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Immigration Overhaul Proposal Doesn't Appear to Include Health Care

By Dena Bunis, CQ HealthBeat Managing Editor

January 28, 2013 -- The estimated 11 million illegal immigrants living in the United States probably would still not qualify for federal health care benefits under an immigration policy overhaul recently proposed by a group of senators.

The bipartisan proposal would allow those here illegally to earn their way to legal status and citizenship. In the meantime, those who pass a background check and pay a fine and any back taxes would be given a probationary status that would allow them to live and work legally in the United States. Those with that status would go to the back of the line for permanent legal status, commonly known as a green card. Based on the current number of green cards available, that wait could easily be more than a decade.

However, one of the bullet points in the proposal says: "Current restrictions preventing non-immigrants from accessing federal public benefits will also apply to lawful probationary immigrants." That means that anyone under the probationary status would not be eligible for Medicare, Medicaid, or the Children's Health Insurance Program.

Immigration experts said that provision also suggests that those in the in-between status also would not be eligible for any benefits from the 2010 health care law, including federal subsidies to buy insurance on the health exchanges. They also would not be able to buy insurance on the exchanges, even without subsidies.

"It's going to be a tricky issue, and it has touched a nerve before," said Angela Kelley, vice president for immigration policy and advocacy at the Center for American Progress, which has pushed for a comprehensive immigration policy overhaul for many years. "I don't think that anybody has reached a conclusion or there has been a deal cut on how it will be treated," she said.

Because the proposal doesn't specifically exclude health law participation, there may be room for negotiation, said Jenny Rejeske, a health policy analyst at the National Immigration Law Center's Washington, D.C., office.

"We think there's an opening there, and we're hoping to find a way to work with Congress to make sure that immigrants have access to affordable health care," she said.

But Kelley pointed to the terms of President Barack Obama's executive action on immigration last June for guidance. When Obama announced that hundreds of thousands of illegal immigrants who were brought to the United States as children would be allowed to stay here without fear of deportation, Health and Human Services Secretary Kathleen Sebelius made it clear that the president's action did not mean that these young people could access federal health benefits, including those available under the health care law (PL 111-148, PL 111-152).

"Considering what's happened in the past, we are disappointed," Rejeske said. She said immigration advocates hope to be able to convince Congress that "costs will go down for everybody if immigrants are able to pay into the system. It's common sense."

Under the health care overhaul, only U.S. citizens and legal permanent residents can buy insurance from the exchanges, which are scheduled to begin covering individuals and small businesses in 2014. Also under the health care law, illegal immigrants are not subject to the insurance mandate. They still can be treated in hospital emergency rooms.

"It's an issue that will have some dollar signs beside it and always raises red flags for people," said Kelley, who referred to the comment Republican Rep. Joe Wilson South Carolina made during Obama's joint address to Congress in 2009. Wilson shouted "You lie!" when Obama said illegal immigrants would not benefit from the health care law.

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