By Sonal Ambegaokar, New America Media
This week, President Obama signed into law legislation that will bring a
sea change to the American health care system. This legislation, known
as the Patient Protection and Affordability Act, will stop insurance
companies from harmful practices, make health insurance more affordable
for low- and middle-income families and small businesses, and will begin
to control the skyrocketing costs of the U.S. health care system.
The new health care reform bill should draw both cheers and jeers from
immigrants across the country. Despite the bill’s investment and focus
on preventative health care and wellness, funding to increase diversity
in the health work force, and national recognition of health disparities
and cultural and linguistic competence, the status quo in obtaining
affordable health insurance will only change for some immigrants. Others
will continue to be left out.
Health Insurance for Citizens and Legal Immigrants
Naturalized citizens and “lawfully present” immigrants will have the
same access to affordable health insurance as U.S.-born citizens in the
new insurance exchanges. They will be required to get health insurance
and pay a tax penalty for not having health insurance. They can apply
for tax credits to make health insurance more affordable and apply for
an exemption from the requirement if health insurance remains
unaffordable.
Medicaid for Low-Income Legal Immigrants
However, under the new law, many of the lowest income lawfully present
immigrants will remain ineligible or be required to wait years to enroll
in the most affordable health insurance, Medicaid. While they can buy
health insurance and apply for tax credits in the insurance exchange,
this option may still be unaffordable for low-income immigrant families
who will be forced to choose between paying for health insurance and
basic necessities as they do today. Without the option of Medicaid
coverage, many of these immigrants may remain uninsured and be forced to
delay their care when they fall ill.
Undocumented Immigrants
Undocumented immigrants, including undocumented children, are not
provided any options for affordable health insurance by this health care
bill. Under existing rules, undocumented immigrants are not eligible
for federal health care programs. Although many undocumented immigrants
pay taxes and would like to pay their fair share for health insurance,
they are not allowed to get tax relief to help make insurance more
affordable. Fortunately, citizen and legal immigrant children of
undocumented parents will be able to apply for tax credits on their own
in order to have affordable health insurance. But these complicated
rules may ultimately leave children of undocumented parents uninsured.
The worst part of this bill is the restriction that prevents
undocumented immigrants from buying health insurance with their own
money. Because they are not allowed to buy insurance, undocumented
immigrants are explicitly exempted from the insurance requirement.
Unfortunately, this will not prevent undocumented immigrants from
falling ill and needing health care. Thus the health care reform bill
continues to allow millions in our society to remain uninsured and
forced to forgo or delay care, the very thing health care reform is
trying to remedy.
Excluding undocumented immigrants is not only short-sighted but will
create administrative nightmares for everyone else. Unlike today, anyone
who wants to buy health insurance under the new health care bill will
have to provide proof of citizenship or immigration status. This is the
only way to enforce the restriction against undocumented immigrants.
Thousands of U.S.-born citizens were recently unable to get the care
they needed at the time they needed it due to similar and costly red
tape in Medicaid because they did not have proof of their birth or a
passport to prove they were citizens. Rather than simplifying how we buy
health insurance, the new bill adds paperwork, bureaucracy, and delay
at taxpayers’ expense.
Leaders in Washington have had the courage to make fundamental changes
to the long-broken health care system. Let us hope they can go one step
further to ensure that everyone living in the United States has access
to quality, affordable health care.
Sonal Ambegaokar is a health policy attorney with the National
Immigration Law Center.