Rafael Román Martel

Obama has said, proudly and often, “I am going to give health insurance to 47 million Americans who are now without coverage.” But are they “Americans?”

That 47 million statistic includes illegal immigrants, who virtually all lack insurance. In fact, about one in four of those lacking insurance is here illegally. And they are, by far, the group most in need of health insurance.

About 15 million of the remaining uninsured are eligible for Medicaid but haven’t signed up, mainly because they haven’t gotten sick. When they do, they enroll in Medicaid and we pick up the full tab for their health care relatively cheaply. (About 80 percent of each Medicaid dollar goes to nursing-home care for the elderly, only about 20 percent for the medical needs of the poor.)

The rest of the uninsured pool? Virtually all the children are eligible for the State Children’s Health Insurance Program. Some aren’t enrolled because the parents haven’t bothered, but most are eligible. That leaves about 20 million uninsured adults who are US citizens or legal immigrants. There are far better ways to handle their needs than to turn our entire health-care system upside down.