President Obama has made it clear time and time again: The Patient Protection and Affordable Care Act (PPACA) does not confer any health benefits on undocumented immigrants. His opponents, suffice it to say, have not been entirely convinced.
Skepticism of the president's claim was infamously displayed by U.S. Rep. Joe Wilson, R-SC, who rose from his seat during the president's 2010 State of the Union address and shouted, "You lie!" after Obama stated that the health law, which was in the works at the time, would not provide coverage to those in the country illegally.
It is very clear that the health benefits that the federal government now extends to citizens and legal residents, such as Medicaid and subsidies, to purchase insurance through the federal and state marketplace exchange, are not available to unauthorized immigrants.
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But plenty of local governments do spend money to provide services to the undocumented. A recent analysis by the Wall Street Journal found that of the 25 counties with the largest estimated populations of undocumented immigrants, 20 provide some type of publicly-funded medical service to residents regardless of legal status.
Not all of the counties are liberal bastions, but most are found in major metropolitan areas where Democrats typically run local government. The five largest are in the metropolitan areas of Los Angeles, Chicago, Houston, Dallas, and New York.
The Journal highlights a number of local officials across the country who are happy to explain their reasoning in providing care to a population that is largely uninsured.
"If federal programs exclude people who live here and get sick here, then someone has to care for them," said George Leventhal, a Democratic council member in Montgomery County, Maryland, outside of Washington D.C. "We all pay anyway."
The costs are not innocuous. The Journal estimated that spending on health care for unauthorized immigrants among the 25 counties amounted to $1 billion a year. But supporters of the initiatives say it still is better than the alternative.
"We are saving money to the system by doing this," César Palacios, head of Proyecto Salud, a public health program that serves immigrants in Montgomery. "If we don't pay now when it is easy money, we are going to pay later on."
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