My Comments: The article that follows is part of my response to the current popular political phrase “Medicare For All”. Unfortunately, that’s an overly simplistic phrase that fails to properly reflect the underlying need for a total re-evaluation of our current health care delivery system here in the US.
Yes, there’s a growing national discussion about health care in this country, especially among those trying to secure the Democratic Party nomimation for President. This is a very good thing since the healthcare delivery system in this country is a mess.
How did it get to be such a mess? Back in the 1920’s, a movement began that included physicians who banded together to provide health care on what today we might call a subscription service. You paid a monthly fee to an associated medical group and you received health care. Unions also got into the act so if you were a dues paying member of said union, you were eligible to receive health care.
The American Medical Association saw this as a threat to their belief that a “fee for services rendered” was in the best interest of their membership. As a result, they threatened to excommunicate any MD who provided such health care. They would be kicked out of the AMA, which for many meant they could no longer practice medicine. It effectively put an end to that business model, which is what we have today.
Meanwhile, and supported by the AMA, pharmaceutical companies got further into the mix, hospitals no longer had clinics competing for patients, and insurance companies gained more traction in the health care delivery system. As it evolved, it became known as the Insurance Model.
It’s an incredibly complex system with millions of participants, all of whom have turf to defend. Meanwhile you and I have experienced an annual cost increase in excess of 10% per year for the past several decades, all the while enjoying shorter life expectancies than found in other nations, at double the price or more.
It’s unsustainable and a remedy has to be found. It will only happen if we can find political leadership not married to any of the primary stakeholders other than you and I as citizens. Don’t expect it to happen overnight, or for the insurance industry, the pharmaceutical industry, or the hospital industry to accept an outcome that doesn’t favor them. With the Supreme Court deciding corporations are people and can use their deep pockets to buy politicians, expect rule changes to be few and far between.
Personally, I want to see the Affordable Care Act, or Obamacare, be expanded to include all 50 states. Then over time, modified to include everyone, including those of us now covered under Medicare.
A recent Facebook post laments that senior citizens have to pay for federal health care benefits while undocumented immigrants enjoy the insurance gratis.
“Why do seniors on Social Security have to pay for Medicare and a supplemental (insurance) and the illegals get it all for free?” asks a post published on the Columbian Post’s Facebook page on Jan. 31.
The post, which had been shared more than 14,000 times by Feb. 26, was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed.
First, we wondered: What is the Columbian Post? According to its Facebook account, the Columbian Post is “an American Exceptionalism themed news media page” that aims to “promote and honor American heritage and the constitutional rights of our readers and fans.”
The page also includes this disclaimer: “We’re a growing paper. We don’t report fake news. We share OPINIONS, and News UPDATES. When we make mistakes we correct them. Please refrain from making snap judgements which are not true at all.”
We wanted to ask the Post for more information about its claim that undocumented immigrants get Medicare for free but it wasn’t possible to send a message to the account on Facebook and there’s no contact information on its website.
So we started researching the statement.
Who is eligible for Medicare?
The U.S. Centers for Medicare & Medicaid Services did not directly respond to PolitiFact’s query about whether the Facebook post’s claim is accurate. Instead, a spokesman for the agency said that individuals who want to apply for Medicare Part A and Part B must contact Social Security, which determines that person’s eligibility on behalf of Medicare.
According to the Social Security Administration’s requirements for entitlement, they must be 65 years old, a U.S. resident and either a citizen or a lawful permanent resident who has lived in the country continuously for the five years immediately preceding the month all other requirements are met.
Steven Wallace, a community health sciences professor at the University of California, Los Angeles, told PolitiFact in an email that undocumented immigrants aren’t eligible for either Medicare or Social Security.
“You have pay into those systems for 10 years to be eligible and need a valid social security number to do so,” Wallace wrote. “When undocumented immigrants work with a SS number, it is either fake or someone else’s. So they pay into the system but are unable to claim benefits.”
Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities, a liberal think tank, also said the Facebook post’s claims were false.
“Social Security and Medicare benefits cannot be paid to people who are not lawfully present in the United States, among other requirements,” he said in an email. “Even lawfully present immigrants have to (be) residents for at least five years to qualify for Medicare benefits.”
He directed us to two government documents. The first, the Program Operations Manual System for Social Security, notes that people in the country illegally are not eligible for benefits.
The second document, a publication from the Centers for Medicare & Medicaid Services, covers enrolling in Medicare, health insurance for people who are 65 and older, younger than 65 with certain disabilities, or people of any age with end-stage renal disease.
Who pays for Medicare and who doesn’t?
Medicare has different parts. Part A is hospital insurance that covers inpatient care at hospitals, hospice care and home health care. Generally, people are eligible if they’re 65 or older and meet citizenship and residency requirements; get disability benefits from Social Security or the Railroad Retirement Board for at least 25 months; get disability benefits because they have ALS; have end-stage renal disease and meet certain requirements.
Part B is medical insurance that helps cover doctor appointments, among other care. An immigrant “lawfully admitted for permanent residence who has lived in the U.S. without a break for the 5-year period immediately before the month (they) file for enrollment in Part B” is eligible for that insurance.
Most people do not have to pay a premium for Part A, according to CMS, but everyone must pay for Part B if they want it.
But Alan Taylor Kelley, a doctor and clinical lecturer at the University of Michigan, told PolitiFact that “undocumented immigrants do not have access to any standard Medicare or Medicaid insurance programs offered by the federal government.”
While undocumented immigrants can get “emergency” Medicaid covering “very limited urgent/emergent services only,” he said, there is no available Medicare program.
“In fact,” he said, “many pay into Medicare through taxes but don’t collect the benefit, thereby subsidizing the Medicare Trust Fund.” The fund finances Medicare health services through payroll taxes, general tax revenue and premiums enrollees pay, according to the Tax Policy Center.
Taylor pointed to a January 2016 article in the Journal of General Internal Medicine found that though “unauthorized immigrants seldom have access to public health insurance programs such as Medicare Part A,” they have “prolonged the life of the Medicare Trust Fund.”
Sometimes the system is misused
There has been news coverage about undocumented immigrants benefiting from Medicare, but they shouldn’t have.
The Obama administration in 2014 announced plans to remove undocumented immigrants from Medicare rolls. Though officials then said immigrants are generally ineligible to receive federal benefits if they’re in the United States illegally, the New York Times reported, “many illegal immigrants have received benefits because the Medicare agency did not update its rules or policies to carry out the restrictions imposed by Congress.”
The inspector general at the Department of Health and Human Services said that Medicare had improperly paid tens of millions of dollars a year to hospitals, doctors, nursing homes and pharmacies that had provided services to illegal immigrants, according to the Times.
In 2018, the Justice Department prosecuted an undocumented immigrant who was convicted of using another man’s identity to apply for and receive Social Security disability benefits and Medicare benefits. He was sentenced to 13 months in prison and ordered to pay the approximate $423,000 he stole in restitution.
Looking elsewhere, we found an Oct. 19, 2017, post on the National Conference of State Legislatures that describes confusion over who is eligible for what as health care reform and immigration reform debates intersect. But, the post says, unauthorized immigrants aren’t eligible for federal health insurance programs. They’re “only eligible for more discrete programs like emergency medical assistance under Medicaid, services in federally qualified health centers and certain health programs.”
The Facebook post claims that legal residents must pay for Medicare while undocumented immigrants get the federal health insurance for free. As far as payment for Medicare goes, some people do have to pay a premium for Part A, according to CMS, but most don’t. And everyone must pay for Part B if they want it.
But the meat of this statement is about immigrants and the suggestion that they’re milking Medicare benefits that law-abiding citizens don’t get. While there have been reported cases of some undocumented immigrants having improperly received benefits, undocumented immigrants are not eligible for Medicare.