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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
(213) 674-2829