes.com/news/local/lame-dialysis29-2008oct29,0,4485373,full.story(noting that some states choose to cover dialysis treatments rather than admit patients with more expensive diagnoses in the emergency room).

39 See infra Part I.

40 Seam Park, , Substantial Barriers in Illegal Immigrant Access to Publicly-Funded Health Care: Reasons and Recommendations for Change, 18 Geo. Immigr. L.J. 567, 581 (2004).Google Scholar

41 Julia Field Costich, Legislating a Public Health Nightmare: The Anti-Immigrant Provisions of the “Contract with America” Congress, 90 Ky. L.J. 1043 (2002).

42 Alan Jenkins & Kevin Shawn Hsu, American Ideals & Human Rights, 77 Fordham L. Rev. 439 (2008).

43 See Alexandro Vivero Neill, Human Rights Don't Stop at the Border: Why Texas Should Provide Preventative Health Care for Undocumented Immigrants, 4 Scholar 405, 425 (2002).

44 Id.

45 Universal Declaration on Human Rights, G.A. Res. 217A, at 71, art. 25(1), U.N. GAOR, 3d Sess., 1st plen. mtg., U.N. Doc A/810 (Dec. 10, 1948) (“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family ….”; see also Constitution of the World Health Organization 1, available at http://www.who.int/governance/eb/who_constitution_en.pdf (“the enjoyment of the highest standard of attainable health is one of the fundamental rights of every human being ….”).

46 See Texas v. United States, No. B-94-228, slip. op. (S.D. Tex. Aug. 7, 1995), aff’d, No. 95-40721 (5th Cir. Feb. 28, 1997); Arizona v. United States, No. 94-0866, slip. op. (D. Ariz. Apr. 18, 1995), aff’d, 104 F.3d 1095 (9th Cir. 1997); Padavan v. United States, No. 94-CV-1341, slip. op. (N.D.N.Y. Apr. 18, 1995), aff’d, 82 F.3d 23 (2d Cir. 1996); California v. United States, No. 94- 0674-K, slip. op. (S.D. Cal. Mar. 3, 1995), aff’d, 104 F.3d. 1086 (9th Cir. 1997); Chiles v. United States, 874 F. Supp. 1334 (S.D. Fla. 1994), aff’d, 69 F.3d 1094 (11th Cir. 1995), cert. denied, 517 U.S. 1188 (1996).

47 See Doe v. Plyler 458 F. Supp. 569 (1978); Matthews v. Diaz, 426 U.S. 67 (1976).

48 See Illegal Immigration Reform and Immigrant Responsibility Act of 1996, Pub. L. No. 104-208, 110 Stat. 3009 (enacted as Division C of the 1997 Omnibus Consolidated Appropriations Act).

49 See id.; Mahmoudzadeh, supra note 18, at 470 (2007).

50 Id.

51 Id.

52 Id.

53 See Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193, 110 Stat. 2105.

54 See Mahmoudzadeh supra note 18, at 471.

55 Id.; see 42 U.S.C.A. § 611 (West 1996) (“Each State to which a grant is made under section 603 of this title shall, at least 4 times annually and upon request of the Immigration and Naturalization Service, furnish the Immigration and Naturalization Service with the name and address of, and other identifying information on, any individual who the State knows is unlawfully in the United States.”).

56 See 8 U.S.C.A. § 1612 (a)(1), (3) (West 2001); Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-93, 110 Stat. 2105; see Recent Legislation, Welfare Reform – Treatment of Illegal Immigrants – Congress Authorizes States to Deny Public Benefits to Noncitizens and Excludes Legal Immigrants from Federal Aid Programs, 110 Harv. L. Rev. 1191, 1192 (1997) (noting “section 402(b) authorizes states to determine the eligibility of … a qualified alien [legal immigrant] for any designated Federal program”).

57 Id.

58 See N.Y. Soc. Serv. Law § 122 (2002); Md. Code. Ann., Health § 15-103(a)(2)(vii) (2008); Tricia A. Bozek, Immigrants, Health Care, and the Constitution: Medicaid Cuts in Maryland Suggest that Legal Immigrants Do Not Deserve the Equal Protection of the Law, 36 U. Balt. L. Rev. 77, 86 (2006).

59 Press Release, National Immigration Law Center, Aliessa et al. v. Novello: N.Y. Law Restricting Immigrants’ Eligibility for State Medical Aid Found Unconstitutional (June 29, 2001), available at http://www.nilc.org/immspbs/health/health011.htm; see also N.Y. Soc. Serv. Law § 122 (2002).

