No Obamacare or Safety Net While on Senate’s Path to Citizenship

There’s lots of fanfare about the path to citizenship in the Senate’s immigration reform bill, but the bill leaves serious questions about how newly legalized people will survive once on that path. This is perhaps nowhere more concerning than in the context of the full exclusion of newly legalized immigrations from Obamacare health insurance exchanges and other federal benefits.
Under the bill, immigrants on the 10-year path to citizenship—what’s called the Provisional Registered Immigrant status, or RPI—would be excluded from all means-tested federal benefits. Let’s just make clear what this means. Millions of people who work overwhelmingly in low-income jobs and who owe several thousand dollars in fines and in some cases need cash for mandatory English classes (in addition to paying the regular taxes that all workers pay) will be barred completely from programs meant to keep families afloat. That’s Medicaid, the State Children’s Health Insurance Program, food stamps, cash assistance, Social Security Insurance and Obamacare’s insurance exchange.
It’s not just that these folks are left out. It’s that they’re left out even though they will have paid for years into the programs through payroll taxes.
And there’s more than just the 10-year wait to gain access to safety net benefits. Currently, undocumented immigrants are excluded from all of these programs. And for the most part, green card holders are left out until they’ve been here for 5 years. This means that those granted the new RPI status will be treated like undocumented immigrants for 10 years and then, because of the five-year bar for people with green cards, they’ll have to wait until they become a citizen in three years, or without citizenship, 15 whole years.
Thirteen to 15 years is a long time without safety net support for immigrants who are about 27 percent more likely to be poor than non-immigrants. For those who are currently undocumented, those poverty disparities are larger.
In the context of Obamacare, the vast majority of people in provisional status won’t be able to afford the full cost of private healthcare without the tax credits that most Americans receive. But unlike citizens who can’t afford private insurance on the healthcare exchanges, these immigrants are ineligible for Medicaid.
“Aspiring citizens on the roadmap to citizenship are paying taxes, working, learning English, and contributing to our economy and communities,” Kimberly Inez McGuire, of the National Latina Institute for Reproductive Health, wrote in an email. “Unfortunately, it will be 15 years before many will have access to affordable health care. It’s unfair. And for a woman with undiagnosed breast or cervical cancer, 15 years may be the difference between life and death.”
In sum, the bill seems not to know how to treat immigrants with provisional status. On the one hand, it says these folks will be “considered lawfully present in the United States for all purposes.” But at the same time, it carves out exclusions from federal programs: they are “not eligible for any federal means-tested public benefit.”
So the bill says they have legal status, but of a lesser kind. I suppose that’s what “provisional” means.
A note on the technicalities in Obamacare
Newly legalized immigrants granted access to the 10-year path to a green card will be excluded from the subsidies and tax-credit supports built into the Affordable Care Act. But several healthcare advocates and experts I talked to pointed out that the language of the bill leaves some ambiguity that, if interpreted in a certain way could make this situation worse.
They say that as the bill is written, it’s possible that people with RPI status, even as they’re excluded from health insurance exchange tax credits, may be pegged with the individual mandate penalties that Americans who refuse to buy healthcare are forced to pay. That is, immigrants won’t get any help paying for unaffordable care, but could be fined for not buying into the system anyway.
The language is indeed confusing. The sections of the ACA and the tax code that the immigration bill cites do not appear to deal with exclusion from the Obamacare health insurance mandate. But a Senate staffer who worked on the bill did tell me clearly that the senators’ intent in writing the legislation was to exclude RPI status immigrants from healthcare altogether—mandate and all. I imagine we could see that section go through a technical fix for clarity in the weeks to come.

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