Getting healthy young people to buy health insurance is key to making President Obama’s health care overhaul work, but his administration is excluding roughly one million illegal immigrant youth allowed to remain in the country from the law’s mandates and benefits.
Officials quietly ruled last week that a new group of young immigrants to whom Mr. Obama has granted temporarily legal status may not partake of the law’s major benefits, nor are they subject to the mandate to buy insurance.
The move appeases Republicans — who have long claimed that the 2010 law will allow those in the country illegally to claim health benefits.
And it clears up some ambiguity about whether the law would apply to the new category of immigrants, created in June when the president halted deportations of most illegal immigrant students and young adults, many of whom were brought to the U.S. as young children and don’t remember the countries where they were born.
But it also means that many of these young people won’t buy insurance at all, while their legal counterparts will be required to sign up for health coverage, helping to shoulder the burden of health care costs for those who are older and sicker.
“Here you have a population of non-elderly, young, working, high-achieving adults who can enter a health care system and could have had the possibility of being required to purchase insurance and now we’ve removed them from the pool,” said Jennifer Ng'andu, a health policy director for the National Council of La Raza.
The question of whether illegal immigrants would benefit from the health care law has been a sticky one from the outset, with Republicans insisting that it would enable them to enroll in new benefits they hadn’t helped pay for, despite the president’s promises to the contrary.
South Carolina Rep. Joe Wilson, a Republican, famously yelled “you lie” when Mr. Obama said the legislation would not apply to undocumented immigrants while addressing Congress seven months before the Affordable Care Act was passed.
But analysts say he’s largely kept that promise.
The law doesn’t change current restrictions barring undocumented immigrants from signing up for Medicaid, the federal insurance program for the poor, and the Children’s Health Insurance Program (CHIP). And immigrant adults lawfully in the U.S. must still wait five years before signing up for Medicaid.
And under the newest guidelines, those who may temporarily remain in the U.S. under the administration’s new deportation policy won’t be allowed to enroll in health exchange plans, access coverage subsidies or sign up for the pre-existing condition insurance pool.
But some critics still say the law failed to lay out clear guidelines for how to verify that someone may legally enroll in the insurance exchanges, potentially opening the door to fraud. Iowa Rep. Steve King, a Republican, has claimed that 5.6 million illegal immigrants will gain coverage under the law.
Medicaid already uses a highly-regarded verification program known as the SAVE system. But the law doesn’t mandate SAVE for enrollment in the exchanges, instead allowing the Department of Health and Human Services (HHS) to spell out verification rules. So far, the agency has remained vague on the matter.
“HHS is given flexibility … to modify the verification process, so it kind of tilts the system to say you don’t have to use the more rigorous proven system and whatever you come up with you can still go back and revisit that and make it more tilted in favor of less rigorous verification,” said Jim Edwards, a fellow with the Center for Immigration Studies.
But Ms. Ng'andu called the charge “pure hogwash.” While she applauds the health care law for proving legal immigrants with more access to coverage, she said the law lays out plenty of benchmarks to block those illegally here from signing up for any new benefits.
“It’s a sad and misleading attempt to generate opposition to the law,” she said. “Undocumented immigrants have access to no more than they were before the Affordable Care Act passed, and some would say that will actually have less access in 2014 than they do today.”