Immigration Reform&

Health Care Access

Alvaro M. Huerta, Esq.National Immigration Law Center

July 30, 2013

National Immigration Law Center

• Our mission is to defend & advance the rights & opportunities of low-income immigrants and their family members.

• We envision a U.S. society in which all people — regardless of their race, gender, immigration or economic status — are treated equally, fairly, and humanely, have equal access to justice, education, government resources and economic opportunities, and are able to achieve their full potential as human beings.

• Founded in 1979.

• Offices in Los Angeles, Oakland, and Washington, DC.

A Historic Moment

• Immigration Reform being debated in Congress, including a pathway to citizenship for up to 11 million living in U.S.

• Health Reform (ACA) about to be implemented; debates about coverage continue in the states.

• Even with the ACA and immigration reform, barriers to health coverage will remain for many immigrants.

• Changing demographics make it imperative to address the needs of immigrant families in both systems.

Immigrants and the ACA

Lawfully Present Immigrants• Medicaid/CHIP

– “Qualified” immigrants

– 5-year bar

• Marketplace/Exchange

– “Lawfully present”*

– No 5-year bar

– Eligible for tax credits and cost-sharing reductions

– Subject to individual mandate

Undocumented

• Emergency Medicaid

• No Marketplace/Exchange access

• No ACA subsidies

• Exempt from individual mandate

• Remain eligible for FQHCs

Health Coverage of Immigrants

• More likely to be uninsured:– 47% of non-citizens are uninsured, compared to 16% of U.S.

born citizens1

– 71% of undocumented adults are uninsured. – But citizens make up the bulk of the uninsured (80%).2

• Children of Immigrants Lack Coverage:2

– 45-55% of low-income immigrant children in the U.S. are uninsured.

– 17% of low-income citizen children lack coverage. – 29% of undocumented children lack insurance

• Use Less Health Care:– Immigrants use less health care, – Per capita, immigrant use of health services costs less than half

the cost for average citizen.

Immigration Reform Bills

Senate

• Bipartisan “Gang of 8” Senators introduced “Border Security, Economic Opportunity, and Immigration Modernization Act” (S. 744) on April 16, 2013

• Senate Judiciary Committee markup of S. 744 - May 2013 (includes Senator Feinstein)

• Senate passed the amended bill on June 27, 2013, with a vote of 68-32

Immigration Reform Bills

House

• Bipartisan “Task Force of 7”* still working on bill

(includes Reps. Becerra and Lofgren)

• Unclear if there will be a “road to citizenship”

• Piecemeal approach possible

• What was the hang up? – HEALTH CARE!

– *Rep. Labrador leaves the group

Key Provisions in S. 744• Road to Citizenship

• 4 New Statuses:1) Registered Provisional Immigrant (RPI)2) Blue card3) Family V visas4) W non-immigrant visas

• Mandatory E-Verify

• Improves current paths:– Fixes family backlog

• BUT eliminates sponsoring siblings (in future)

• Eliminates diversity visas

– Increases limits of U-Visas from 10,000 to 18,000

• Future flow – “guestworkers”

Registered ProvisionalImmigrant Status (RPI)

ELIGIBILITY:

1. Be physically in the U.S. on or before December 31, 2011

2. Maintain continuous presence up until the date of application

3. Settle any unpaid taxes; AND

4. Not have certain offenses such as:• Felony• Aggravated Felony• 3 or more misdemeanors (other than minor traffic violations)• Gang activity• Certain foreign offenses• Unlawful voting• Limited waiver available for some offenses

The S. 744 Road Map to Citizenship

RPI application

• Year 1

• $500 fine + fees

RPI renewal

• Year 6

• $500 fine + fees

Green card application

• Year 10

• $1000 fine

• $1070 fees

U.S. citizen

• Year 13

• $680 fees

Total:• 13 years • $3750 +

fees

Rights with RPI Status

• Authorized to work while in RPI status (will be issued SSN and RPI card)

• Considered admitted and lawfully present while in RPI status (BUT not eligible for ACA subsidies)

• Authorized to travel outside of the U.S. for up to 180 days

DREAM Timeline

• May apply for RPI status

• At the end of 5 years in RPI status:

– DREAMers can apply for LPR status

– AND immediately apply for citizenship (time in RPI status counts toward naturalization)

Access to Health CareAfter Immigration Reform

RPIs/Blue Card/V Visas• Medicaid/CHIP

– Not eligible during status– 5-year wait after LPR

• Marketplace/Exchange– Not eligible for ACA

subsidies• Excluded even though

“lawfully present”

– Eligible after LPR (with no waiting period)

• Exempt from individual mandate

During Status• Emergency Medicaid

• Can buy full price insurance in Marketplace/Exchange

• Remain eligible for FQHCs

• Corker-Hoeven Amendment– Excludes B and F Visa holders

from ACA subsidies

– Social Security and Medicare

National Immigration Law Center: www.nilc.org

National Council of La Raza: www.nclr.org

National Health Law Program: www.healthlaw.org

Center on Budget and Policy Priorities: www.cbpp.org

California Immigrant Policy Center: www.caimmigrant.org

Resources on Immigrants and Benefits

Alvaro M. Huerta

Skadden Fellow & Staff Attorney

National Immigration Law Center

huerta@nilc.org

(213) 674-2829