This update comes to us courtesy of our friends at the New York Immigration Coalition.
Congressional leaders and President Obama are back after taking a break for the holidays and passage on Christmas Eve of the Senate’s health reform bill, H.R. 3590, the “Patient Protection and Affordable Care Act.” Now that both the House and the Senate have passed their respective bills, they must come together to negotiate a final bill. Congressional leaders have decided to bypass the Conference Committee process for a more abbreviated negotiation process among Democratic leadership and committee chairs, including Senate Majority Leader Harry Reid; House Speaker Nancy Pelosi; House Majority Leader Steny Hoyer; Senate Majority Whip Dick Durbin; House Committee Chairs George Miller, Charles Rangel, and Henry Waxman; Senate Committee Chairs Max Baucus and Tom Harkin; as well as NY Senator Charles Schumer, Vice Chair of the Democratic Conference.
This negotiation process is the last chance to make the improvements that are of vital importance to immigrant workers and families.
By and large, the House bill better exemplifies the general goals of health reform – making health insurance more affordable for millions of people (including immigrants who are naturalized citizens and lawful residents), helping to contain the skyrocketing costs of the health care system in the United States, and including many provisions to reduce health disparities and improve health outcomes. However, there are still grave inequities for immigrant community members, both lawfully residing and undocumented, that must be addressed in this final negotiation process. While naturalized citizens and many lawfully residing immigrants would gain access to more affordable health insurance, the five-year waiting period in federal Medicaid for lawfully residing immigrants remains and undocumented immigrants are excluded from reforms. Most appalling is a provision in the Senate bill, which will be used as the basis for negotiations, which prohibits undocumented immigrants from buying full-price insurance with their own money in the new Exchange insurance marketplace. Below is a discussion of the major provisions in the bills and the impact on immigrants.
Undocumented Immigrants & the Exchange. The Senate bill contains a dangerous provision prohibiting undocumented immigrants from buying health insurance with their own money at full price in the Exchange, while the House bill does not. The exclusion must not make it into the final bill. This provision is completely counterproductive to the goals of health reform. Health reform should allow opportunities for more people to pay into the health care system, not less. It is costlier to the health care system and to tax payers to exclude people – without insurance people avoid care until it becomes more serious, and more costly. Also, verifying the citizenship or immigration status of each person who wants to pay their own money in the Exchange would be very costly to do and to an inhuman end – to keep people who just want to keep themselves and their families healthy from buying insurance with their own money. It is unfathomable to think that a provision of health reform would actually cause some people to lose the coverage they currently have. Finally, creating an immigration status requirement for the purchase of private goods sets a dangerous and unacceptable precedent.
Undocumented Immigrants, Medicaid & Subsidies. Undocumented immigrants are already restricted from most public health insurance programs, including Medicaid and Family Health Plus in New York, and neither bill changes that policy. Also, neither bill allows undocumented immigrants to be eligible for the affordability/tax credits or subsidies that would make insurance more affordable.
Lawfully Residing Immigrants & Medicaid. Tragically, neither bill restores federal Medicaid eligibility for lawful permanent residents within their first five years. This means that the most recent, lowest income legal residents will still not have access to a critical safety net benefit that their own tax money supports. Yet these same people will be required to buy insurance. Importantly, as a result of a lawsuit in 2001, New York extends Medicaid and Family Health Plus coverage to all lawfully residing immigrants who meet the income guidelines regardless of how long they have been lawful residents, and must continue to do so with state-only money.
The NYIC acknowledges New York Senators Schumer and Gillibrand for cosponsoring an amendment filed by Senator Menendez giving states the option to restore Medicaid to lawfully residing immigrants within their first five years. Although the amendment did not come to a vote before the Senate bill was passed, Senate Majority Leader Reid made a commitment to the Democratic caucus that this provision would be included in the Senate Conference Report. We must hold him and Congress to that commitment.
Lawfully Residing Immigrants & Subsidies. Hundreds of thousands of lawfully residing immigrants in New York who currently make too much money for Medicaid or Family Health Plus, do not receive insurance through an employer, and cannot afford to buy insurance on their own are eligible in both bills for the affordability/tax credits that will make insurance more affordable.
The Politics of Reform. The Obama administration will be especially influential in this final bill negotiation process. The President must hear from you that the exclusion of undocumented immigrants in the Exchange is unacceptable and that the five-year waiting period in Medicaid for legal immigrants must be removed. Allowing undocumented immigrants to use their own money to buy unsubsidized insurance in the Exchange is consistent with the goal of achieving just and humane immigration reform this year, and not a bargaining point.
As we look to the Senate/House negotiations, we have these priorities:
1) Everyone, regardless of immigration status, should be able to buy insurance with their own money in the Exchange. Adopt the House policy.
2) Lawfully residing immigrants must be treated fairly.
a. Include Senate amendment 2991 enabling states to restore Medicaid to legal immigrants in their first five years.
b. For legal immigrants who live in states that retain the five-year waiting period, make sure that subsidies for those lowest income legal immigrants are fair.
c. Allow all lawful residents, including non-immigrant visa holders to be eligible for subsidies.
3) Adopt House provisions for verification of citizenship and immigration status, which are more established, streamlined, and protective of individual rights.
4) Protect the safety net health care system so that the millions of people who remain uninsured after reform passes still have access to health care.
Contact: Jenny Rejeske, Health Advocacy Coordinator, 212-627-2227 x223, firstname.lastname@example.org.