Hundreds of thousands of immigrants could be locked out of the health insurance marketplaces if the Senate’s new health-care bill becomes law.
Buried among the bill’s provisions that roll back the Medicaid expansion and lower marketplace subsidies is a shift in eligibility requirements. Rather than all legal immigrants being able to receive tax credits and buy coverage in the marketplace like under the Affordable Care Act, the new bill — aside from a few, narrow exceptions — allows only permanent residents and people who immigrated for humanitarian reasons to participate.
Many of the newly excluded people on temporary visas would face a dramatic reduction in insurance options. Temporary students and workers are often in roles, such as seasonal farm work, where pay is too low to afford insurance without assistance, according to Labor Department data. Given their ineligibility for Medicaid, the marketplaces were often their only option.
Though some students would have insurance available through their schools, though, and workers — especially high-skilled ones — through their employers.
“This proposal would really attack people at the time they need it most,” said Matthew Lopas, a health policy attorney for the National Immigration Law Center, referring to excluded groups such as asylee applicants and torture victims.
Conservatives defend the exclusion, saying it prevents medical tourism — where sick people move to the U.S. temporarily to get subsidized medical care but don’t stay in the insurance pool while they’re healthy. “For people to jump in, file a claim, and jump out, it’s very destabilizing for the market,” said Ed Haislmaier, a research fellow at the conservative Heritage Foundation.
Tom Miller, a fellow at the right-leaning American Enterprise Institute, said the exclusion reflects a view common among Republicans that there should be “a difference between benefits available to citizens and noncitizens.” Lopas described the exclusion more harshly: The program is “based on anti-immigrant sentiment, an idea that some people are more worthy than others.”
More than a third of legal immigrants were eligible for tax credits in 2015, many of whom would lose them under the Senate bill. The logical conclusion: “I’d expect that the rate of insurance among immigrants would fall,” said Shelby Gonzales, a policy analyst at the Center on Budget and Policy Priorities. It’s already more common for foreign nationals to be uninsured: 23 percent of non-elderly legal immigrants are uninsured, compared to 10 percent of citizens.
The exclusion isn’t just bad for the affected immigrants, it’s bad for the insurance pool as a whole, according to Lopas. Having a pool with more people, especially more young people — which students and temporary workers tend to be — makes the insurer’s expenses more stable and brings down costs for everyone. How much costs may change, however, depends on how many people would have to leave the market, which there isn’t much data on.
It remains unclear whether the Senate GOP’s bill will pass. Republicans will need almost all of their members to support it, but several senators have already expressed concern or outright opposition.