Late News: Coverage conundrum

As lawmakers wrestle over federal immigration reform, some are stuck on how to address healthcare coverage for some 11 million immigrants living illegally in the U.S.

Congress made progress on the issue May 21 when the Senate Judiciary Committee passed the Border Security, Economic Opportunity and Immigration Modernization Act.

In addition to strengthening border security, the bill provides a registered provisional immigration status. Individuals without legal permission would be allowed to live in the country legally for six years while they pursue citizenship, with the possibility of extending for another six.

But the bill does not address how they would receive healthcare services—a sticking point that has slowed the efforts of a bipartisan group of eight House members to agree on immigration legislation of their own.

Under the Senate bill, people given the new legal status could buy coverage in the insurance marketplaces created by the Patient Protection and Affordable Care Act, according to the National Immigration Law Center. They still would not—as stipulated for noncitizens in the Affordable Care Act—get subsidies for the coverage. That raises questions about how they would get insurance until they're citizens and who will pay for it. Some House Republicans, according to media reports, want immigrants to risk deportation if they fail to buy insurance.

The issue is a major concern for hospitals, especially as they prepare for an influx of patients next year from the state Medicaid expansions and the insurance exchanges.

“They're not going to provide Medicaid expansion and subsidies out of the box,” said Tom Nickels, senior vice president of federal relations at the American Hospital Association. “However, there is an acknowledgement in both the House and Senate that our members are still providing services to this population as mandated by federal law, EMTALA.”

The AHA is working to convince leaders that any immigration legislation should include a fund to help hospitals care for the immigrants on the path to citizenship. Nickels said it would be similar to the $1 billion included in 2003's Medicare Prescription Drug, Improvement and Modernization Act to help hospitals pay for the emergency services provided to immigrants.

A congressional aide familiar with the negotiations among the bipartisan group in the House said Democrats want to be sure that people who work in the U.S. don't have barriers to accessing affordable healthcare. Other House members are working on immigration bills, and House Speaker John Boehner (R-Ohio) signaled last week that the lower chamber “simply won't take up” the bill emerging in the Senate, but rather will produce its own legislation.

Senate Majority Leader Harry Reid (D-Nev.) has said he expects to bring the Senate bill to the floor for debate in June.

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