Health Affairs is a reliable barometer of the direction of mainstream health policy. The following is from the abstract of a May 2014 article:
Undocumented immigrants were excluded from the health benefit Marketplaces created by the Affordable Care Act partly because of claims that they contribute to problems such as high costs and emergency department (ED) crowding. This article examines the likely health care use and costs of undocumented immigrants in California in 2009-10. Using data from the 2009 California Health Interview Survey (CHIS), we developed a model that estimated the state’s adult and child undocumented immigrant population…We found that undocumented immigrants in California, and the uninsured among them, had fewer or similar numbers of doctor visits, ED visits, and preventive services use compared to U.S. citizens and other immigrant groups. Allowing undocumented immigrants to purchase insurance in the Marketplaces and ensuring receipt of low-cost preventive services can contribute to lower premiums and reduce resource strains on safety-net providers.
Aside from the inaccurate representation of the reasons why people who receive subsidized policies through ObamaCare must be legal U.S. residents, the authors claim that premiums will fall if the uninsured are covered. They do this despite the fact that a number of solid studies indicating that providing coverage typically increases utilization by roughly 30 percent. (See the results on emergency department and outpatient utilization from the Oregon Medicaid experiment, Anderson et al. on the relationship between the probability of having health insurance and emergency department visits and inpatient admissions, and the RAND Health Insurance Experiment on utilization differences between “free” coverage and high deductible coverage.)
We also know that covering “low-cost preventive services” with insurance increases premiums, especially when men have to pay for mammograms.
Given the extent of taxpayer subsidies for the “Marketplaces,” it might be less expensive and more effective to repeal the individual mandate, institute a tax credit for proof of insurance coverage, and reimburse safety net institutions based on the estimated fraction of uninsured people in their catchment area.