Illegal: Health Care and Undoc­u­mented Immi­grants Essays

Submitted By mystical72113
Words: 1582
Pages: 7

The PPACA does not pro­vide undoc­u­mented immi­grants with eli­gi­bil­ity for pub­lic insur­ance pro­grams. Because undoc­u­mented immi­grants are not regarded as “qual­i­fied indi­vid­u­als” under the law, it also does not allow undoc­u­mented immi­grants to pur­chase health insur­ance through the new state health exchanges even if they are able to do so with their own money.21 Sec­tion 1312 of the Act states, “If an indi­vid­ual is not, or is not rea­son­ably expected to be for the entire period for which enroll­ment is sought, a cit­i­zen or national of the United States or an alien law­fully present in the United States, the indi­vid­ual shall not be treated as a qual­i­fied indi­vid­ual and may not be cov­ered under a qual­i­fied health plan in the indi­vid­ual mar­ket that is offered through an Exchange.”22

Despite these restric­tions, the law does include addi­tional fund­ing for the health care safety-net, includ­ing an $11 bil­lion increase for FQHCs and the law’s expan­sion of the Med­ic­aid pro­gram may pro­vide addi­tional rev­enue to many FQHCs and other safety-net providers. Yet, the PPACA also calls for an $18 bil­lion dol­lar reduc­tion in Med­ic­aid DSH pay­ments and a $22 bil­lion reduc­tion in Medicare DSH pay­ments through 2020. The DSH cuts are based on the assump­tion that hos­pi­tals will not need to pro­vide as much char­ity care once the health reform is imple­mented. Because undoc­u­mented immi­grants will not receive pub­lic or pri­vate insur­ance cov­er­age under health reform, they are likely to rep­re­sent a larger per­cent­age of the nation’s unin­sured pop­u­la­tion. This raises impor­tant ques­tion about future polit­i­cal sup­port for the health care safety-net.23

Access to health care for undoc­u­mented immi­grants in the U.S. is shaped by sev­eral poli­cies and pro­grams at the fed­eral state and local level. With the excep­tion of emer­gency med­ical care, undoc­u­mented immi­grants are not eli­gi­ble for fed­er­ally funded pub­lic health insur­ance pro­grams, includ­ing Medicare, Med­ic­aid and the Child Health Insur­ance Pro­gram (CHIP).1Medicare is a social insur­ance pro­gram that pro­vides health insur­ance to peo­ple age 65 and over, as well as peo­ple with per­ma­nent dis­abil­i­ties and end-stage renal dis­ease. Med­ic­aid is a means-tested social wel­fare pro­gram that pro­vides health insur­ance to cer­tain cat­e­gories of poor peo­ple. CHIP, cre­ated in 1997, is a block grant pro­gram to expand cov­er­age to chil­dren in fam­i­lies with incomes that exceed Med­ic­aid eli­gi­bil­ity.2 There is no orga­nized, national pro­gram to pro­vide health care for undoc­u­mented chil­dren. U.S.-born chil­dren in mixed-status fam­i­lies may be eli­gi­ble for Med­ic­aid or CHIP if they qual­ify on the basis of income and age. Although fed­eral funds may not be used to pro­vide non-emergency health care to undoc­u­mented immi­grants, some states and local gov­ern­ments use their own funds to offer cov­er­age to undoc­u­mented chil­dren.3 For exam­ple, the Healthy Kids pro­gram in San Fran­cisco cov­ers unin­sured chil­dren under the age of 19, includ­ing undoc­u­mented chil­dren.4 Sim­i­larly, the All Kids pro­gram Illi­nois cov­ers all chil­dren under the age of 19 who meet pro­gram income require­ments, regard­less of immi­gra­tion sta­tus.5 PRUCOL (Per­ma­nent Res­i­dence Under Color of Law) is a pub­lic ben­e­fits eli­gi­bil­ity cat­e­gory that refers to indi­vid­u­als who are in the U.S. with the knowl­edge of immi­gra­tion ser­vices and are not likely to be deported.Before the adop­tion of the Per­sonal Respon­si­bil­ity and Work Oppor­tu­nity Rec­on­cil­i­a­tion Act of 1996,6 peo­ple with PRUCOL sta­tus were eli­gi­ble for Med­ic­aid, but PRWORA elim­i­nated their eli­gi­bil­ity with the excep­tion of emer­gency ser­vices. In New York, the State Court of Appeals (Aliessa et al. v. Nov­ello) con­cluded that deny­ing access to Med­ic­aid vio­lated the equal pro­tec­tion clauses of…