NPR Story
7:03 am
Sat April 6, 2013

Will Unauthorized Immigrants Get Federal Health Benefits After Reform?

Originally published on Tue April 9, 2013 6:27 am

PHOENIX — About 48 million Americans lack medical insurance. That’s poised to change next year when federal tax credits for insurance and expanded access to Medicaid become available to certain Americans under the Affordable Care Act.

But there’s a huge group left out -- the 11 million immigrants in the country illegally are currently barred from both programs.

One of those who is ineligible is 19-year-old Maria Diaz. She was born in Mexico and grew up in Arizona without papers. Her young life so far hasn’t involved many encounters with doctors.

“We didn’t have like extra money to just throw out if I broke something,” Diaz said. “So as a child I actually took precautions of trying not to hurt myself or get sick or break bones.”

Due to the Obama administration’s deferred action program for young immigrants, Diaz recently got a work permit and is now working.

But her new minimum wage job babysitting at a gym doesn’t come with benefits.

“At this point in my life I still don’t have health insurance or someone to go to if I don’t feel good,” Diaz said. “I would have to take a second thought about actually going anywhere because of how much it would cost.”

Unauthorized immigrants — including young immigrants who were brought as children and qualified for deferred action like Diaz — will be barred from buying insurance under the new health care exchanges that the Affordable Care Act will create next year.

Those immigrants are also barred from Medicaid. That program currently only accepts U.S. citizens, legal permanent resident who have had that status for more than five years, refugees and very specific categories of humanitarian immigration cases.

But could that change with immigration reform?

Florida Senator Marco Rubio, one of the so-called “Gang of Eight” senators drafting immigration reform legislation, told Rush Limbaugh earlier this year that federal health benefits could jeopardize a deal.

“If Obamacare is available to 11 million people, it blows a hole in our budget and makes this bill undoable,” Rubio said. “That's one of the major issues we're going to have to confront. “

Adding these immigrants under the Affordable Care Act would cost billions, and would mean expanding a program that many Republicans already want to repeal.

Forthcoming immigration reform proposals are expected to grant those here illegally some kind of provisional legal status which will require they wait several years, likely 10 to 15, for various federal health benefits. That path could be shorter for young immigrants like Diaz who were brought here illegally as children.

But there are also huge costs to leaving these immigrants uninsured for several years.

“Since all of us now are required to pay for insurance under the Affordable Care Act, it is better for us to have immigrants in the pool,” said Sonal Ambegaokar of the National Immigration Law Center.

“Because if there are more people in the pool, especially those who are younger and healthier, which immigrants generally are, then our individual premium costs will go down.”

Ambegaokar said insuring these immigrants would help reduce expensive emergency room visits, which shifts the cost to the state and local level.

It’s worth mentioning that not every immigrant in the country illegally and awaiting immigration reform is uninsured. An estimated 40 percent actually have health insurance -- most of them through their jobs, according to the Migration Policy Institute.

The rest though, in the absence of federal benefits, will likely rely on safety net health providers.

One such place is the Wesley Community and Health Center in South Central Phoenix that serves low income patients.

“Our insured patients total 12 percent of our patient population, so that means 88 percent of our patients are uninsured,” said Betty Mathis, who runs the center.

These kinds of clinics all over the country are bracing for increased demand next year as more low-income people qualify for Medicaid and start using medical services

But they will also be one of the only options for the uninsured.

Randy Capps with the Migration Policy Institute says these safety net providers might be overwhelmed, especially in states with a high immigrant population.

“The currently unauthorized population — and that is the population that would legalize under immigration reform — is heavily concentrated in the Southwest,” Capps said. “So those states are most at risk for pressure on their safety net health care systems.”

Arizona, Nevada, California and Texas have the highest share of uninsured, poor adults who won't get Medicaid because of immigration status, according to estimates by the Robert Wood Johnson Foundation.

Adding to the strain, hospitals, the ultimate safety net, will be receiving fewer federal dollars to treat uninsured patients.

But there is a potential fix, according to Capps.

“The last legalization law, way back in 1986, provided state grants to help cover health care costs for legalizing immigrants,” Capps said. “These kinds of grants are being discussed again in immigration reform.”

Maria Diaz, the uninsured 19-year-old, questioned the long-term savings of leaving people out of the Affordable Care Act who are on a path to remaining in the country permanently.

“Maybe once they are documented, their health conditions have increased to the extent that once they are a citizen or a resident, you have to pay even more for those problems,” Diaz said.

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