President Joe Biden on Friday rescinded a Trump-era rule that required green card applicants to provide proof of health insurance, or evidence they could pay for it, before entering the country, saying the move does not advance the interests of the U.S.
"My administration is committed to expanding access to quality, affordable healthcare," Biden said in a statement. "We can achieve that objective, however, without barring the entry of noncitizens who seek to immigrate lawfully to this country but who lack significant financial means or have not purchased health insurance coverage."
The requirement was never put into effect, as a judge issued an enjoinment on the case within a month of it being proposed. The Trump administration had argued that the measure was necessary to reduce uncompensated care costs. Many of the plans pushed toward immigrants were not functionally available, said Esther Sung, senior litigator for the Justice Action Center, who argued on behalf of immigrant group plaintiffs that filed the initial federal lawsuit. The administration recommended new immigrants sign onto Tricare, for example, which is available for military members and their families, or Medicare, which is age-restrictive and, in some states, only available to individuals who have been in the U.S. for at least five years, she said.
At the time of the enjoinment, the Justice Action Center estimated this policy would have axed two-thirds of legal applicants' chances for green card approval.
"It was really kind of a diabolical double whammy in that, in the same breath, it undermined the Affordable Care Act, as well as would have more or less completely shut down most of the United States immigration system," Sung said.
Because the recommended plans were not realistic options for coverage, Sung said that it would have created a market for "junk insurance," with new immigrants signing up for non-ACA compliant plans just before a global pandemic hit. This would have actually increased uncompensated care costs, she said, since it would have led to an increase in costly trips to emergency departments and community health centers that could have sparked unpaid bills.
"What this means is that immigrants who are coming to the United States can buy subsidized health insurance from the ACA marketplaces, the way that Congress had intended for them to, and that strengthens the overall health insurance system in the United States," Sung said.
It makes sense that Biden aimed to unwind this proclamation after axing the so-called public charge rule, which would have weighed immigrants' use of Medicaid and other public programs against their residency applications, said Randy Capps, director of research on U.S. policy for the Migration Policy Institute, a nonpartisan immigration think tank. That proclamation went through a lengthy public comment period and attracted broad opposition across the healthcare industry, with the American Hospital Association and American's Health Insurance Plans opposing the charge.
This mandate, meanwhile, was broadly layered on top of the public-charge rule. Officials tried to rush it into effect within a month of its proposition, and the proposed rule didn't have time to attract the same attention, Capps said. It represents another Trump initiative aimed at watering down the Affordable Care Act exchanges, and preventing lower-income individuals from immigrating to the U.S., Capps said.
Of the approximately 1.1 million people who obtain green cards each year, only 15% are able to secure coverage through their employer, he said. The rest are either uninsured, qualify for Medicaid or buy plans off the exchanges. If the rule had been put into effect, it could have had far-reaching impact on existing immigrant communities.
"By creating a pool of people who would purchase the non-ACA compliant policies, or maybe cheaper policies with less coverage, that could extend into the immigrant community here in the U.S.," Capps said. "That could have distorted the market."
By tossing this rule, the Biden administration is signaling its support of legal immigration and the ACA. He added that most of the people who immigrate to the U.S. are "reasonably young" and "healthier people." Lawmakers initially argued that they should qualify for ACA plans since they help to lower insurers' risk pools, Capps said, which generally lowers premiums for all enrollees.
"These lawful permanent residents are definitely an important segment of the private health insurance market through the exchanges," Capps said.