60 See Md. Code. Ann., Health § 15-103(a)(2)(vii) (2008); Bozek, supra note 58.

61 Ehrlich v. Perez, 908 A.2d 1220 (Md. 2006); Aliessa v. Novello, 754 N.E.2d 1085 (N.Y. 2001).

62 Ehrlich v. Perez, 908 A.2d 1220 (Md. 2006).

63 Id.

64 Aliessa v. Novello, 754 N.E.2d 1085 (N.Y. 2001).

65 See Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193, 110 Stat. 2105.

66 Fremstad & Cox, supra note 28, at ii.

67 United States Department of Health & Human Services, Centers for Medicare and Medicaid Services, National SCHIP Policy Overview, http://www.cms.hhs.gov/NationalSCHIPPolicy/ (last visited Mar. 20, 2009).

68 42 C.F.R. § 457.10 (2004); see Press Release, U.S. Department of Health & Human Services, States May Provide SCHIP Coverage for Prenatal Care (Sept. 27, 2002), http://www.hhs.gov/news/2002pres/20020927a.html.

69 Id.

70 See Diane Aguilar, Using SCHIP to Offer Prenatal Care to Undocumented and Non- Qualified Immigrants in Wisconsin: The Benefits, Risks, and Shortcomings, 20 Wis. Women's L.J. 263, 264 (2005).

71 See id.

72 42 C.F.R. § 457.10 (2004).

73 Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111- 3, 123 Stat. 8.

74 Robert Pear, House Votes to Expand Children's Health Care, N.Y. Times, Jan. 14, 2009, available at http://www.nytimes.com/2009/01/15/washington/15healthcare.html?scp=2&sq=schip&st=cse.

75 Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111- 3, 123 Stat. 8, § 211.

76 The Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (2000).

77 See id. at sec. 1395dd(a), a hospital must screen “any individual (whether or not eligible for benefits under this subchapter) ….”

78 See id.

79 See id.

80 42 U.S.C. § 1395dd(a)-(b) (2000).

81 See id.

82 Id. at § 1395dd(e)(1). Additionally, with respect to a pregnant woman “who is having contractions – (i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or (ii) that transfer may pose a threat to the health or safety of the woman or the newborn child.”

83 Id. at § 1395dd(e)(3)(B).

84 Diaz v. Div. of Soc. Serv. & Div. of Med. Assistance, 628 S.E.2d 1, 5 (N.C. 2006).

85 See Mahmoudzadeh, supra note 18, at 476.

86 Alan Zarembo & Anna Gorman, Citizenship Often Determines Who Gets Medical Care, L.A. Times, Oct. 29, 2008, available at http://www.latimes.com/news/local/la-medialysis29-2008oct29,0,4485373,full.story.

87 Id.

88 Id.

89 Id.

90 Canedy, supra note 26 (noting that states with high rates of illegal immigration have high burdens placed on hospitals from illegal immigrants that use emergency rooms as a principle source of care).

91 See generally Berk et. al., supra note 20, at 51; see also Mary Engel, Latinos’ Use of Health Services Studied, L.A. Times, Nov. 27, 2007, at B-1 (noting that illegal immigrants were 50% less likely to use emergency rooms than native born citizens, contrary to the argument that illegal immigrants’ overuse of hospital emergency rooms causes emergency room closures).

92 Deficit Reduction Act of 2005, Pub. L. No. 109-171, 120 Stat. 4.

93 Medicaid Coverage Dwindles: New Law Takes Toll, Adds Complexity to Patient Access, Healthcare Registration Apr. 2007, at 1.

94 See id.

95 See id.

96 Svetlana Lebedinski, , EMTALA: Treatment of Undocumented Aliens and the Financial Burden it Places on Hospitals, 7 J.L. Soc’y 146, 161 (2005).Google Scholar

97 Canedy, supra note 26; see also Sontag, Immigrants Facing Deportation, supra note 30.

98 See Canedy, supra note 26.

99 See id.

100 Sontag, Immigrants Facing Deportation, supra note 30, at A1.

101 Madeleine Pelner Cosman, Illegal Aliens and American Medicine, 10 J. Am. Physicians & Surgeons 6 (2005) (suggesting that one of the country's best emergency medical response organizations, Los Angeles Country Trauma Network, was mostly dismantled as a result of EMTALA and the burden illegal immigrants place on it).

102 Svetlana Lebedinski, EMTALA: Treatment of Undocumented Aliens and the Financial Burden it Places on Hospitals, 7 J.L. Soc’y 146, 161 (2005).

