Slamming the Hospital Door: Cornyn's Health-Care Opinion Neither Compassionate nor Conservative
In recent weeks, local headlines about Attorney General John Cornyn have focused primarily on his dubious leadership of the Legislative Redistricting Board, where he led the ongoing attempt to make the Legislature look and sound even more like a meeting of the Greater Floydada Chamber of Commerce. But back in July, at the request of the Harris County District Attorney, the AG also issued a legal opinion that may well have more devastating negative consequences for all of us, and especially for the state's poorest citizens. According to the AG's July 10 opinion, county hospital districts can only provide discounted or free health care to undocumented immigrants for "emergencies." In the absence of specific state legislation, anything else -- including treatment of chronic but not immediately life-threatening illnesses like high blood pressure or diabetes or asthma -- would be a violation of federal law.
The law in question is the "Personal Responsibility and Work Opportunity Reconciliation Act of 1996," the welfare-deform gargoyle from Newt Gingrich's Contract With America cravenly signed into law by Bill Clinton. As Cornyn now reads the law (and it's hardly a universal interpretation), the feds could withdraw Medicaid and Medicare funds if hospital districts continue to provide such care, and district administrators could be subject to criminal sanctions. This is not an absolutely new controversy (Tarrant County preemptively stopped providing such non-emergency care four years ago), but it recently exploded in Harris County (where the opinion was requested) and Montgomery County, and some smaller districts (e.g., in the Valley) have responded to Cornyn's opinion by running and hiding as well.
Cornyn's opinion (which does not have the force of law) is almost certainly lousy legal advice. It is also terrible public policy and a mockery of Cornyn and the GOP's so-called "conservatism." Should it hold up, it will exacerbate the health-care crisis across the state, and not surprisingly, it will cost hospital districts and Texas taxpayers a bundle of money -- because it is a simple fact that emergency health care is much more expensive than preventive, pre-emergency care. More importantly, many thousands of people who live, work, and pay taxes in Texas are once more being treated as though they are less than fully human, and as though when they are injured or ill they have no right to health care services that they have helped pay for.
The Cornyn opinion has not been much of an issue yet in Austin, where there is no "hospital district" as such and health care services are administered by the county and city using a combination of local, state, and federal funds. "We're still reviewing it, but we don't think the opinion will apply to us," said Bob Flocke, spokesman for Austin and Travis County Health and Human Services. "Hospital districts are more restricted than cities in what they can do." Flocke said he wouldn't want to speculate what might happen if such a law did apply to Austin, but added, "The most expensive medical care there is, is in emergency rooms; public health at the moment in Texas is already in a difficult situation, and this would make it worse."
But there is an Austin hook to this story, and it's a dispiriting one. In the wake of Cornyn's opinion, the Young Conservatives of Texas, which has an active UT chapter, has been leading the charge to get district attorneys to "investigate" hospital districts for potential violations. The YCT has filed formal complaints with DAs in Harris and several other counties, asking them to "investigate promptly before even more funds are illegally spent." Announcing the complaint, YCT state vice-chairman and third-year UT law student Mark Levin said, "It is an abuse of power for hospital districts in Harris, Dallas, El Paso, and Bexar Counties to continue to illegally force taxpayers to underwrite free health care for every citizen of another country who illegally crosses the border."
That's one of the milder moments in the YCT statement. Much of it is a repellent diatribe against immigrants from Mexico, along these lines: "YCT does not believe Texas taxpayers have an obligation to provide free health care to all of the citizens of Mexico ... because the only difference between an illegal Mexican immigrant who successfully crosses the border and a Mexican citizen who remains in Mexico is that the former has broken our laws. Why shouldn't Texas taxpayers' largesse simply be used to open a public hospital on the other side of the border and save Mexicans the trip?" Moreover, says Levin, the availability of free health care threatens to turn Texas into "Mexico's nursing home."
Asked about this inflammatory and very specifically ethnic rhetoric, Levin responded that while "parts of the statement could have been better phrased, let's not play games: Everybody knows that the vast majority of illegal immigrants are from Mexico." But even if that is true -- then "everybody" should also know that these same people by the thousands grow our food, build our houses, clean our homes and businesses, serve our meals, and raise our children, all at ridiculously low wages. Moreover, they pay taxes through their rents, property, and purchases just like the rest of us. Indeed, because of this state's notoriously regressive tax structure, working poor people generally pay a higher percentage of their incomes in taxes than those who are better off. They are subsidizing us, not we them.
Marc Levin (young and inexperienced as he admittedly is) and other so-called "conservatives" are welcome to argue law and policy. They are not welcome to single out Mexican immigrants for demagogic abuse based on self-serving ignorance and willful misinformation. But that is the human whirlwind reaped by the reckless and pandering politics of Newt Gingrich, Bill Clinton, and John Cornyn.