Will the Immigration Executive Action Affect the Affordable Care Act?

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My concern when I heard that the President had gone ahead with his executive action on immigration was how would it affect healthcare and the Affordable Care Act/ACA? It was interesting to see that immigration advocates rallied behind Mr. Obama’s actions, describing them as a much-delayed victory for millions of people.

Administration officials have said the president’s actions were designed to be “legally unassailable,” which activists said led the White House to make some tough choices. Michael D. Shear and Robert Pear in their latest article in The New York Times. Nov.19, 2014, discussed the various aspects of the affect of the President’s latest executive action.

“Farm workers, for example, will not be singled out for protections because of concerns that it was difficult to justify legally treating them differently from undocumented workers in other jobs, like hotel clerks, day laborers and construction workers.

However, the White House decision to deny health benefits underscores how far the president’s expected actions will fall short of providing the kind of full membership in American society that activists have spent decades fighting for. The immigrants covered by Mr. Obama’s actions are also unlikely to receive public benefits like food stamps, Medicaid coverage or other need-based federal programs offered to citizens and some legal residents. Remember, undocumented immigrants aren’t eligible to buy health coverage through the Marketplace. They’re not eligible for premium tax credits or other savings on Marketplace plans.

The immigrants are those people who are going to avoid treatment if they can’t afford it and then potentially require much more expensive treatment down the line using the emergency rooms and waiting until they need more extensive treatment instead of preventative healthcare utilizing primary care physicians, physician assistants and nurse practitioners in an office or clinic. Why would he and the administration exclude them?”

What is interesting is that even the present lawful immigrants haven’t been able to get coverage and wouldn’t for years even if the bipartisan bill that passed the Senate last year with Democratic and Republican support were to suddenly wend its way through the new Republican Congress.

An analysis by the Kaiser Family Foundation linked here said even under current law “some lawfully present immigrants who are authorized to work in the United States cannot enroll in Medicaid, even if they have been in the country for five or more years.”

An act of Congress would still be required before the undocumented immigrants impacted by the President’s order would be granted broad coverage under existing Medicaid programs for the poor as well as the Children’s Health Insurance Program, known as “CHIP,” coverage.

The health care restriction may be the most immediate concern for many immigrants and for activists who have urged Mr. Obama to act to prevent deportations. Advocates for immigrant rights were infuriated in 2012 when the White House ruled that Dreamers would not get subsidized insurance coverage.

But the restriction reflects the political sensitivities involved when two of the most contentious issues in Washington, health care and immigration, collide. It also suggests that the White House has decided not to risk angering conservative lawmakers who have long opposed providing government health care to illegal immigrants and who fought to deny immigrants coverage under the Affordable Care Act.

Some advocates said this week that they saw a paradox in the president’s policy. On one hand, they said, Mr. Obama plans to provide relief to millions of undocumented immigrants so that they can come out of the shadows and be better integrated into American society. On the other hand, they said, the administration is shutting them out of the health care system that would help them become productive members of society.

“We would all benefit if more people had access to health care services,” said Angel Padilla, a health policy analyst at the National Immigration Law Center, an advocacy group for low-income immigrants.

Stephen W. Yale-Loehr, who teaches immigration law at Cornell, said he believed the president had the legal authority to decide whether the immigrants included in his executive actions qualified for health benefits.

“Just as the president has broad discretion to decide whether to allow undocumented individuals to get a temporary reprieve from deportation,” Mr. Yale-Loehr said, “he also has broad authority to decide whether to grant them work authorization and health benefits.”

“In this case, it appears he is willing to grant the former,” he added, “but not the latter.”

Senator Jeff Sessions, the Alabama Republican who has vehemently opposed giving benefits to undocumented immigrants, disagreed with that assessment.

“It is plain that President Obama has no authority to grant lawful status to those declared unlawful by the duly passed laws of the United States,” he said. “Nor does the president have any authority to declare such individuals eligible to receive health benefits that have been restricted to lawful residents.”

The White House decision on health benefits may be intended to undercut one line of attack by Mr. Sessions and other Republicans. In recent days, as it became clear that Mr. Obama was preparing to announce an executive order, conservative commentators and radio hosts suggested that the president wanted to give health coverage to millions of immigrants who would be given legal status.

The question of whether illegal immigrants should have access to health care benefits has long been a central part of the immigration debate. Legislation passed in the Senate in 2013 would also have denied undocumented immigrants access to federal health benefits, including the Affordable Care Act, for as long as 13 years. But in that legislation, immigrants could eventually qualify for full legal status and for federal benefits.

Sylvia Mathews Burwell, the secretary of health and human services, was asked about health care coverage in a webcast with Latina bloggers last week.

She confirmed to the bloggers that immigrants who were covered by Mr. Obama’s 2012 executive actions could not receive subsidies from the HealthCare.gov marketplace. She called that decision “more than a health care issue” and said it had to be resolved in the context of immigration laws.

“I think everyone probably knows that this administration feels incredibly strongly about the fact that we need to fix that,” Ms. Burwell said. “We need to reform the system and make the changes that we need. It will lead to benefits in everything from health care to economics.”

However, she said that federal aid, including health care benefits, could be available to children who are United States citizens but living with parents who are illegal immigrants. Such so-called mixed families “should not be scared,” she said, because they may be eligible for coverage and financial assistance.                                            The House and the Senate needs to develop a bill to provide a path to citizenship to people who are prepared to pay back taxes, get right with the law, learn English as in the Senate bill. I believe that with the GOP having the majority in both the House and the Senate that there is a good chance that we can create an effective immigration bill as long as we also consider strengthening the border, that is if they are not paralyzed by their own political motives.

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