Fact Check: GOP flier says NC senator voted to give illegal immigrants health care
Posted September 25, 2014
Rockingham, N.C. — State Sen. Gene McLaurin, D-Richmond, isn't surprised to be playing defense this election cycle, but he said "it was a shock" to see a flier criticizing him for backing an immigration bill that top Republicans leaders also voted for.
Of 17 state Senate Democrats, he is the only one who is an incumbent in what analysts say is a swing district where voter registration and historical trends suggest Republicans could take the seat.
Given that seat's profile, it's no wonder McLaurin campaigns as what national analysts would call a "blue-dog Democrat," a conservative Democrat who will sometimes vote with the GOP, particularly on fiscal issues. For his part, McLaurin said he models his political philosophy on an answer former U.S. Sen. Terry Sanford once gave to the question of partisan labels.
"I'm a North Carolina regular," McLaurin said. "I don't feel like I fit any label."
So, it is no surprise that a recent North Carolina Republican Party campaign flier sought to eat away at that image by featuring a picture of McLaurin pasted next to a picture of President Barack Obama.
"Would an Independent Democrat Allow Businesses to Hire Illegal Immigrants Instead of American Workers?" screams a headline on the flier. "Of Course Not. But Gene McLaurin Did."
The flip side of the flier argues that McLaurin's votes for Medicaid expansion could be read as a vote to expand "Obamacare" to illegal immigrants.
The ad is a hard-hitting attack in an area of the state that has been hit hard by factory job losses and where losing jobs to foreign workers is a salient issue. But a good part of it could apply to a number of Republican senators running for re-election this year as well.
THE IMMIGRATION BILL: The immigration vote in question came down in 2013. It dealt with a bill that called for more coordination among state agencies in their efforts to curb illegal immigration and tightened requirements that city and county governments require that contractors use the federal e-verify program to check the immigration status of workers.
However, one piece of the bill said that employers throughout the state, whether they were contractors or not, did not have to use the e-verify program for workers whose contracts extended less than 90 days. This was a provision that agricultural interests pushed hard for because farmers frequently hire seasonal workers, particularly around harvest time. Having to run background checks, the argument went, would cause delays in bringing in crops that farmers couldn't afford.
The North Carolina Farm Bureau and other agricultural organizations pushed hard for the exemption.
"These inequities could put farmers at risk of not being able to hire enough workers, and, ultimately, crops could be left in the fields to rot," Agricultural Commissioner Steve Troxler said at the time.
"This legislation has a loophole that would allow businesses to exempt a higher percentage of their employees from proving they are legal U.S. citizens or residents," McCrory said at the time. "Every job an illegal immigrant takes is one less job available for a legal North Carolina citizen. We must do everything we can to help protect jobs for North Carolinians first and foremost."
The flier in question cites McCrory's statement as well as the Senate's veto override vote. However, at the time, McCrory only presented hypothetical situations and word of mouth to back up his assertions, rather than specific instances of the "loophole" being used outside the agriculture industry.
McLaurin was one of 39 senators – 26 of them Republicans – who voted to override McCrory's veto. That's the vote cited in the flier.
"This race is about Gene McLaurin," said Ray Martin, director of the North Carolina Republican Senate Caucus' political operations. Asked if this same attack couldn't apply to Senate President Pro Tem Phil Berger or House Speaker Thom Tillis, who both voted to override McCrory's vetoes, Martin said, "Everyone has to make their own decisions. This race is about Gene McLaurin's record."
HEALTH CARE FOR IMMIGRANTS: The flip side of the flier continues the immigration theme.
"Obama and McLaurin. Together on Illegal Immigration. Together on ObamaCare Expansion – Even for Illegal Immigrants," it reads.
The legislative history on this bill is a little more straightforward, although the health care claim is somewhat tortured.
Medicaid is a health insurance program for the poor and disabled that is jointly funded by the federal and state governments.
Currently, North Carolina's health insurance program for the poor and uninsured covers most recipients whose families earn up to 100 percent of federal poverty benchmarks. The federal Affordable Care Act, what some people call "Obamacare," would have paid for states to expand Medicaid programs to those making 138 percent of poverty and and covered childless adults who are now largely left off the Medicaid rolls.
That amendment failed on a party-line 17-33 vote.
So, how does the state Republican Party's flier get from Medicaid expansion to providing health coverage to illegal immigrants?
Don Taylor, a health care expert at Duke University's Sanford School of Public Policy, was initially stumped. The bulk of what people think of as Obamacare helps lower-income people afford health insurance by providing subsidies when they shop on health care exchanges.
The Affordable Care Act "bans them (undocumented immigrants) from receiving exchange subsidies in five or six different parts of the law. It is really forbidden," Taylor said. Similarly, federal Medicaid rules say care provided to those in the U.S. illegally cannot be paid with Medicaid funds.
A SMALL EXCEPTION: There is one exception to Medicaid's rules against paying for care of people in the U.S. illegally. That exception applies in cases of severe medical emergency or birth. As pointed out by The Washington Post's Wonk Blog, "The program doesn't really have a name, but it is referred to colloquially as emergency Medicaid. It is reimbursement offered to hospitals to provide emergency and maternity care to people who, based on their income and other factors, would be eligible for regular Medicaid if only they weren't a) in the country illegally, or b) in the country legally but not lawful long enough to join Medicaid (five years)."
The GOP flier cites that Wonk Blog post.
Taylor said that North Carolina has been dealing with this emergency clause long before the Affordable Care Act came along. The 2000 case of an immigrant who received emergency care for cancer went all the way to the state Supreme Court. That ruling affirmed that Medicaid had to pay for some care that treated life-threatening illnesses but did not have to pay for other care of a non-emergency nature.
Federal data for fiscal year 2012, the latest available, shows that the "Emergency Services for Undocumented Aliens" cost the state and federal governments a combined $36.8 million, $24.2 million of that came from the federal government.
Reports of the debate at the time don't show medical costs for undocumented immigrants figuring into the debate.
"I don't remember any discussion about illegal immigration in the whole debate," McLaurin said.
That's small wonder since the amount spend on ESUA is a tiny fraction of North Carolina's overall Medicaid spending, which is roughly $14 billion annually.
McLaurin added that he voted to expand Medicaid in order to help both working people who can't afford health care as well as cash-strapped rural hospitals that are struggling with bills many of their patients can't pay.
SORTING OUT THE LOGIC: So, McLaurin did vote to expand Medicaid as allowed under the Affordable Care Act, and for decades, Medicaid has had a program where it would pay for emergency care provided to those in the United States illegally. To the extent that there are people here illegally whose families find themselves earning between 100 and 138 percent of poverty wage and who would otherwise qualify for Medicaid, the program could find itself picking up the tab for increased emergency care.
Absent that expansion, hospitals would still be treating patients with life-threatening conditions and may just end up simply writing off those costs.
THE CALL: Just stop.
The health care claims in this flier may have been enough to earn it a red light all on their own. The issue of illegal immigration has hardly ever figured into North Carolina's Medicaid expansion debate. The piece of the Medicaid program that gives this claim a sliver of credibility is tiny compared to overall spending in North Carolina.
But the GOP's flier earns extra marks for hubris and hypocrisy by slamming McLaurin, a Democrat, for a vote that put him squarely in step with the General Assembly's Republican leaders. McLaurin voted with the majority of Senate Republicans to override McCrory's veto. During debate on the immigration bill, little if any evidence was presented that a business other than a farm operation would make use of the 90-day exemption, and the bulk of that legislation was aimed at tightening immigration restrictions, not loosening them. This flier gets a an unqualified red light on our fact-checking scale.