KATY CLARK: I'm Katy Clark. This is The World a co-production of the BBC World Service, PRI and WGBH-Boston. A top Senate Democrat today unveiled his version of health care reform. Max Baucus is the Chairman of the Senate Finance Committee. His bill does not call for a publicly-run health insurance option, but otherwise, it's pretty much what President Obama called for in his speech last week. That is, a plan to bring the United States into line with other wealthy countries which provide health care coverage for all or almost all. Whether that includes any of the country's estimated 12 million illegal immigrants has been the subject of much debate recently. We're going to discuss that with John Sheils. He is Vice President of The Lewin Group, a non-partisan health care management consulting firm. Okay, John, the now famous "You lied" shout by Congressman Joe Wilson. In the Baucus proposal, would there be any way for illegal or undocumented immigrants to get health care coverage?
JOHN SHEILS: Well, no. Things really wouldn't be any different for undocumented people than they are today. Under the existing law, if you're not documented, you can't get coverage under the Federal Medicaid Program, and Medicaid is the program that covers many of the poor in the United States. Those individuals regardless of how low their income, cannot be enrolled in Medicaid, and it certainly looks like that will continue to be the case under this bill. It is true, though, that if you have an emergency, if you need emergency care, as an undocumented individual you can get the services and it can be reimbursed under Medicaid.
CLARK: What about illegal immigrants who are here working? Can they be getting health insurance through their jobs?
SHEILS: They do today. It's estimated about half of undocumented workers are actually getting coverage from an employer.
CLARK: How do they get that and how is that translated into cost and other things?
SHEILS: Well, there's really no requirement that you demonstrate that you are here legally to purchase insurance from an insurer. It's interesting. They did a survey, INS did a survey of people who were recently permitted to stay here after an amnesty program, and they asked them what life was when they were undocumented? And about 45% of them said that they had insurance through an employer. The health plans really aren't required in any way to determine that you're here legally in order to give you coverage.
CLARK: So will that be the same case under the various proposals that are being discussed in Washington right now?
SHEILS: It would be the same under the House Bill and under the Baucus Bill it appears that people would be able to continue to purchase private insurance without proving that they're here legally. They would not qualify for any of the premium subsidies created under the Baucus Program or under the House Bill under the subsidies provided under those bills. The Premium Subsidy Program is something that would be over and above the Medicaid Program. Medicaid would cover the very poorest people in the country. The Premium Subsidy Program would help people buy private insurance, and that would be for people whose incomes are too high to qualify for Medicaid, but too low to be able to purchase the coverage on their own.
CLARK: And I wanted to get to the question about crowded emergency rooms. There's this perception that crowding in ERs is caused by illegal immigrants using the ERs like a clinic. How true is that?
SHEILS: Well, I think that's probably an overstatement. Certainly, over half of the undocumented don't have coverage. So they're more likely to be uninsured and more likely to need to go to an emergency room because the physician won't take them without insurance.
CLARK: And how many people are we talking about when we say that over half?
SHEILS: Well, we're talking about maybe five or six million people, but that's just a small portion of the total uninsured population. We have 49 million uninsured people. Only six million of them are undocumented people. But the undocumented actually represent a pretty small part of the problem.
CLARK: John Sheils is with The Lewin Group, a non-partisan healthcare management consulting firm outside Washington, D.C. John Sheils, thanks for speaking with us.
SHEILS: All right, thank you.