President Barack Obama's executive order temporarily lifting the threat of deportation for up to 5 million undocumented immigrants is not expected to change their eligibility for public healthcare benefits under the federal reform law.
Still, experts say the order may indirectly lead to a significant number of immigrants, particularly children, enrolling in Medicaid as well as private health plans. That's because it will remove the threat of deportation for parents of children who are legal residents or citizens and who already are eligible for public programs. Parents of children with legal immigration status account for the vast majority—roughly 4 million individuals—of those impacted by the president's action.
“Undocumented parents fear coming forward to get their citizen children enrolled in coverage,” said Angel Padilla, a health policy analyst at the National Immigration Law Center. “They have been afraid to do this.”
Also, the order will enable currently undocumented adults to work legally and qualify for employer-provided health benefits.
Administration officials confirmed that people affected by the president's executive order still will be barred from buying coverage through the insurance exchanges and won't be eligible for Medicaid. That decision disappointed many healthcare experts and advocates for immigrants, but it wasn't unexpected. The Obama administration followed the same policy for the Deferred Action for Childhood Arrivals program, which has allowed nearly 600,000 law-abiding immigrants who came to the country as children to avoid the threat of deportation since it was issued in 2012.
“It's unfortunate that these folks are not going to have access to affordable healthcare,” Padilla said. “It's a missed opportunity.”
A study released this month by researchers at Georgetown University and the National Council of La Raza underscores the potential for enrolling Hispanic children. It found that 11.5% of Hispanic children were uninsured in 2013, compared with 7.1% of all kids. But immigration status is not the issue for the overwhelming majority of Hispanic children, 93% of whom are U.S. citizens. The study found that two-thirds of uninsured Hispanic kids were eligible for coverage through either Medicaid or the Children's Health Insurance Program.
“The problem is not so much that we don't have eligibility for the kids,” said Sonya Schwartz, a research fellow at Georgetown's Health Policy Institute and a co-author of the report. “It's more just getting them in the door.”
Schwartz said many groups that will be helping parents apply to adjust their immigration status under Obama's executive order are also working on healthcare enrollment outreach efforts for Medicaid and exchange plans. So there will be an opportunity to educate them about insurance options for their children.
Another ripple effect from the executive order may be more undocumented immigrants obtaining healthcare coverage from their employers. Currently, many immigrants who lack documentation find work in the underground economy, especially in jobs such as housecleaning or construction. But with legal work permits, they'll be able to apply for on-the-books jobs with healthcare benefits.
But Obama's unilateral action left congressional Republicans fuming, even though Presidents Ronald Reagan and George H.W. Bush also issued executive orders granting relief to undocumented immigrants. “By ignoring the will of the American people, President Obama has cemented his legacy of lawlessness and squandered what little credibility he had left,” House Speaker John Boehner said in response to the president's executive order.
That clouds the prospects for a budget deal when Congress returns from the Thanksgiving break, with the government set to run out of money on Dec. 11. It also shrinks the likelihood of progress during the lame-duck session on any other issues, including a permanent fix to Medicare's sustainable growth-rate formula for physician payment. And it could intensify GOP efforts to repeal or roll back the Patient Protection and Affordable Care Act.
Even without coverage under the Affordable Care Act, undocumented immigrants aren't entirely cut off from public insurance. In some states, notably with Medi-Cal in California, they're eligible for publicly funded healthcare programs. In addition, pregnant women are typically eligible for emergency Medicaid to cover the costs of delivering their babies.
But for most of the undocumented immigrants who gain relief from deportation under Obama's executive order, there will be no affordable coverage options. They are not even allowed to buy an exchange plan using their own money. “Healthcare is going to remain very, very unaffordable for most of these families,” Schwartz said. “The parents are really going to live in a precarious situation.”
Follow Paul Demko on Twitter: @MHPDemko
