Will Health Care Concerns Stymie Immigration Progress?

If there’s one issue that’s receiving as much attention as health reform these days, it’s immigration.  Like “Obamacare,” the issue is divisive.  And wouldn’t you know it–aliens’ access to health care is one of the issues preventing Congress from moving forward with a reform bill.

The House has yet to propose a bill, but the Senate is currently debating Senate Bill 744, the Border Security, Economic Opportunity, and Immigration Modernization Act.  The bill creates a pathway to citizenship for certain undocumented aliens by conferring upon them registered provisional immigrant (RPI) status.  Generally, RPIs would be permitted to convert to lawful permanent resident (LPR) status after 10 years.  During that 10-year period, they would be ineligible for means-tested public benefits, as defined in section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) (P.L. 104-193), including Medicaid and the Temporary Assistance to Needy Families (TANF) program.  In fact, the bill would require the HHS Secretary to periodically audit the programs to ensure that RPIs are not fraudulently receiving such benefits.  While RPIs will be permitted to purchase private insurance through the new marketplaces, they would be ineligible for the cost-sharing reductions described in section 1402 of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148).  They would also not be subject to PPACA’s individual mandate requiring all adults to be insured.  After becoming LPRs, aliens would become eligible for cost-sharing subsidies.  After three years, and in some instances, five years, of LPR status, permanent residents would become eligible for participation in means-tested public benefit programs.

Senators Marco Rubio (R-FL) and Orrin Hatch (R-UT) have proposed additional amendments, including one that would deny cost-sharing subsidies for purchasing health insurance through the marketplace to RPIs who convert to LPR status until they have held that status for five years.  Those LPRs who gained that status through more traditional routes, however, would continue to become eligible for the subsidies upon obtaining LPR status.  Senators Rubio and Hatch have also proposed an amendment that would prevent undocumented aliens who later obtain legal status from receiving credit for Social Security and Medicare taxes paid into those trust funds from receiving credit for those taxes that would allow them to qualify for benefits.  The amendment would require the Social Security Administration (SSA) to prove that the any alien, with or without a history of undocumented status, worked legally.

Naturally, immigrant advocates oppose limitations on access to health care.  The Center on Budget and Policy Priorities responded to proposed amendments with a report emphasizing the lengthiness of the legalization process and the tough restrictions that the bill already proposes.  The report referred to the proposal to prevent legal aliens from receiving credit for taxes paid while in undocumented status “unworkable,” noting that the neither the Social Security Administration (SSA) nor the Department of Homeland Security (DHS) has the records or the resources to make accurate determinations “for tens of millions of quarters.”  It argued that the proposed denial of cost-sharing subsidies to RPIs who convert to LPR status for an additional five years would create a two-tiered health care system where some LPRs would lack access to health coverage while other would not.  The Migration Policy Institute noted in a report that 71 percent of undocumented adult aliens and 47 percent of undocumented children are uninsured; 94 percent of that group have incomes below 400 percent of the federal poverty level, which is the cutoff for cost-sharing subsidies.  Thus, it is unlikely that the vast majority of undocumented aliens will purchase health insurance.  This is not the only report to suggest that aliens, whether undocumented or not, tend to seek health care less frequently than citizens.

Clarissa Martinez-De-Castro, director of civic engagement and immigration at the National Council of La Raza argues that allowing potential RPIs, who are “disproportionately young,” would actually benefit the marketplace by allowing the young and healthy to contribute money to pay for insurance coverage for those who are not.  However, she noted that pushing for such a measure could stop immigration reform from happening.  Representative Luis Gutierrez (D-IL), who disagrees with the measures, noted “Even when we are not discussing immigrants, Republicans and Democrats do not see eye to eye on who should have access to health care and under what circumstances.”  Perhaps the biggest stumbling block, as one columnist noted, is that the questions of whether aliens should receive public money for health care or benefit from work performed in undocumented status, “isn’t a technical one.  It’s a moral and ethical one on which those concerned primarily with the welfare of poor immigrants and those concerned primarily with ensuring that legal processes are fair and don’t reward certain behavior, are bound to disagree.”

The debate is currently ongoing.  And you can be sure that lawmakers on both sides of the aisle will make their voices heard.