To understand how efforts to crack down on illegal immigrants can end up backfiring against U.S. citizens, see today's New York Times story titled "Citizens Who Lack Papers Lose Medicaid."

The article describes how new federal requirements designed to keep illegal immigrants from receiving assistance through the joint federal and state health care program for the poor have instead excluded tens of thousands of U.S. citizens who've had trouble complying with stringent documentation requirements.

Under the Deficit Reduction Act of 2005, most people who want Medicaid must provide "satisfactory documentary evidence of citizenship," which could include a passport or a birth certificate and driver's license. The law was authored by two Republican congressmen from Georgia: Nathan Deal and Charlie Norwood, who has since passed away.

State officials told the Times that the Bush administration is going beyond the law's requirements by requiring applicants to submit original or certified documents, leading to delays or even denials of coverage:

Florida, Iowa, Kansas, Louisiana, New Mexico, Ohio and Virginia have all reported declines in enrollment and traced them to the new federal requirement, which comes just as state officials around the country are striving to expand coverage through Medicaid and other means.


In Florida, the number of children on Medicaid declined by 63,000, to 1.2 million, from July 2006 to January of this year.

"We've seen an increase in the number of people who don't qualify for Medicaid because they cannot produce proof of citizenship," said Albert A. Zimmerman, a spokesman for the Florida Department of Children and Families. "Nearly all of these people are American citizens."


Dr. Martin C. Michaels, a pediatrician in Dalton, Ga., who has been monitoring effects of the federal rule, said: "Georgia now has 100,000 newly uninsured U.S. citizen children of low-income families. Many of these children have missed immunizations and preventive health visits. And they have been admitted to hospitals and intensive care units for conditions that normally would have been treated in a doctor's office."

The Times' revelations of how Medicaid's crackdown on illegal immigrants is hurting poor U.S. citizens should come as no surprise: The Center on Budget and Policy Priorities last year released the results of a survey that indicated the Deficit Reduction Act jeopardized Medicaid coverage for as many as 5 million U.S. citizens. Many of those who'd be most likely to experience difficulty in securing those documents -- such as Hurricane Katrina survivors living in temporary facilities -- were not represented in the survey, suggesting that the number of those likely to be harmed by the requirement was probably higher.

And it should be noted that while Medicaid was designed as a program to aid the poor, it's increasingly being used by the middle class. In fact, the program now pays for half the costs of all nursing home care in the United States, as previously middle-class seniors spend down their assets in order to foot bills that typically run more than $60,000 per year. Other middle-class Medicaid beneficiaries include people whose children or other dependents suffer severe disabilities such as cerebral palsy, mental retardation and multiple sclerosis.

As we ponder how Medicaid's crackdown on illegal immigrants is affecting U.S. citizens, a progressive think tank offers a report calling for a national immigration policy that helps rather than hurts middle-class Americans and those aspiring to attain middle-class status.

The Drum Major Institute for Public Policy -- a New York-based nonprofit founded by an advisor to the Rev. Martin Luther King Jr. -- recently released an updated version of an earlier report titled "Principles for an Immigration Policy to Strengthen and Expand the American Middle Class."

The report points out that the American middle class depends on the economic contribution of legal and illegal immigrants -- including paying taxes that help fund Medicaid -- so therefore any pro-middle-class immigration policy would reject mass deportation. It also argues for a policy that strengthens immigrants' workplace rights:

Because employers threaten undocumented immigrants with deportation, these workers cannot effectively assert their rights in the workplace by, for example, asking for raises, complaining about violations of wage and hour or workplace safety laws, or by supporting union organizing drives.

As long as this cheaper and more compliant pool of immigrant labor is available, employers are all too willing to take advantage of the situation to keep their labor costs down.

U.S.-born workers are left to either accept the same diminished wages and degraded working conditions as immigrants living under threat of deportation or be shut out of whole industries where employers hire predominantly undocumented immigrants.

As today's Times' story makes clear, Americans should be concerned not only by the degradation of working conditions under current immigration policy, but also by that policy's unraveling of the social safety net.