The $1-Billion Misunderstanding : That amount would barely cover medical costs for illegal immigrants in California alone

Reality has a way of taking many of the grand ideas that emanate from Washington and making them look, well, very inadequate. And maybe even weirdly out of step.

That’s something the Clinton team should remember this week as it unveils the long-awaited draft plan to overhaul the nation’s health care system. And that’s something California must not let the President forget as it fights for its fair share of federal funds to cover the costs of medical treatment for illegal immigrants. Because those costs are horrific.

Ira Magaziner, director of the White House’s health care task force, says that federal health insurance coverage would not be extended to illegal residents. Instead, as part of the Clinton plan, the government would set up a separate pool, totaling about $1 billion, that Administration officials insist would pay the costs to treat illegal residents and deal with other “regional health priorities.” These include the prevention of communicable diseases--including tuberculosis and AIDS--as well as controlling violence in the inner city.

That’s a lot to ask of a measly billion in a nation of 50 states. In fact, a hard look shows that the numbers aren’t even close to adding up.

Under federal law, hospitals must provide emergency medical treatment, regardless of a person’s nationality or ability to pay. Right now California is home to nearly half of the nation’s estimated 3 million illegal immigrants. In 1986 federal immigration reform was supposed to provide adequate compensation to states whose existing illegal populations had in effect been “grandfathered”--retroactively covered--by the reform. But little of that money ever got here. And medical treatment now costs the state about $880 million annually, an expense that has tripled in the last four years. Of course, illegal immigrants contribute to the state’s economy in many ways; but the medical bill for their treatment, mandated by federal law, keeps soaring.

To make matters worse, two factors add considerably to the state’s medical costs, Times writer Irene Wielawski said in a recent two-part series on illegal immigrants and the health care system. One is that out of fear of deportation, many illegal residents do not seek preventive or early care and instead wait until their ailments become severe, and consequently more expensive to treat. Another troubling phenomenon is that of well-off foreigners coming to California primarily to use its hospitals and then falsely saying they are unable to pay.

Perhaps new immigration reform would help. But so would more money. To have a credible plan the numbers must add up. So far Clinton’s proposal falls far short of what’s needed. This is a gentle--but crucial--reminder.