On a conference call with reporters, US Health and Human Services Secretary Kathleen Sebelius reiterated the President’s support for a controversial measure in the Senate health care bill that would ban undocumented immigrants from purchasing insurance coverage on the exchanges with their own money.

Sebelius was asked if she thought undocumented workers should be allowed on the exchange, and she replied, “The President has made it clear that he feels undocumented immigrants should be able to purchase health insurance in the private market, not on the exchange.”

The language in question in the Senate bill is on page 160:

(3) ACCESS LIMITED TO LAWFUL RESIDENTS. — If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.

It’s unlikely that there will be a separate private market for individual plans after the exchange gets implemented. With the subsidies only available for the exchanges, and the millions of people eligible for them likely to take advantage of that, only a small sliver of the country would be in that private market, making it supremely cost-ineffective for insurers to keep serving it.

Back in September the White House admitted that the non-exchange private market would “shrink” because of the exchanges, though they maintained it would still exist. That would only be true if the exchanges were not working properly to lower costs and increase choice. Sebelius and the White House appears to be hoping for some kind of black market insurance to sprout up to serve the undocumented.

This continued insistence on banning immigrants from purchasing health insurance with their own money will be a flashpoint in the House if it is included in the final bill. House members in the Tri-Caucus, representing African-Americans, Hispanics and Asian/Pacific Islanders, have consistently opposed this approach and backed the House leadership down from including it in their bill. The Tri-Caucus cited public health concerns from creating a two-tiered system where the undocumented become the uninsured, as well as the fiscal irresponsibility of making emergency rooms the primary caregivers to that community. We will unquestionably hear about threats to vote against the entire bill if the harsh immigrant restrictions are included.

Sebelius convened the conference call to tout a series of state-by-state reports that look at the consequences for health care if the Senate bill passed, contrasted with what would happen if the status quo remained.

…I should note that Open Congress has created an online HTML version of the Senate health care bill, where you can create permalinks to and even comment on any section. It’s a great resource.