No matter what health care bill emerges from Congress, roughly one in six uninsured Californians will be excluded because they are not legal residents.President Barack Obama still refers to the plan as “comprehensive health insurance reform,” although essentially none of its provisions are likely to be available to an estimated 12 million illegal immigrants, a group that typically receives no insurance at work and lacks the means to buy it on their own, advocates say.That means an estimated tens of thousands living in San Diego and Riverside counties will remain without insurance — whether the Senate ultimately passes a bill and no matter how generous the subsidies for the poor or punitive the penalties for those who refuse.”It will be out of the reach of many Americans. … That is not comprehensive,” said Jennifer Ng’andu, deputy director of the Health Policy Project at the National Council of La Raza.San Diego County alone may have 150,000 illegal immigrants who receive millions of dollars worth of health care —- paid for by taxpayers —- in local emergency rooms, according to various estimates.Excluding them has been a political flashpoint, with many conservatives arguing that providing more health care for people who are not legally in the country is both unaffordable and unfair.”It shouldn’t encourage future immigration or help out those who are here illegally now,” said Dustin Carnevale, a spokesman for the Federation of American Immigrant Reform, a Washington-based group that advocates restricted immigration.FAIR estimates that U.S. taxpayers already spend $11 billion a year on health care for illegal immigrants, and that the cost would rise to $30 billion if they are offered the same subsidies as citizens in the health care bill.Such concerns have prompted some Democrats with a long record of supporting immigrant rights, including President Obama, to go out of their way to point out that they are not included in the legislation.However, their exclusion may have some unintended consequences.It means that a pool consisting of millions of potential customers who are typically younger and healthier than the general population will be kept out of the insurance exchanges. If illegal immigrants were allowed to enter the exchanges and receive health insurance, it would “reduce health care costs” for other participants, Ng’andu said.Still using the ERIllegal immigrants will continue to use emergency rooms, which cannot turn away patients based on their immigration status, as their first line of medical treatment, a practice that cost California hospitals an estimated $1.2 billion last year, according to the state Department of Health Services.And it may provide an added incentive for some employers to hire illegal immigrants rather than citizens in order to avoid new requirements that they provide health insurance to their workers, making it even more difficult for Americans to find jobs.Nearly 7 million California residents lack health insurance. Of that number, more than 1 million are not legal residents, according the UCLA Center for Health Policy Research.Even the millions of illegal immigrants across the country who do buy insurance would be barred under the Senate health bill from qualifying for the most affordable rates.”Disease and illnesses do not discriminate based on immigration status,” Rep. Mike Honda, D-San Jose, and several other Democrats wrote in an open letter to congressional leaders, seeking to have such provisions eliminated. “It is not rational to exclude individuals who are willing and able to share in the responsibility of paying into the system. There are also public health implications when a large portion of the U.S. population has severely limited access to health care coverage.”Yet a misconception persists that the measures will spend billions on illegal immigrants, wielded by critics as a reason to reject the bill.It was anger over that issue that prompted Rep. Joe Wilson, R-South Carolina to howl: “You lie!” at Obama as he addressed a joint session of Congress earlier this fall.However, both bills —- the one passed by the House earlier this month and the one currently before the Senate —- explicitly exclude illegal immigrants from receiving benefits.Senate bill most exclusiveBoth bills forbid anyone without legal immigration status from receiving government subsidies, which are intended for people who are too poor to buy their own insurance. The Senate bill goes further, saying that they cannot participate in the measure’s insurance exchanges. That means that even illegal immigrants who buy their own insurance will not be able to purchase the least expensive policies.”Undocumented immigrants are going to be hit two ways —- they won’t have papers to be here and (they) will be uninsured because even if they have the money to pay, they are not allowed to,” said Steven Wallace, assistant director of the UCLA Center for Health Policy Research.That clause has prompted the greatest outcry from immigrant defenders in Congress, who point out that without insurance, the tab for immigrant care will continue to fall on taxpayers.”They’re going to go to the emergency rooms. They won’t have insurance. The costs will be shifted to the rest of us and to taxpayers. We should encourage our undocumented population to buy insurance with their own money,” said Rep. Jared Polis, D-Colo., on the House floor earlier this month.Yet with the measure’s outcome resting on the votes of a handful of Democrats from swing states and districts, any changes to the immigration clauses are likely to make the bills even more restrictive.House compels coverageIn a further burden for some immigrants, the House bill requires residents to buy insurance regardless of their immigration status. However, it does not permit for government subsidies to those who are in the U.S. illegally.That means that some immigrants deemed as residents under IRS rules —- those who have been in the U.S. for 31 days of the current year and a total of 183 in the last three years —- must buy insurance even though they will receive no help in purchasing it.Some Republicans have pushed for tighter verification procedures in the health care bill to make certain that people who do not qualify for the government subsidies do not receive them. Conservatives contend that illegal immigrants will use fake documents to get coverage and that it will provide a new lure to come to the U.S.Others reject stricter verification procedures for fear it will drive away legitimate users who do not have drivers’ licenses, passports or easy access to birth certificates. Ng’andu estimated there are as many as 13 million citizens who lack such identification.”Efforts to exclude unauthorized immigrants and efforts to tighten verification make barriers for citizens to gain insurance,” said Marc Rosenblum, a senior policy analyst of the nonpartisan Migration Policy Institute