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Health Care Law Subsidies Would Increase Under Senate Immigration Bill, CBO Says

By Dena Bunis, CQ HealthBeat Managing Editor

June 19, 2013 - There would be 10.4 million more legal immigrants in the United States by 2023 if the immigration overhaul bill that the Senate is debating were to become law, and that could cost the federal government $82.3 billion more in health care law subsidies over a decade, according to the Congressional Budget Office (CBO) score of the legislation.

While the pending bill (S 744) does not provide health care law subsidies to the estimated 11 million illegal immigrants who would be eligible to transition to legal status, the measure also includes a number of family unification and employment provisions that would add to the number of legal immigrants in the country. Those new legal immigrants would be eligible for a variety of federal benefits, including access to the new health care law exchanges and the subsidies that the overhaul (PL 111-148, PL 111-152) provides to help people afford their insurance premiums.

Overall, the CBO says, direct costs from the health care law and such programs as Medicaid, the Children's Health Insurance Program (CHIP), food stamps and Medicare would cost $259 billion from 2014 to 2023.

However, the analysis also says that even with those and other costs of implementing the immigration legislation, because of increased payroll and income taxes that these new legal immigrants would pay, enactment of the measure would save the federal government $175 billion from 2014 to 2033.

When it comes to the 11 million illegal immigrants who could transition to legal status, the Senate bill makes clear that such provisional-status immigrants could not get health care law benefits. Lawmakers, including Democrats who have long fought to provide health coverage to all immigrants, have shied away from a debate on health care and the immigration overhaul, citing the emotional politics involved in putting the two issues together.

But, the CBO analysis said, for such means-tested programs as Medicaid and CHIP, the Senate bill is "unclear" as to exactly who would be eligible for such programs and when.

For such programs, the CBO analysis says that if the Senate bill were enacted, "executive branch agencies would probably face pressure from states and other stakeholders to provide people who are lawfully present in the United States with the federal benefits that are available to qualified aliens, including assistance provided through Medicaid, CHIP, SNAP (food stamps), student loans and Pell grants."
Because of that, the CBO analysis assumes that some people who attain provisional status, a blue card or a new V-visa would not be excluded from some federal benefits.

"Specifically, CBO incorporates the costs of providing SNAP benefits for individuals under age 18 and providing Medicaid and CHIP coverage under the CHIPRA option to children and pregnant women,'' the analysis said.

Under the 2009 reauthorization of CHIP, states could waive the five-year waiting period before newly legalized immigrants could be eligible for Medicaid and CHIP. So far, 22 states have taken advantage of that provision.

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