Border Bill Should Include Citizenship Verification For Medicaid

Incoming Senate Majority Leader John Thune, R-S.D., has outlined a strategy for the new Republican Congress to address border and national security needs early this year in a budget reconciliation bill. As I explained two years ago, increasing defense spending via reconciliation would circumvent perpetual Democrat demands to couple increases in defense and nondefense spending, which have led to costly omnibus spending bills. 

But a border security measure should also include a logical complement: enhanced citizenship verification procedures for federal health care programs. These measures would not just help pay for new security spending but also deter additional migration.

Weak Verification of Citizenship

While federal law has required applicants for many programs to declare their citizenship status since 1986, for decades most states took little action to verify these declarations. In July 2005, the Department of Health and Human Services Office of Inspector General released a report noting that 47 state Medicaid programs always or often allowed self-declaration of citizenship and that 27 states took no action to verify those self-declarations. Within months, the Republican-controlled Congress in Section 6036 of the Deficit Reduction Act required Medicaid programs to review “satisfactory documentary evidence of the citizenship or nationality of the individual.”

No sooner had these requirements taken effect in July 2006 than Democrats, who regained control of Congress that November, began working to circumvent them. In 2007, as part of legislation reauthorizing the children’s health insurance program, they proposed an alternative verification mechanism based on matching an applicant’s name and Social Security number. While this mechanism could potentially verify citizenship status, it does not confirm the applicant’s identity, thereby encouraging fraud.

President George W. Bush twice vetoed Democrat bills containing the more lenient verification regime in 2007, but Barack Obama signed the measure into law shortly after taking office in February 2009. Democrats utilized a similar measure when crafting Obamacare later in 2009; Section 1411 of the law relies upon the same Social Security match mechanism.

Republican Outrage — Then Capitulation

In September 2009, the immigration issue soared in prominence when Rep. Joe Wilson, R-S.C., exclaimed, “You lie!” in response to Obama’s claim in his address to Congress that “the reforms I’m proposing would not apply to those who are here illegally.” While Wilson objected to an initial House bill with no citizenship verification provisions at all, the enacted version of Obamacare signed into law again required verification of citizenship but not identity. During the debate over the law, then-Rep. Jim Moran, D-Va., demanded that a constituent show identification before asking a question at a raucous town hall, raising an obvious question: Why not extend the same requirement to applicants for taxpayer-funded benefits?

Despite the national attention that Wilson’s outburst drew to immigration verification in 2009, Republicans effectively forgot about the issue upon regaining control of Congress and the White House. Rather than using the children’s health insurance reauthorization as leverage to relitigate the matter, the Republican Congress passed, and President Trump signed into law, a nine-year reauthorization of this program, with nary a peep about immigration verification or any other policy.

Time for a Second Chance 

Budget reconciliation provides a perfect opportunity for the new Republican Congress to remedy an oversight from Trump’s first term. Lawmakers can strike the lenient verification requirements contained in Obamacare and instead require state Exchanges and Medicaid programs to utilize the original verification regime that Republicans established in the Deficit Reduction Act.

The best policy argument for this change comes from none other than Hillary Clinton. Testifying before Congress about her health care plan in September 1993, she said, “We do not want to do anything to encourage more illegal immigration into this country. We know now that too many people come in for medical care as it is. We certainly don’t want [illegal aliens] having the same benefits that American citizens are entitled to have.”

During his first campaign in 2016, Donald Trump drew elite derision for claiming that Mexico would fund his proposed border wall. Over eight years later, it would provide some poetic irony for Congress to fund enhanced border security in part by preventing taxpayer-funded benefits from going to undocumented immigrants.