Mitt Romney’s Immigration Problem

Mitt Romney's health care plan subsidized health care for illegal immigrants.

After spending more than a month scoring political points on the right  by hitting Rick Perry on his deviations from the standard conservative line on immigration issues, such as Texas’s in-state tuition program. Now, however, questions are being raised about how illegal immigrants are treated under the public policy program with which Romney is most identified:

The Massachusetts healthcare law that then-Gov. Mitt Romney signed in 2006 includes a program known as the Health Safety Net, which allows undocumented immigrants to get needed medical care along with others who lack insurance.

Uninsured, poor immigrants can walk into a health clinic or hospital in the state and get publicly subsidized care at virtually no cost to them, regardless of their immigration status.

The program, widely supported in Massachusetts, drew little attention when Romney signed the trailblazing healthcare law. But now it could prove problematic for the Republican presidential hopeful, who has been attacking Texas Gov. Rick Perry for supporting educational aid for children of undocumented immigrants in Texas.

“We have to turn off the magnet of extraordinary government benefits,” Romney said at the recent Fox News-Google debate in Florida.

Perry has defended the Texas program, saying it is better to educate young people, even if they are in the country illegally, to help them become productive members of society.

Similarly, supporters of the Massachusetts program note there are ultimately higher costs for denying care to sick patients regardless of their immigration status.

The Massachusetts program, which cost more than $400 million last year, paid for 1.1 million hospital and clinic visits. It’s unclear how many undocumented patients benefited because the state does not record that data.

The Romney campaign is saying it was never the intent of the program as drafted that it provide subsidized health care for illegal immigrants, and said that if this is what has occurred, it’s because of the way his successor has implemented the program:

The Romney campaign was quick to react to the article, and to criticize Democratic Gov. Deval Patrick, who succeeded Romney.

“Federal law requires emergency medical care for illegal immigrants. And if illegal immigrants are getting access to additional healthcare in Massachusetts, it’s liberal Gov. Deval Patrick that has made it easier for them to do so. All of the regulatory activities involving the Health Safety Net Fund, including who could get care, were made long after Mitt Romney left office,” said Romney spokesperson Andrea Saul


“Mitt Romney’s record on illegal immigration is clear: as governor, he vetoed an in-state tuition bill for illegal immigrants and authorized his state troopers to detain people based on their immigration status. On the other hand, liberal Gov. Patrick has the same position on illegal immigration as Rick Perry – he favors in-state tuition and reversed an executive order to detain illegal immigrants – and neither can be trusted to deal with such an important issue,” added Saul.

The Perry campaign, obviously, sees things differently:

“When faced with the illegal immigrant benefits this morning, the Romney campaign tried to deny indisputable facts and to cover their tracks by blaming Gov. Patrick,” Perry national press secretary Mark Miner said in a statement. “The truth is Gov. Romney’s plan intended to provide free health care to illegal immigrants, and the law and rules he approved were clear about providing free health care to illegal immigrants.”

In the end, I think it’s pretty clear that Romney has the better policy argument here, and that the Perry campaign’s effort to score points here is ignoring important facts. Under Federal Law, anyone who walks into an emergency room must be treated regardless of their insurance status. This causes many people without insurance, and especially people in the country illegally, to use Emergency Rooms as clinics, which in turn raises the cost of care for everyone. One of the main motivations of the Massachusetts program was to find a way to shift these ER visits to clinics, which are more appropriate places to treat routine visits to begin with, and which also happen to be much less expensive than an ER visit. The solution they came up with was to subsidize clinic visits for the indigent, regardless of immigration status. As Ed Morrissey notes, the only other alternative would have been to deny any subsidized care at all to the indigent, and that simply wasn’t going to pass in a state like Massachusetts (and probably not in many others, either).

The problem that Romney faces in the context of the GOP primary, though, is that the long-winded policy explanation I went through just now isn’t going to work in a political environment dominated by sound bites and 30 second commercials, and it would be hard for it to come across well in the context of a Presidential debate with short response times and constant back-and-forth between the candidates. The GOP base is already wary of Romney because of the health plan to begin with — I suppose Tim Pawlenty’s one contribution to the 2012 race will be that he helped popularize the term RomneyCare, for example. Adding the illegal immigrant thing into it will just make it harder for Romney to make the eventual peace with the base that will have to be made if he is indeed going to be the nominee, as I still suspect.

