Heres a story of how unwarranted fears and ignorance can lead to government waste and discrimination.
In an obscure provision of the recently passed federal budget law for fiscal year 2006, Congress and the president have mandated a new eligibility rule for federally-supported Medicaid health coverage. Effective July 1, 2006, a person applying for Medicaid will have to produce a birth certificate or a passport to establish eligibility. All those already covered by Medicaid will have to produce these papers at their next redetermination of eligibility to retain eligibility. This provision will wreak havoc on people who need health coverage but cannot produce these papers, and it will cause the state of Illinois to have to spend scarce financial and human resources to conduct this bureaucratic activity in more than 2 million cases a year.
Federal law already requires proof of citizenship or legal immigration status, and these provisions are already being effectively administered. In a report issued in July 2005, the Office of the Inspector General of the federal department that operates the Medicaid program found that there was no evidence that undocumented immigrants were accessing the Medicaid program by falsely claiming citizenship. Congress was well aware of this but passed the new birth certificate provision anyway.
In my experience as a legal aid lawyer at a high-volume storefront in Chicago neighborhoods some while ago, there was a steady supply of birth certificate cases. For one reason or another, a person needed to produce a birth certificate and did not have one to produce. The overwhelming majority were African-Americans born in the rural South who were not born in a hospital and, often, did not even have a doctor present. Another group were people of all races who were suffering from mental disabilities caused by age, illness or trauma, who may have originally had a birth certificate but no longer possessed one. Another group were people who had been displaced from Europe during the upheavals of the 20th century who never had, or no longer had, orthodox documentationsome of whom also had memory losses. In terms of volume, one study estimates that as many as 20 percent of African-Americans born between 1939 and 1940 lacked a birth certificate. There may be a similar issue with Native Americans and rural whites. It is clear that the disproportionate burden of this new requirement will fall on older people, people with disabilities, and minority groups. Ultimately, the impact will be the loss of their health coverage.
Illinois Gov. Rod Blagojevich has written the President asking him to reject this new requirement. It is not lost on governors and Medicaid administrators throughout the country that one of the main impacts will be to increase pointless and costly bureaucracy. In a time of state fiscal difficulty, this is particularly disappointing. Coming from a Congress and an administration famously against big, pointless government activities, it is extremely ironic. Illinois has more than 2 million separate Medicaid cases every year, and those are just the cases that are approved. That means at least 2 million paperwork tasks that did not previously exist.
The birth certificate provision is not necessary. Instead, it will have the discriminatory impact of profoundly hurting many, mostly elderly, people with disabilities and minorities. It will impose large, senseless expenses on the states. Maybe the real purpose of the new law is to shift responsibility and cost of providing health coverage to the states. Perhaps this is just another way the current administration is soaking the states so it can afford a war and a series of tax cuts for the wealthy few.
When unwarranted fears and ignorance lead to discriminatory and wasteful public policy, its regrettable, and hopefully reversible.
John Bouman is advocacy director for the National Center on Poverty Law. Reprinted with permission from the Illinois Editorial Forum.
From the May 10-16, 2006, issue