103 Deborah Sontag, Getting Tough - Deported in a Coma, Saved Back in the U.S., N.Y. Times, Nov. 9, 2008, at A1, available at http://www.nytimes.com/2008/11/09/us/09deport.html?scp=1&sq=deported%20in%20a%20coma&st=cse.

104 Id.

105 Id.

106 Sontag, Immigrants Facing Deportation, supra note 30.

107 Id.

108 Canedy, supra note 26.

109 Sontag, Immigrants Facing Deportation, supra note 30.

110 See id.

111 Sontag, Deported in a Coma, supra note 103.

112 Id.

113 Id.

114 Id.

115 Id.

116 Id.

117 Id.

118 Id.

119 Id.

120 See Bruce Patsner, Repatriation of Uninsured Immigrants by U.S. Hospitals: The Jimenez Case, Health Law Perspectives, Dec. 16 2008, http://www.law.uh.edu/healthlaw/perspectives/2008/(BP)%20deport.pdf.

121 Montejo v. Martin Mem. Med. Ctr. Inc., 874 So. 2d 654 (Fla. Dist. Ct. App. 2004).

122 Id. at 657 (citing 42 U.S.C. § 1395X(ee) (2008) and 42 C.F.R. § 482.43 (2009)).

123 Id.

124 See Patsner, supra note 120.

125 Id.

126 Id. at 4.

127 See Mahmoudzadeh supra note 18, at 477.

128 See Robert Pear, United States Is Linking Status of Aliens to Hospital Aid, N.Y. Times, Aug. 10, 2004, at A1, available at http://query.nytimes.com/gst/fullpage.html?res=9903E2DD1E3CF933A2575BC0A9629C8B63 (identifying which states were given federal aid to relieve the economic burden that illegal immigrants place on local hospitals).

129 See Eric Benson, States Lead the Way on Health Insurance Reform, 35 J.L. Med. & Ethics 329, 329 (2007).

130 See id.

131 Id.

132 Massachusetts Commonwealth Connector, Overview, http://www.mahealthconnector.org/portal/site/connector/menuitem.a6bd9ea72595da2ea87b5f57c6398041/?fiShown=default (last visited Mar. 20, 2009).

133 See Benson supra note 129, at 329.

134 Id.

135 Id.

136 Commonwealth Connector, Facts and Figures 3 (2008), http://www.mahealthconnector.org/portal/site/connector/menuitem.d7b34e88a23468a2dbef6f47d7468a0c?fiShown=default.

137 Id.

138 Sharon Long, Allison Cook & Karen Stockley, Urban Institute, Massachusetts Division of Health Care Finance and Policy, Health Insurance Coverage in Massachusetts: Estimates from the 2008 Massachusetts Health Insurance Survey 3 (2008), http://www.mahealthconnector.org/portal/site/connector/menuitem.d7b34e88a23468a2dbef6f47d7468a0c?fiShown=default.

139 114.5 CMR 17.00 (2008), available at http://www.mass.gov/Eeohhs2/docs/dhcfp/g/regs/114_5_17.pdf.

140 Kaiser Family Foundation, The Role of Employer-Sponsored Health Coverage for Immigrants, supra note 9.

141 Benson, supra note 129, at 330.

142 Id.

143 Id.

144 Id.

145 See The Barack Obama Health Care Plan, supra note 1.

146 Id.

147 Id.

148 Id.

149 Id.

150 See William P. Gunnar, The Fundamental Law That Shapes the United States Health Care System: Is Universal Health Care Realistic Within the Established Paradigm?, 15 Annals Health L. 151, 155 (2006).

151 Id.

152 Id. at 156.

153 Id. at 156.

154 See Matthews v. Diaz, 426 U.S. 67, 79-80 (1976); Reno v. Flores, 507 U.S. 292, 306 (1993); Lewis v. Thompson, 252 F.3d 567 (2d Cir. 2001).

155 Lewis v. Thompson, 252 F.3d 567 (2d Cir. 2001).

156 Id. (quoting Matthews v. Diaz, 426 U.S. at 79-80).

157 Reno v. Flores, 507 U.S. at 306.

158 Matthews v. Diaz, 426 U.S. at 79-80.

159 Id. at 81.

160 Lake v. Reno, 226 F.3d 141, 148 (2d Cir. 2000).

161 Heller v. Doe, 509 U.S. 312, 320 (1993).

162 Madden v. Kentucky, 209 U.S. 83, 88 (1940).

163 Lewis v. Thompson, 252 F.3d 567, 583 (2d Cir. 2001).

164 Id.

165 See Aleman v. Glickman, 217 F.3d 1191 (9th Cir. 2000) (denial of food stamps to certain divorced aliens); City of Chicago v. Shalala, 189 F.3d 598 (7th Cir. 1999) (denial of food stamps, supplemental security income, and other income benefits); Rodriguez v. United States, 169 F.3d 1342 (11th Cir. 1999) (denial of food stamps and supplemental security income); see also Kiev v. Glickman, 991 F. Supp. 1090 (D. Minn. 1998); Abreu v. Callahan 971 F. Supp. 799 (S.D.N.Y. 1997).