More importantly, though, this is the kind of story that could blunt the effectiveness of Romney’s criticism of Perry on immigration generally. In some ways, Perry’s rather lame effort to pin the hiring of an illegal immigrant on Romney at the last debate was intended to do that as well, but it clearly hasn’t worked because there was simply no merit to the charge. With this, however, the most Romney can say is that they never intended that the law would subsidize health care for illegal immigrants, even though it’s pretty clear that this is exactly what happened. Blaming Deval Patrick for this doesn’t strike me as something that’s going to go over very well with Republican voters, not in the least because most of them don’t know who Patrick is and probably couldn’t care less. The next time Romney tries to bring up Perry’s tuition program, Perry can just point at this as an example of Romney flip-flopping on yet another issue. It’s not a fatal issue for Romney by any means, but it complicates things for him and it provides Perry with some much-needed cover on a hot button issue.  If Perry is going to stage a comeback, this could be the kind of thing that helps him do it.

FILED UNDER: Borders and Immigration, Campaign 2012, Environment, Healthcare Policy, US Politics, , , , , , , , , , ,
Doug Mataconis
About Doug Mataconis
Doug Mataconis held a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May 2010 and contributed a staggering 16,483 posts before his retirement in January 2020. He passed far too young in July 2021.


  1. jan says:

    Under Federal Law, anyone who walks into an emergency room must be treated regardless of their insurance status. This causes many people without insurance, and especially people in the country illegally, to use Emergency Rooms as clinics, which in turn raises the cost of care for everyone.

    The use of ER’s, to circumvent being fiscally liable for one’s medical treatment, even for minor maladies such as colds, is the very reason so many ER’s have closed in CA.

  2. ponce says:

    Wonder if Perry will torpedo any chance Romney had of beating Obama before the primaries are over?

  3. Rob in CT says:


    If we had a single-payer health insurance system, poor people’s primary care for colds would not be an issue for the ER.

    As for illegal immigrants, we can either:

    a) refuse to treat them, which requires that the ER folks be sure about whether or not a person is a citizen before treating, which is functionally impossible as a matter of policy (because people show up in the ER unconcious, for one thing); or

    b) eat the cost, and bicker over how to pay for it.

  4. Hey Norm says:

    Both Romney’s and Perry’s so called “immigration problems” are reasonable solutions to problems. Unfortunately the Teapublicans are anything but reasonable. This is just one more instance of Romney having to pander to the extremists, which will make his pivot to the general election more difficult.

    Interesting that Jan laments the closing of ER’s because people were uninsured, but feels the ACA forcing personal responsibility is socialism on the march.
    A conundrum wrapped in an enigma.

  5. Hey Norm says:

    Interesting thought.
    What is a real possibility is the White House damaging Romney enough During the primary races for Perry to win. Which of course would leave Obama running against an un-electable Rick Perry… or Herman Cain even.

  6. de stijl says:

    It’s telling that the very bottom rung of basic human decency has somehow become anathema to a subset of our fellow citizens – that the demise of a hypothetical uninsured person is something to be cheered.

    Maybe it has always been so and I’ve just been too naive to see it, but it is sad and chilling.

  7. PD Shaw says:

    It seems to me that Texas subsidizing college education is entirely a policy choice, even if Perry is correct its heartless to disagree with the choice. OTOH Massachusetts appears to be stuck by the implications of federal law.

    I was in an emergency room in the Missouri Ozarks recently*; the front desk repeatedly refused to take insurance or personal information until my son was released. There was nobody waiting in the E.R.; I just wanted to move things along and fill out the paperwork, but nope. I could have probably walked out or faked a name at that point, but that’s the inherent risk of providing services first.

    * Yes, I think federal law should require access to emergency care for all-comers.

  8. PJ says:

    Romneycare also covers abortions.
    Now, I don’t have a problem with that.
    People whose votes Romney is going to need might though.

  9. steve says:

    @jan- That is a bit too simple an explanation. The total number of ER beds in CA has remained stable. The large majority of avoidable visits is for the under 1 y/o group. Good analysis at link.


