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 a...
A Historic Moment
• Immigration Reform being debated in
Congress, including a pathway to citizenship for up to 11
million ...
Immigrants and the ACA
Lawfully Present Immigrants
• Medicaid/CHIP
– “Qualified” immigrants
– 5-year bar
• Marketplace/Exc...
Health Coverage of Immigrants
• More likely to be uninsured:
– 47% of non-citizens are uninsured, compared to 16% of U.S.
...
Immigration Reform Bills
Senate
• Bipartisan “Gang of 8” Senators introduced “Border
Security, Economic Opportunity, and I...
Immigration Reform Bills
House
• Bipartisan “Task Force of 7”* still working on bill
(includes Reps. Becerra and Lofgren)
...
Key Provisions in S. 744
• Road to Citizenship
• 4 New Statuses:
1) Registered Provisional Immigrant (RPI)
2) Blue card
3)...
Registered Provisional
Immigrant Status (RPI)
ELIGIBILITY:
1. Be physically in the U.S. on or before December 31, 2011
2. ...
The S. 744 Road Map to Citizenship
RPI
application
• Year 1
• $500 fine
+ fees
RPI
renewal
• Year 6
• $500 fine
+ fees
Gre...
Rights with RPI Status
• Authorized to work while in RPI status (will be issued
SSN and RPI card)
• Considered admitted an...
DREAM Timeline
• May apply for RPI status
• At the end of 5 years in RPI status:
– DREAMers can apply for LPR status
– AND...
Access to Health Care
After Immigration Reform
RPIs/Blue Card/V Visas
• Medicaid/CHIP
– Not eligible during status
– 5-yea...
National Immigration Law Center: www.nilc.org
National Council of La Raza: www.nclr.org
National Health Law Program: www.h...
Alvaro M. Huerta
Skadden Fellow & Staff Attorney
National Immigration Law Center
huerta@nilc.org
(213) 674-2829
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  • * DACA exclusion from ACA and Medicaid/CHIP
  • 1 Key Facts about Medicaid and the Uninsured. Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation Permanente (March, 2013), available at http://kff.org/disparities-plicy/fact-sheet/key-facts-on-health-coverage-for-low/. 2 The Uninsured-A Primer. Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation Permanente (Oct. 2012), 6, available at http://kff.org/uninsured/issue-brief/the-uninsured-a-primer/.
  • Nilc immigration reform and health care - drc webinar presentation 073013 (1)

    1. 1. Immigration Reform & Health Care Access Alvaro M. Huerta, Esq. National Immigration Law Center July 30, 2013
    2. 2. 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.
    3. 3. 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.
    4. 4. 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
    5. 5. 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.
    6. 6. 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
    7. 7. 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
    8. 8. Key Provisions in S. 744 • Road to Citizenship • 4 New Statuses: 1) Registered Provisional Immigrant (RPI) 2) Blue card 3) Family V visas 4) 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”
    9. 9. Registered Provisional Immigrant 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
    10. 10. 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
    11. 11. 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
    12. 12. 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)
    13. 13. Access to Health Care After 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
    14. 14. 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
    15. 15. Alvaro M. Huerta Skadden Fellow & Staff Attorney National Immigration Law Center huerta@nilc.org (213) 674-2829
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