VOICES: Health care reform offers a mixed bag for immigrants

By Sonal Ambegaokar, New America Media

This week, President Obama signed into law legislation that will bring a sea change to the American health care system. This legislation, known as the Patient Protection and Affordability Act, will stop insurance companies from harmful practices, make health insurance more affordable for low- and middle-income families and small businesses, and will begin to control the skyrocketing costs of the U.S. health care system.

The new health care reform bill should draw both cheers and jeers from immigrants across the country. Despite the bill's investment and focus on preventative health care and wellness, funding to increase diversity in the health work force, and national recognition of health disparities and cultural and linguistic competence, the status quo in obtaining affordable health insurance will only change for some immigrants. Others will continue to be left out.

Health Insurance for Citizens and Legal Immigrants

Naturalized citizens and "lawfully present" immigrants will have the same access to affordable health insurance as U.S.-born citizens in the new insurance exchanges. They will be required to get health insurance and pay a tax penalty for not having health insurance. They can apply for tax credits to make health insurance more affordable and apply for an exemption from the requirement if health insurance remains unaffordable.

Medicaid for Low-Income Legal Immigrants

However, under the new law, many of the lowest income lawfully present immigrants will remain ineligible or be required to wait years to enroll in the most affordable health insurance, Medicaid. While they can buy health insurance and apply for tax credits in the insurance exchange, this option may still be unaffordable for low-income immigrant families who will be forced to choose between paying for health insurance and basic necessities as they do today. Without the option of Medicaid coverage, many of these immigrants may remain uninsured and be forced to delay their care when they fall ill.

Undocumented Immigrants

Undocumented immigrants, including undocumented children, are not provided any options for affordable health insurance by this health care bill. Under existing rules, undocumented immigrants are not eligible for federal health care programs. Although many undocumented immigrants pay taxes and would like to pay their fair share for health insurance, they are not allowed to get tax relief to help make insurance more affordable. Fortunately, citizen and legal immigrant children of undocumented parents will be able to apply for tax credits on their own in order to have affordable health insurance. But these complicated rules may ultimately leave children of undocumented parents uninsured.

The worst part of this bill is the restriction that prevents undocumented immigrants from buying health insurance with their own money. Because they are not allowed to buy insurance, undocumented immigrants are explicitly exempted from the insurance requirement. Unfortunately, this will not prevent undocumented immigrants from falling ill and needing health care. Thus the health care reform bill continues to allow millions in our society to remain uninsured and forced to forgo or delay care, the very thing health care reform is trying to remedy.

Excluding undocumented immigrants is not only short-sighted but will create administrative nightmares for everyone else. Unlike today, anyone who wants to buy health insurance under the new health care bill will have to provide proof of citizenship or immigration status. This is the only way to enforce the restriction against undocumented immigrants. Thousands of U.S.-born citizens were recently unable to get the care they needed at the time they needed it due to similar and costly red tape in Medicaid because they did not have proof of their birth or a passport to prove they were citizens. Rather than simplifying how we buy health insurance, the new bill adds paperwork, bureaucracy, and delay at taxpayers' expense.

Leaders in Washington have had the courage to make fundamental changes to the long-broken health care system. Let us hope they can go one step further to ensure that everyone living in the United States has access to quality, affordable health care.

Sonal Ambegaokar is a health policy attorney with the National Immigration Law Center.