Monthly Archives: October 2012

The Affordable Care Act and Deferred Action for Childhood Arrivals: Immigrant Exclusion in Health Reform

by Lindsey Hennawi, Program Assistant

It’s tough to be hard on President Obama just one month away from the presidential election.

After all, the Patient Protection and Affordable Care Act, an unprecedented piece of health care legislation, has been lauded by health justice advocates across the country for its promise to provide uninsured and underinsured Americans with options for health coverage which were previously unavailable to them. And the recently implemented federal policy known as Deferred Action for Childhood Arrivals (DACA) allows would-be DREAMers—undocumented youth who were brought to the US as children and who would be granted a path to citizenship under the as of yet un-passed Development, Relief, and Education for Alien Minors Act—to apply for work authorization and live without fear of being deported.

While these measures are historic, they also both fall short. The strength of the DACA program as a means to advance the rights and status of undocumented immigrants was undermined by a barely publicized announcement from the White House. According to the new rule, DACA individuals will be excluded from health coverage under the Affordable Care Act. In the past, people granted deferred action status were considered “lawfully present” undocumented immigrants and were thus eligible to participate in federal benefits programs. This new policy, however, explicitly exempts those who qualify for DACA relief from participating in these programs.

While some states have systems in place whereby lawfully present undocumented immigrants are still eligible for public health insurance from state pools of funding, this option is not universally available. Without the federal guarantee that lawfully present undocumented immigrants can benefit from the new Exchanges and Medicaid, these individuals will have to rely on whatever standards their state imposes, which can vary widely and may disproportionately impact certain immigrant communities. Some states have already started to deny benefits to DACA beneficiaries. Notorious anti-immigrant Arizona Governor Jan Brewer, for example, has illegally ordered state agencies to deny drivers’ licenses and other state benefits to DACA grantees. Apparently inspired, governors in Mississippi, Nebraska, and Texas have made similar declarations.

As a result of this federal exclusion, hundreds of thousands of undocumented youth who no longer have to worry about being deported still have to worry about how to access health care—an issue President Obama himself has described as central to the very success and character of our democracy.

There are a lot of good, practical reasons why DACA individuals should not be denied benefits under health care reform. The Affordable Care Act, with its pledge to insure the 30 million undocumented American citizens, completely excluded undocumented immigrants. The ACA will gradually reduce federal funding  allocated to compensate hospitals for the care they provide to uninsured and underinsured  patients, and the loss of this funding may threaten these hospitals’ ability to treat undocumented immigrants. The Exchanges, which will serve as a conduit through which people can purchase health insurance under the Affordable Care Act, could benefit from the addition of young, healthy people (such as many DACA individuals) paying into the pool in order to spread risk. And without regular access to affordable primary and preventive care, we will see an increase in negative health outcomes and costs that may ultimately burden the system.

Without inclusive, federal protections for health care access, undocumented immigrants will always be subject to denials of access to care, and the president’s landmark health care reform will fall short of achieving its lofty and sorely needed goal. If President Obama really wants to work toward improving immigrant rights and health—or even just to preserve the American democracy in which he believes—he needs to reconsider and reverse his latest decision. It’s just the right thing to do.

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