The Trump Administration recently announced plans to revoke DACA (Deferred Action for Childhood Arrivals) Dreamers’ eligibility for health insurance through the Affordable Care Act (ACA) as part of a new proposed rule. The proposal would undo a rule that was estimated to allow 147,000 immigrants to obtain healthcare coverage.
Healthcare Innovation recently spoke with the policy manager of the National Asian Pacific American Women’s Forum (NAPAWF), Sydelle Baretto, about immigrants’ barriers to healthcare.
Could you explain the current situation a bit?
When Obamacare was initially passed, DACA recipients were not qualified as legally permanent residents, so they did not have access to the ACA marketplace. Then, a new rule was put out last year, giving them access to the ACA marketplace and allowing them to purchase plans.
If you’re an undocumented immigrant, you are not eligible for Medicaid, CHIP, and you don’t have access to the ACA marketplace.
The new proposed rule would essentially take away access to the ACA marketplace for DACA recipients. People have until April 11 to submit comments to the government to say, this is why you should or shouldn’t do this.
Given the current administration’s stance on immigrants, I think it is, unfortunately, probably likely that DACA access will be revoked, especially since this was a relatively recent policy.
Are other immigrant communities affected by the new proposed rule?
It also revokes ACA access for Temporary Protected Status (TPS) holders. Those are from a range of different countries who have a temporary status that allows them into the United States.
Could you talk about the potential impact on both patients and providers?
In the rule that CMS submitted, they estimate that between 750,000 and 2 million people will lose their health insurance. The rule also includes things that punish low-income families.
If folks don’t have access to healthcare, that means they’re probably not going to seek preventative care. If something comes up, they’re having symptoms, they’ll let things get worse. Then they’re going to need to go to the emergency room.
If that person doesn’t have health insurance, whether it’s federal or private health insurance, the hospital has to take on the cost of care. It’s called uncompensated care, so when hospitals have large amounts of uncompensated care, they often seek to transfer those costs onto people with health insurance.
Overburdening our emergency care system is definitely not a good thing, and it’s always better for both patients and providers when people are able to access preventative and routine care.
Regarding reproductive care, how would the new rule impact immigrant women?
It’s a really tough time for reproductive rights. For undocumented female immigrants, there’s about 2 million of them that live in states that have restrictions or bans on abortion. Given the uptick in immigration enforcement activity, it makes it less likely that immigrants are going to seek insurance coverage or healthcare in general. The fear of being criminalized for accessing reproductive healthcare is doubly increased for folks who already have a fear of criminalization due to their immigration status.
I think a lot of people think, when you’re talking about restrictions on reproductive healthcare access, that it’s just abortion. It’s not just abortion…it includes things like contraception and pap smears. About a third of immigrant women of reproductive age are uninsured, which means that they don’t have access to that affordable reproductive preventative healthcare.
A quarter of children in the US have an immigrant parent. They’re twice as likely to be uninsured as children whose parents are citizens. This lack of health insurance not just only affecting immigrants but also their children, maybe US citizens.
A lot of these immigrants may be working low-wage jobs. These are jobs that don’t have paid leave of any kind sometimes. If they get sick….that might mean missing a paycheck. That paycheck could be the thing that they needed to be able to put food on the table. It could mean that they then lose their job.
You see this kind of domino effect of how access to healthcare, including reproductive healthcare, is not just about keeping your health. It’s about being able to keep taking care of your family and provide for them. These ripple effects don’t just affect the inner community but may affect all of us.
If finalized, the rule would also reduce the open enrollment period for all marketplaces to November 1 through December 15. How would this impact different communities?
This makes it difficult for people across ethnicities and races with very low incomes. Navigating these systems is not easy, even if English is your native language, let alone if you have any kind of language barrier.
There are also income verification measures that this same proposed rule includes that could disproportionately impact immigrant families who are of mixed status, so families where some people are citizens, some are new green card holders, or undocumented. This punishes not just immigrants but also families who are low income, who are the ones who need access to the marketplace the most.