  10. Wayne says:

    In the end the political buzz phrase taken from it will be“Perry gave illegals instate tuition” and “Romney gave illegals free medical insurance”.

  11. Ron Beasley says:

    @ponce: I think the nasty primary contest between Obama and Clinton in 2008 could have cost Obama the election except that after 8 years of Bush there was no way a republican was going to win. If it gets real nasty between Romney and Perry or whoever it could certainly hurt his chances.

  12. Wayne says:

    The number of beds is not the same as the number of facilities. The number of visits per population have decline. The study said also said the following.

    “One study found that more than 40 percent of patients seeking emergency department care in California waited longer than a recommended threshold of one hour”
    “In addition, studies of public hospitals in Los Angeles and San Francisco have found that about 10 percent of patients left without receiving treatment after waiting on average more than six hours for care”

  13. jan says:


    You’re correct that most of the avoidable visits are by infants. However, I recall reading numerous articles denoting the closure of ER’s, which was putting a strain on other ER’s in the area to service emergency calls.

    One of our local hospitals built a new ER a few years ago. They developed a triage system of accommodating patients in the waiting room, by separating them into different sections denoting most immediate needs from those with more minor problems. This method allowed them to treat life and death situations ahead of ones who could medically afford to wait longer, which seem to speed the room up and cause less omissions of medically treating those who had the greatest malady.

    There is also this article in the LAT which discussed California’s dwindling ERs.

  14. michael reynolds says:

    You really are a ninny.

    Every ER has a triage system. Every single ER. What do you think, they let accident victims bleed out while they treat ear infections?

    If you propose that we let a two year-old illegal immigrant die for lack of medical care, why don’t you just say that?

    If not, then you’re down here in the socialist muck with the rest of us trying to make the best of a bad situation.

    Yes or no?

  15. jan says:

    @michael reynolds:

    What do you think, they let accident victims bleed out while they treat ear infections?

    And, you don’t think that has ever happened in the muddle of overcrowded ER’s?

    If you propose that we let a two year-old illegal immigrant die for lack of medical care, why don’t you just say that?

    Where was that even inferred? You’re just getting light-headed being on that soap box of your’s.

    If not, then you’re down here in the socialist muck with the rest of us trying to make the best of a bad situation.

    Yes or no?

    I don’t see an either/or in medical care. There are fairer, better ways, though, to go about implementing health care which generally would incorporate private, affordable insurance for the majority, a separate insurance pool for people with financial/medical risk factors, and then a safety net option for all others.

    IMO, a more creative way, sans the pulleys of government orchestrating it, can be worked out which would cover the basics of health care — hopefully, including provisions rewarding those who employ self-help ways of maintaining health through lifestyle changes of diet, exercise, non-smoking etc. (much like State Farm does in their good-driver programs), low cost screening for early detection of problems, and coverage for less expensive ways to address medical problems such as homeopathy, acupuncture, and other medicinal eastern remedies.

  16. michael reynolds says:

    You know what? Forget I said anything. There’s really no point engaging you.

  17. EddieInCA (currently in GA) says:

    @michael reynolds:

    Re: jan

    “Welcome to the party, Pal.”

  18. ponce says:

    IMO, a more creative way, sans the pulleys of government orchestrating it, can be worked out which would cover the basics of health care…

    If that were possible, wouldn’t it already have been done?

    Or are the American poor looking for decent medical care like the Palestinians, whose 45 years of waiting for their own country isn’t quite enough time?

    And really, left to people like Jan, no amount of waiting is ever enough.

  19. grumpy realist says:

    After living in Japan and the U.K., and dealing with the US medical system–I’m firmly in the camp for a National Health Service. Everyone is going to have to deal with a doctor at some point during his or her life; let’s make it as efficient as possible.

    Actually, what I’d prefer is a dual-track system, where private medical services would work in parallel with a NHS. If you didn’t like how the NHS was treating you, you could go to a private doctor. Competition, right?

    Anyone who wants to keep illegal immigrants from hospitals: right. Just wait until we get a few more cases of people with antibiotic-resistant TB running around coughing on everyone. Have you ever heard of the term EPIDEMIC?