Posted on 07/19/2015 12:16:48 PM PDT by nickcarraway
Uniting the two highly combustible issues of Obamacare and immigration could reignite a fierce health-care reform controversy. By 5:11 AM EDT
California lawmakers and activists are spearheading a first-in-the-nation plan to let undocumented immigrants buy Obamacare health insurance. Supporters say the California proposal, which would need federal approval and couldn’t start until 2017, is the next logical step in expanding health insurance to a population that was intentionally excluded from the president’s health-care law. But uniting the two highly combustible issues of Obamacare and immigration could reignite a fierce health-care reform controversy. Story Continued Below
There’s no guarantee the California plan still winding through the state’s legislature will succeed, even with Democrats in control of the statehouse, the governor’s mansion and the White House. California Gov. Jerry Brown isn’t commenting on the legislation, which has been approved by the state Senate but not by the Assembly. But just last month, Brown agreed to spend millions in state dollars to provide health care to undocumented children, mirroring similar efforts in a handful of other liberal states.
For the Obama administration, the California effort could mark the return of a sore point in the early days of the Obamacare debate. Republicans never trusted Democrats’ repeated assurances while the law was being drafted that the Affordable Care Act wouldn’t cover undocumented immigrants. That built up to Rep. Joe Wilson’s infamous “You lie!” moment, when the South Carolina Republican interrupted President Barack Obama’s 2009 health care address to Congress.
National anti-immigration forces are taking note of the bill in California, home to the country’s largest population of undocumented immigrants. To Dan Stein, president of the Federation for American Immigration Reform, which was a leading voice against the comprehensive immigration reform bill that stalled in Washington two years ago, the California proposal signals a weakening in enforcement of immigration laws.
“A bill like this is a camel’s nose. If you see a camel’s nose under the tent, it’s not too long before the whole camel will be in the tent,” he said. “Or the tent will be on the ground.”
The bill’s sponsor, state Sen. Ricardo Lara, acknowledges the political risk. But he remains optimistic that the Obama administration, if given the chance to review California’s proposal, would see it as an opportunity to move immigration reform forward before its second term wraps up. Supporters are hoping submit the plan for federal review in 2016, to avoid the uncertainty that would come with a new president the following year. “We are trying to come up with sensible, progressive policies that help to integrate every Californian,” Lara said. “It just makes common sense.” The 2010 health care law bans undocumented immigrants from enrolling in Medicaid. And not only are they barred from getting subsidies to buy private insurance on the health insurance exchanges, they can’t buy the Obamacare plans with just their money. That prohibition especially riles immigrant advocates, who say there’s no reason to ban people from purchasing exchange plans if they can afford it on their own. “Not allowing certain types of immigrants to pay into the exchange of the ACA is coming back to haunt us fiscally,” California Senate President pro Tempore Kevin de León said, referring to the Affordable Care Act.
The issue is already making its way into 2016 presidential politics. Democratic presidential hopeful Martin O’Malley, a former Maryland governor, this week proposed an immigration reform plan that would provide health care, including Obamacare subsidies, to some undocumented immigrants.
Yet the effort in California, home to roughly 2.5 million undocumented immigrants, could turn out to be largely symbolic. Undocumented immigrants can already buy private health plans not sold through the Obamacare exchanges, and those who have already struggled to afford insurance probably wouldn’t find it easier to buy exchange plans since they wouldn’t be allowed to receive federal subsidies. On average, those subsidies reduce the monthly premium by nearly 75 percent.
“Would simply saying there’s not a legal barrier to you buying it make people want to do it?” said Nancy Berlinger, a Hastings Center scholar who has studied undocumented immigrants’ access to health care.
Cost would still be a struggle, supporters of the effort acknowledge. But they still see a clear benefit. Mixed-status families with a combination of legal residents and undocumented immigrants may have been reluctant to buy health insurance because of misguided fears about deportation. Opening the state’s exchange to everyone could assuage those worries and boost insurance sign-ups.
“It’s important symbolically to be more welcoming of families to enter the health system,” said Anthony Wright, executive director of Health Access California. The California bill wouldn’t immediately open the state’s exchange to undocumented immigrants, who are primarily Latino. Instead, it would direct California to seek permission from the federal Department of Health and Human Services through an Obamacare waiver program that allows states to shape their own health care reforms.
However, the administration hasn’t spelled out the guidelines for the “state innovation waivers” program, which doesn’t start until 2017, and it’s unclear whether the White House would rethink its Obamacare coverage ban for undocumented immigrants. An HHS spokesperson said the department hasn’t discussed the California proposal with state officials and declined to comment on the bill.
Under full Obamacare implementation, 31 million people will still be uninsured a decade from now, according to projections from the nonpartisan Congressional Budget Office. Nearly a third of them would be immigrants who aren’t allowed to get coverage.
But even for those Latinos who can get coverage, their experience under the health care law has been mixed. The Latino uninsured rate dropped from 42 percent to just under 30 percent since the ACA’s coverage expansion took effect nearly two years ago, according to HHS statistics. But that’s still much higher than the 9 percent uninsured rate for whites and 13 percent rate for African-Americans.
Advocates had hoped even more Latinos, who skew younger and healthier than the general population, would have enrolled by now, but they say missteps in the ACA rollout have hurt the signup effort. They say language barriers and ongoing tech glitches have also prevented larger coverage gains.
Whether allowing Obamacare coverage for undocumented immigrants would boost enrollment depends on the outreach effort from California’s insurance marketplace and advocates, said Laurel Lucia, a health care policy expert at the University of California Berkeley Center for Labor Research and Education. An estimated 320,000 undocumented immigrants are expected to purchase individual health plans in four years, according to Lucia’s projections. How many of them would get coverage through the exchange is unclear, she said.
Some states, including California, are putting up their own funds to insure more undocumented immigrants, but not through Obamacare programs. The bill Brown signed last month will provide Medicaid coverage to roughly 170,000 undocumented children at an estimated cost of $132 million per year.
California’s Medicaid program, like New York’s, also uses state money to cover so-called “DREAMers” — the young undocumented immigrants who were protected from deportation under the White House’s 2012 deferred action program. Massachusetts, Illinois, and Washington also already use state money to cover undocumented children, while the District of Columbia funds coverage for undocumented children and adults.
Supporters argue that providing access to comprehensive health care is better for the individuals and the entire health care system. Without it, people will wait to get care until there’s a medical crisis, raising costs for everyone.
“In the absence of federal action on comprehensive immigration reform, states and immigrant communities in the states are just tired of waiting,” said Gabrielle Lessard, a health policy attorney at the National Immigration Law Center. “It just makes more sense for them as individuals, for the community as a whole, and for the health care system.”
Let me guess....”buy” would mean “be given for free”.
IIRC you're a Howie Carr listener.If you are you know that *his* response to your question would be "got a mirror?"
Howie usually nails it-—but in my case it’s my five hardworking kids who’ll pay the price—— I’m retired.
Two of them voted for the idiot.
I just shake my head.
.
Exactly
Agree that illegality is no bar to what is being done. The Rule of Law no longer exists.
YOU LIE !!!
When Congressman Wilson said, "you lie," and all the liberal trolls freaked out, we all knew that he was correct. It's finally being admitted.
They should be required to have health insurance just like the rest of us in America. Just no subsidy.
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