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Affordable Health Care for America Act (H.R. 3962)

The Good, the Bad, and the Ugly for Immigrants

Tuesday, NOVEMBER 10, 2009

Late Saturday night, November 7, 2009, the House of Representatives passed the "Affordable Health Care for America Act" (H.R. 3962) by a close vote of 220-215.  This health reform legislation could be a critical step towards changing the status quo to help Americans obtain quality, affordable health care.  Yet the bill sends mixed signals to immigrants in terms of whether immigrants and their families will be fully integrated in our communities with fair access to affordable health care.

What's Good for Immigrants in HR 3962

• Like citizens, low and middle income, lawfully present immigrants are eligible for affordability credits to help make purchasing health insurance through the Exchange more affordable.  ("Non-immigrants," except for K, T, U, V visa holders, and those residing lawfully under the Compact of Free Association, are not eligible for affordability credits.)

• More employers will be required to cover their employees through an employer mandate, promising more affordable coverage to currently uninsured, immigrant workers. 

• Excessive verification schemes for the affordability credits were rejected and instead, verification of immigration and citizenship status for the subsidies will use well-established procedures currently used in Medicaid under the SAVE (Systematic Alien Verification for Entitlements) system for immigrants and the Social Security Administration (SSA) database for citizens (consistent with the citizenship documentation provisions enacted in the CHIPRA bill)

• Helpful provisions were included to address health disparities and improve health care workforce diversity, to promote a  more culturally competent and linguistically appropriate health care system.

And a critical political victory….

• Despite strong political pressure from immigrant restrictionists on both sides of the aisle, the House's health reform bill allows individuals to purchase health insurance, at full cost, through the newly created exchanges, regardless of their immigration status.

Up until the last hours of this weekend's debate, it was expected that certain Democratic and Republican members of Congress would bring up an amendment in the Republican's Motion to Recommit that would attempt to exclude undocumented immigrants from purchasing at full cost health care insurance in the Exchange.  HR 3962 already explicitly prohibited undocumented immigrants from obtaining federal health coverage and federally-funded subsidies, but for some, these restrictions were not harmful enough.

Key Democratic members threatened to vote against the overall bill if this exclusion of immigrants in the Exchange was added to HR 3962.  As a result of political pressure and strong advocacy by the immigrants' rights community, the amendment to exclude undocumented immigrants was NOT introduced.  Instead, Republicans offered an amendment regarding tort reform, which ultimately failed.

Members of the Congressional Hispanic Caucus (CHC), including Chair Rep. Nydia Velaquez (D-NY), Rep. Lincoln Diaz-Balart (R-FL), Rep. Becerra (D-CA), as well as Rep. Henry Waxman (D-CA) and all of you should be thanked and commended for standing up to divisive politics and ensuring that the Exchange remains open to anyone who wants to buy health insurance for themselves and their family in the new Exchange.  Your efforts helped ensure that health care dollars will be directed towards affordable health care rather than adding onerous and expensive administrative burdens that would deny or delay health care for citizens and legal immigrants who need it.  More should have been done to make health care affordable to everyone, but this battle sends a clear message that the politics of division and scapegoating immigrants will not prevail.

What's Bad for Immigrants in HR 3962

Under HR 3962, undocumented immigrants will be subject to the individual mandate, (the requirement to have health insurance), but do not have access to truly affordable health care coverage.  HR 3962 reaffirms existing restrictions in Medicaid and CHIP on undocumented immigrants, including vulnerable, low-income immigrant children without legal status.  In addition, undocumented immigrants, many of whom pay federal and state taxes, are prohibited from applying for affordability credits or subsidies that will help make health insurance more affordable to low and middle-income families.  Keeping undocumented immigrants uninsured will force them to ignore or postpone health care resulting in costly emergency room visits and harmful health outcomes that will impact all of us in the long-run. 

And…the Ugly for Immigrants in HR 3962

• Despite sound policy arguments and potential cost savings, HR 3962 does NOT remove the five year waiting period that prevents lawfully residing, otherwise eligible immigrants for enrolling in Medicaid and Medicare. 

While more low-income citizens earning 150% or below of the Federal Poverty Level will be enrolled in Medicaid under HR 3962, recently arrived, low-income, lawfully residing immigrants must continue to wait 5 years to be eligible for federal Medicaid.  These citizens in waiting, who will be required to obtain health insurance like everyone else, will be eligible to purchase health insurance through the Exchange with tax credits.  However, the higher out of pocket costs and limited benefits in many private insurance plans will make health care unaffordable and still inaccessible to many low-income immigrants unless the five year waiting period is eliminated. 
HR 3962 still allows states to provide state-funded coverage to lawfully residing immigrants during the five year waiting period.

• The politics of exclusion and using immigrants as a wedge issue will continue to be used during the health reform debate despite this most recent victory.  We need to continue our demands that inclusive, not exclusive policies drive health reform proposals so that we all can have affordable health care.

Next Steps:

• A big thank you to all of you and your allies who demanded immigrants be included in health care reform as part of a workable, realistic solution.

• Contact your Representative, especially those who are members of the House Tri-Caucus:

  • Thank them for preventing harmful restrictions to immigrants and  their families in this most recent vote.

  • Ask them to advocate in Conference Committee for the elimination of the five year waiting period in Medicaid for legal immigrants

• Contact your Senator and ask for their support to:

  • Eliminate the 5 year waiting period for low-income legal immigrant adults in Medicaid and Medicare;

  • Remove the Senate Finance bill's restriction prohibiting undocumented immigrants from purchasing unsubsidized health insurance (bringing the Senate bill in line with HR 3962);

  • Oppose attempts to derail health reform with divisive amendments that exclude or add barriers to immigrants and will only add costs and delay care to millions of citizens if enacted; and  

  • Ensure appropriate levels of federal funding are provided to safety net hospitals and clinics that will continue to provide affordable care for the remaining uninsured.

Thank you for all your efforts to date to promote immigrant inclusion in health care reform  We need to continue to make our voices heard!

Immigrant restrictionists on both sides are trying to make immigrants worse off as a result of health care reform.  It will take a strong show of support to include immigrants and fight off further restrictions.  Please use your power and tell your elected officials that immigrants should have the same chance to pay their fair share and obtain affordable health care like everyone else in America.

Additional Advocacy Materials

• Fact Sheet and Talking Points on Five Year Waiting Period for Legal Immigrants

• Recent Op-Eds on the 5 year waiting period: Huffington Post and New America Media Editorial

• Fact Sheet on: Harm of Excluding Undocumented Immigrants from the Exchange