166 See generally Tamra Boyd, Keeping the Constitution's Promise: An Argument for Greater Judicial Scrutiny of Federal Alienage Classifications, 54 Stan. L. Rev. 319 (2001).

167 Aliessa v. Novello, 754 N.E.2d 1085 (N.Y. 2001).

168 Id.; see also N.Y. Soc. Serv. Law § 122 (2002).

169 Aliessa v. Novello, 754 N.E.2d at 1098-99.

170 Plyler v. Doe, 457 U.S. 202, 230 (1982).

171 U.S. Const. art. I, § 8.

172 See South Dakota v. Dole, 483 U.S. 203, 207 (1987).

173 Alison Fee, Forbidding States from Providing Essential Social Services to Illegal Immigrants: The Constitutionality of Recent Federal Action, 7 B.U. Pub. Int. L.J. 93, 99 (1998).

174 See id.

175 See Texas v. United States, No. B-94-228, slip. op. (S.D. Tex. Aug. 7, 1995), aff’d, No. 95-40721 (5th Cir. Feb. 28, 1997); Arizona v. United States, No. 94-0866, slip. op. (D. Ariz. Apr. 18, 1995), aff’d, 104 F.3d 1095 (9th Cir. 1997); Padavan v. United States, No. 94-CV-1341, slip. op. (N.D.N.Y. Apr. 18, 1995), aff’d, 82 F.3d 23 (2d Cir. 1996); California v. United States, No. 94- 0674-K, slip. op. (S.D. Cal. Mar. 3, 1995), aff’d, 104 F.3d. 1086 (9th Cir. 1997); Chiles v. United States, 874 F. Supp. 1334 (S.D. Fla. 1994), aff’d, 69 F.3d 1094 (11th Cir. 1995), cert. denied, 517 U.S. 1188 (1996).

176 See Texas v. United States, No. B-94-228, slip. op. (S.D. Tex. Aug. 7, 1995), aff’d, No. 95-40721 (5th Cir. Feb. 28, 1997); Arizona v. United States, No. 94-0866, slip. op. (D. Ariz. Apr. 18, 1995), aff’d, 104 F.3d 1095 (9th Cir. 1997); Padavan v. United States, No. 94-CV-1341, slip. op. (N.D.N.Y. Apr. 18, 1995), aff’d, 82 F.3d 23 (2d Cir. 1996); California v. United States, No. 94- 0674-K, slip. op. (S.D. Cal. Mar. 3, 1995), aff’d, 104 F.3d. 1086 (9th Cir. 1997); Chiles v. United States, 874 F. Supp. 1334 (S.D. Fla. 1994), aff’d, 69 F.3d 1094 (11th Cir. 1995), cert. denied, 517 U.S. 1188 (1996).

177 California v. United States, 104 F.3d 1086, 1090 (9th Cir. 1997).

178 Id. at 1089.

179 Id. at 1090.

180 Id. at 1091.

181 Id.

182 See Chiles v. United States, 874 F. Supp. 1334, 1334 (S.D. Fla. 1994).

183 Id.

184 See Texas v. United States, No. 95-40721, 3-4 (5th Cir. Feb. 28, 1994).

185 See U.S. Department of Homeland Security, Office of Immigration Statistics, Estimates of the Unauthorized Immigrant Population Residing in the United States: January 2006 1 (2007), http://www.dhs.gov/xlibrary/assets/statistics/publications/ill_pe_2006.pdf (noting that illegal immigration rates continue to climb).

186 See supra Part II.

187 See supra Part I.

188 See Costich supra note 41, at 1043.

189 Kaiser Family Foundation, The Role of Employer-Sponsored Health Coverage for Immigrants, supra note 9, at 1.

190 See supra Part I.

191 Sean Lengell, Waxman to Push ‘09 Health Care Reform, Wash. Times, Jan. 30, 2009, available at http://www.washingtontimes.com/news/2009/jan/30/waxman-to-push-09-health-care-reform/.

192 See supra Part I.