SHOULD undocumented foreigners in the United States be allowed to have health- security cards and join health alliances, just like American citizens and legal residents will?
No, says the White House. Regardless of any merits in providing truly universal health coverage, administration officials say it's not politically possible to sell coverage for illegal immigrants to Congress or the American public.
Even employers of undocumented workers who are currently providing them with insurance would not be allowed to enroll them under the new health- care system. This would decrease the number of insured people.
The consolation prize is that under the new system, federal law would still require emergency rooms to treat anyone - including foreigners who are in the country illegally. And many states will still provide certain other services, such as prenatal and obstetrical care.
Some members of the president's Health Care Reform Task Force argued that undocumented workers should get the same coverage that legal workers get. Many are, after all, paying income taxes.
But public sentiment toward immigrants is negative, and the Clinton administration does not want to be seen as encouraging more illegal immigration.
``When times get tough, immigrants become the scapegoats,'' says Stan Dorn, a staff attorney at the National Health Law Program.
The situation is particularly acute in California, where about half of the nation's undocumented foreigners reside. California has been particularly hard-hit by recession, and the spiraling cost of health care for the state's poor, including illegal immigrants, is bringing pleas for mercy from state politicians.
In August, Gov. Pete Wilson (R) proposed denying health-care benefits to illegal immigrants.
But public-health officials warn that this would lead to worse health conditions for everybody.
Already, studies show that undocumented foreigners avoid seeking medical care, for fear that they will be discovered by the Immigration and Naturalization Service (INS). When a problem becomes acute, they wind up in emergency rooms, where treatment is much more expensive.
Federal law requires that health providers shield the identities of illegal immigrants from the INS, for humanitarian and public-health reasons.
But Rep. Wally Herger (R) of California is drafting legislation to reverse that policy. The goal, says a spokesman for Representative Herger, is to discourage foreigners from coming to America illegally.
Herger's bill also will call for the home country of an immigrant who has been treated in a US hospital to reimburse the US.
Susan Drake, senior attorney at the National Immigration Law Center in California, faults Herger's proposal on several scores.
First, she says, it ignores the fact that many undocumented workers are paying taxes. And more important, it assumes that free health care is an overriding factor behind illegal immigration.
``That's a fallacy being promoted rather heavily by anti-immigration forces,'' Ms. Drake says. ``They come for jobs, to improve economic opportunity for themselves and their children.''
Advocates for immigrants' rights concede that the status quo is probably the best they can hope for under the Clinton reforms. But even the status quo could wind up leaving undocumented immigrants vulnerable, says Rebecca Chiao, another attorney at the National Immigration Law Center. A lot of immigrants, both legal and undocumented, get their health care from migrant health clinics subsidized by the state and federal governments.
``It's not clear if they'll still exist'' under the new system, says Ms. Chiao.
And even if they do, they could wind up being just for undocumented immigrants. That could leave them vulnerable to political pressure to cut off funding, she says.
One group that supports stricter controls on illegal immigration, the Federation for American Immigration Reform (FAIR), doubts that any of the proposals in the Clinton plan will result in a reduction of illegal immigrants' use of the health-care system. In cases where an employer is now providing health insurance for employees who are undocumented, those people will still get coverage, says Ira Mehlman, FAIR spokesman.
``Despite its promises that illegal aliens would not be eligible for medical care, the Clinton administration's health-care plan has left gaping loopholes that make it difficult for illegal aliens not to receive health-care benefits,'' says a FAIR news release.
``The answer to cutting down on the cost of health care for illegal immigrants is to discourage them from coming in the first place,'' Mr. Mehlman says.