Quote-of-the-day mailing list
-------- Original Message --------
Subject: qotd: Young immigrants excluded from ACA benefits
Date: Wed, 20 Feb 2013 14:35:50 -0800
From: Don McCanne <email@example.com>
To: Quote-of-the-Day <firstname.lastname@example.org>
San Francisco Chronicle
February 19, 2013
Young immigrants shut out of health reform
By Drew Joseph
California's young immigrants who have been granted reprieves to stay in
the country stand to gain little from the federal health reform law that
the state Legislature is working to implement.
The Affordable Care Act excludes illegal immigrants from accessing the
law's benefits, but some immigrant and health advocates are angry that
the young people known as Dreamers have been left out, saying the policy
contradicts the law's intent of expanding coverage to more people.
"It really defeats what the goals of the ACA were to begin with," said
Sonal Ambegaokar, health policy attorney at the National Immigration Law
The Deferred Action for Childhood Arrivals program (DACA), which was
announced in June, allows people who were brought into the United States
when they were young to stay for two years if they pursue education or
military service. The young people eligible for the program are known as
Dreamers, in reference to the proposed Dream Act - legislation that
would give them a path to citizenship.
More than a quarter of the 1.76 million people who are or will be
eligible to apply for DACA - about 460,000 immigrants - live in
California, according to an August 2012 Migration Policy Institute report.
After the DACA program was announced, the Obama administration clarified
the policy, specifying that people to whom DACA applies will not qualify
for Medicaid now or as the health law is implemented. And while many
Americans will receive subsidies to buy insurance through their state's
exchanges - the insurance marketplaces established by the Affordable
Care Act - people granted DACA approval will not be able to purchase
coverage through those exchanges even with their own money.
Critics say the rule does not make sense. They argue that people
approved for the program are lawfully present in the country, but when
it comes to health care, they are treated as undocumented immigrants and
will face a harder time finding coverage.
National Immigration Law Center
Health Care for DACA Grantees
What health insurance options are available to DACA grantees under ACA?
Until recently, like other individuals granted deferred action, DACA
grantees would have had access to all the new health insurance options
under ACA as "lawfully present" individuals. Due to a rule change by the
Obama administration in August 2012, DACA grantees were specifically
excluded from the ACA as well as nonemergency Medicaid and CHIP, and
have the same access to health insurance as do undocumented individuals
despite being granted deferred action by the U.S. Department of Homeland
Security. As a result of the rule change, DACA grantees who have valid
work permits and valid Social Security numbers (SSNs) and who are
* Cannot enroll today in affordable coverage through Medicaid or CHIP
unless their state provides coverage to a broader group of lawfully
* Do not have access today to prenatal care through Medicaid or CHIP
unless their state provides coverage for pregnant women regardless of
the woman's immigration status.
* Cannot apply today for private health insurance under Pre-Existing
Condition Insurance Plan (PCIP) unless their state has a similar health
insurance program that is available regardless of status.
* Will not be able to buy affordable private health insurance, even at
full cost, in the new insurance marketplaces created by ACA after 2014.
* Will not be eligible for federal tax credits (or subsidies) to help
make private health insurance affordable after 2014, even if they are
paying federal taxes.
* Will not be eligible for the Basic Health Plan if their state has this
* Likely will not be required to have health insurance after 2014.
What health care options do DACA grantees and undocumented individuals
* Emergency-room care.
* Community health centers and free clinics.
* Public and safety-net hospitals.
* Public health services (immunizations, treatment of communicable
diseases such as tuberculosis, HIV, or sexually transmitted diseases).
* Emergency treatment under the emergency Medicaid program, including
labor and delivery for pregnancy.
* Hospital and community health centers' financial assistance programs
(also known as "charity care").
* Private health insurance.
Comment: Young immigrant children who were brought to this country and
remained here without proper documentation have been raised here and are
as much a part of our culture as are legal citizens. The Dream Act has
been proposed to grant these individuals legal status to match the
reality that this is their country.
Because of the failure of Congress to pass the Dream Act, President
Obama has established the Deferred Action for Childhood Arrivals program
(DACA). This is not a replacement of the Dream Act, but it is aimed at
the same demographic, and it does provide temporary, potentially
renewable legal status.
It seems that these individuals under DACA should have the same access
to health care as other documented immigrants. However, it was decided
that they would specifically be excluded from the provisions of the
Affordable Care Act. They are not totally excluded from all health care
since they have the same access as undocumented immigrants - those
services and facilities listed above.
Although some might say that these services are adequate for this
population, most of us want not want these limitations placed on our
health care (with the exception of being able to purchase insurance
outside of the exchanges and without subsidies - a problem for this
Immigration policy and health policy are two different topics. They
should be dealt with separately. Right now, Congress is engaged in a
process to reform immigration, and hopefully our lawmakers will
demonstrate wisdom and benevolence in their decisions.
Health care is another matter. Everyone should have whatever health care
is necessary. Period. Our laws and regulations and their implementation
should have a goal of making certain that people get the care that they
need. The Obama administration's interpretation of their own DACA
program falls short.
Under an optimally designed single payer program, whoever you are, if
you need care, you get care. That's the way it should be.