Perspective: Birth Certificate or Passport Requirement Threatens Health Care Coverage for Many

A government budget is a reflection of values and priorities. This is especially true when funds are tight. What do you support, and what do you cut? And how do you explain and justify the choices? Can you make a respectable case, or are you just cynically cutting programs that help those whom you just do not find very important? You be the judge of the answers to these questions regarding the following story.

In an obscure provision of the recently passed federal budget law for the 2006 federal fiscal year, Congress and the president have mandated a new eligibility rule for federally supported Medicaid health care coverage. Effective July 1, 2006, a person applying for Medicaid will have to produce a birth certificate or a passport in order to establish eligibility. All those already covered by Medicaid will have to produce either document at their next redetermination of eligibility in order to retain eligibility. This requirement will wreak havoc on people who need health care coverage but cannot present a birth certificate or a passport. And Illinois will have to spend scarce financial and human resources to conduct this bureaucratic activity in over two million cases a year.

Undocumented Immigrants Unnecessarily Targeted

Supporters of the requirement explain that it will deter undocumented immigrants from falsely obtaining federally supported Medicaid coverage. However, in a report issued in July 2005, the Office of the Inspector General of the federal department that operates the Medicaid program found no evidence that undocumented immigrants were accessing the Medicaid program by falsely claiming citizenship. Federal law already requires proof of citizenship or legal immigration status, and this law is already being administered. While some people are allowed to attest under penalty of perjury that they are citizens, the states can and do demand documentation whenever there is any question about citizenship. The Office of the Inspector General investigated this procedure and found that it was working well and that undocumented immigrants were not falsely accessing the program. Congress was well aware of this but passed the new birth certificate or passport provision anyway.

Citizens to Be Hurt More than Anyone Else

In my experience as a high-volume storefront legal aid lawyer 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. These people fell into a few categories. An overwhelming majority were African Americans who were born in the rural South, were not born in a hospital, and, often, did not even have a doctor present. People from all races and suffering from mental disabilities caused by age, illness, or trauma might have had a birth certificate but no longer possessed one. Many could not remember or state with accuracy where they were born, so obtaining a substitute birth certificate was impossible. People who had been displaced from Europe during the upheavals of the 20th century never had, or no longer had, orthodox documentation, and some had memory losses.  

One study estimates that as many as 20 percent of African Americans born in 1939–1940 lack a birth certificate. There may be a similar problem with Native Americans and rural whites. Clearly the disproportionate impact of this new requirement will fall on older people and people who have disabilities and are citizens and in minority groups, mostly African American. And the impact will be loss of health care coverage.

A Big, Costly, and Pointless Job for States

Gov. Rod Blagojevich is asking the president to veto the budget bill due to this new requirement. Not lost on governors and Medicaid administrators throughout the country is that the new requirement will increase pointless and costly bureaucracy, especially so in a time of state fiscal difficulty. Coming from a Congress and administration famously against big, pointless government activities, it is extremely ironic. Illinois has over two million separate Medicaid cases every year, and those are just the cases that are approved. That means at least two million paperwork tasks that did not previously exist.

How the Illinois Delegation Voted

The Illinois delegation did not split on party lines in the vote on the budget bill that contains this defenseless new requirement. But this is only because, along with all the Democrats in the House delegation and the two senators, Rep. Tim Johnson (R-Sidney) from the 15th District voted against the budget bill. If those who voted for the budget bill defend themselves by claiming that this new birth certificate requirement was just an unfortunate detail buried in a much larger measure, and they were forced to vote for it rather than vote down the whole budget, then we hope that they will be willing to support legislation targeted to repealing this misguided provision.

The birth certificate or passport provision is not necessary to protect the Medicaid program from undocumented immigrants. Instead it will hurt many defenseless citizens, mostly elderly and disabled minorities. It will impose large senseless expenses on the states.

Moreover, and maybe this is the real purpose of the new law, it will shift to states that take responsibility for these citizens the whole cost of providing health care coverage for the people who cannot produce a birth certificate or passport. Perhaps this is just another way that the Bush administration is soaking the states so that it can afford a war and a series of tax cuts for the wealthy few. A budget is a reflection of values and priorities indeed.

For more information, contact John Bouman.