ACA Replacement Bill Not a Good Deal for Immigrants
By Matthew Lopas, NILC health policy attorney
MARCH 16, 2017
The headlines regarding the American Health Care Act, the House Republicans’ Obamacare replacement bill, have rightly focused on the 24 million people the Congressional Budget Office expects will lose health care coverage if the bill is enacted. But if you dig into the bill, you find that it proposes policies that could harm many communities, including immigrants.
Republicans released the bill, which is split into two parts, from its hiding place and jammed it through the committees of jurisdiction within days, before the CBO could score it and without much time for the public to review it.
Others have already digested what is in the bill and added to the CBO’s findings on how it will affect the number of people covered and its affordability, so there’s no need to rehash all of that here. But in short: This is a very poorly conceived plan that does nothing to solve problems in the health care system (including and especially health care’s high cost). It would make coverage inaccessible and unaffordable for millions of people. It would add harmful restrictions on women’s health care options and choice. And it provides for a $600 billion tax cut to wealthy people.
In terms of how it would affect immigrants, the bill contains provisions that would harm their ability to see a doctor when they are sick and to get the care they need to live healthy and productive lives. Many immigrants would not be able to access a key benefit the bill provides for: a new flat, refundable tax credit that replaces the income-based Obamacare subsidies that were designed to make private health insurance more affordable. Taken together, these provisions would erase the progress created by Obamacare.
The Obamacare subsidies are available to immigrants who are “lawfully present,” a category that excludes people who are undocumented or have Deferred Action for Childhood Arrivals (DACA), but otherwise provides an option for people who hold, or who may be applying for, some sort of lawful status. The Republican bill would limit availability of the tax credits to citizens, nationals, or “qualified immigrants,” the standard used in Medicaid, which includes a narrower group of green card–holders, refugees, asylees, and people with some other form of “humanitarian relief.” It excludes many domestic violence survivors, holders of temporary protected status (TPS), and people with work visas, among others.
The bill would also further restrict immigrants’ access to the Medicaid. The process by which immigrants and naturalized citizens verify their eligibility for Medicaid can often take days, weeks or, in extreme cases, months due mostly to imperfect government databases. Recognizing this, Medicaid requires states to provide services to people while their status is being verified. This bill seeks to prevent states from providing services until verification is complete, meaning a person’s ability to see a doctor will depend on the speed of a government agency’s work.
In addition to these policies targeting immigrants, there are many ways that the bill would have a detrimental—sometimes disproportionately detrimental—impact on immigrants. According to the CBO, the “reforms” to Medicaid would effectively cut $880 million from the program (a 25 percent decrease). The 14 million people who’d lose coverage would include many immigrants, and the ripple effect created by nearly doubling the uninsured population would strain safety-net services upon which many uninsured immigrants rely.
The bill would cut other important programs, compounding the problem for low-income, uninsured immigrants. The Prevention and Public Health Fund provides the kinds of programs, like vaccination, that provide access to support the entire community. Planned Parenthood provides services, including reproductive health care, for immigrant women who might not have other options.
This bill has a long way to go before becoming law, and early signs are that across the political spectrum (including in the Republican caucus) and the health care field, it does not have much support.
It most certainly goes the wrong way for immigrants—furthering a system of exclusion instead of one in which a person’s ability to see a doctor is not limited by where they were born, the color of their skin, or how much money they make. If President Trump really does want “insurance for everybody,” then for the sake of all people, including immigrants, Congress must go in a different direction.