Immigrants need not apply for Obamacare

June 4, 2013

Gary Lapon shows how the Democrats are still retreating on health care "reform."

AS THE negotiations and maneuvering over promised immigration legislation drag on, the Democratic Party has demonstrated once again its willingness to sacrifice the interests of its base supporters for the sake of a lousy "compromise" with Republicans.

Late last month, House Minority Leader Nancy Pelosi reiterated that immigrants who embark on the twisted "path to citizenship" under the bipartisan proposal will not qualify for affordable health insurance under the Obama administration's health care law during the 10 to 15 years it will take to complete the process.

According The Hill, Pelosi said, "It is stated very clearly in the Affordable Care Act, [and] it is our position in the immigration bill: no access to subsidies in the Affordable Care Act. Secondly, no access to Medicaid; no cost to the taxpayer...That has always been the Democratic position."

Pelosi's statement is also a reminder of how the health care law's mandate to purchase private health insurance, which kicks in next January, will fall far short of ensuring universal coverage, let alone providing quality, affordable health care for all. The 11 million undocumented immigrants living and working in the U.S. will be consigned to a health care underclass under this law.

House Minority Leader Nancy Pelosi
House Minority Leader Nancy Pelosi

This follows on the heels of the betrayal of another component of the party's base: Democrats on the Senate Judiciary Committee bowed to Republican threats and didn't propose amendments to immigration legislation that would have allowed U.S. citizens to sponsor same-sex partners for citizenship or legal residency, as opposite-sex couples are allowed to do.

Then there is the bipartisan "Gang of Eight" proposal itself. It would fund even more border security measures; includes background checks, fines and tax payments just to embark on the legalization process; and would establish several different statuses for guest workers. As Lance Selfa wrote for, the punitive legislative is geared more to the needs of business to exploit immigrant labor than in providing the rights that immigrants deserve.

THIS ISN'T the first time that immigrants have been excluded from under a law that was supposed to represent health care "reform."

In a move that foreshadowed the problems with Obama's Patient Protection and Affordable Care Act, the state of Massachusetts just a few years ago discontinued subsidized Commonwealth Care health insurance for 30,000 documented immigrants who had been living in the U.S. for less than five years.

Though Republicans continue to deny it, Massachusetts' health care law, passed while Obama's 2012 challenger Mitt Romney was governor, was a model for the Obama health care law. It includes a mandate to purchase private health insurance, enforced with tax penalties; an insurance "exchange" that acts as a market for approved plans; and subsidies for residents who are determined to need help to be able to afford insurance.

Eventually, benefits were partially restored to the immigrants who were cut off in Massachusetts, but they were greatly reduced--worth about a third of the original coverage provided under Commonwealth Care--leaving affordable care out of reach for many if not most. The deal made to partially restore benefits brought in Centene Corp. to provide second-class coverage for immigrants.

This attack on immigrants' access to health care wasn't just mean-spiritedness at the state level--it was connected to a discriminatory federal law. Legislators cut immigrants off the Commonwealth Care program because they more expensive to cover--as the result of a federal law that bars matching funds for "means-tested" benefits like food stamps and Medicaid to immigrants who have been permanent residents for less than five years.

As in so many other ways, the Massachusetts experience provides a preview of what's to come under the Obama health care law.

Immigrants who are currently undocumented are almost certain to be excluded entirely from the subsidies available to low-income households to help them afford the mandate to purchase private insurance.

Meanwhile, documented immigrants who have had permanent residency status for five years or less won't be eligible for the same benefits that everyone else receives. Under the health care law, they will qualify for subsidies to assist them in purchasing health insurance on the exchanges--but they won't qualify for Medicaid, the government insurance program for low-income individuals and families. Even poor children and pregnant women will be excluded, unless they live in one of the 22 states that opt to extend Medicaid coverage to them.

That's a recipe for second-class health care. According to the U.S. Department of Health and Human Services, "[S]ubsidies for out-of-pocket cost-sharing will provide much less generous coverage than that offered through Medicaid, so even if poor immigrant families enroll, many may delay necessary care because of cost."

The irony in all this is that non-citizen immigrants are more likely than most people to be uninsured--and therefore need the help of subsidies or the Medicaid program to get access to health care. As of 2009, just over 50 percent of non-citizen immigrants were uninsured, compared with 20 percent of naturalized citizen immigrants and 17.4 percent of citizens born in the U.S.

In particular, the undocumented are more likely to live below the federal poverty line--meaning they would qualify for health care coverage under Medicaid if they weren't banned until they have had legal residency status for at least five years. Half of all documented immigrants who have lived in the U.S. for less than five years have incomes below 138 percent of the federal poverty level, which means they would qualify for Medicaid if they weren't excluded.

Immigrants also work in more dangerous jobs, such as meatpacking, construction, agriculture and housekeeping--and so they therefore have higher rates of injuries and death on the job than do workers born in the U.S.

It isn't only a small minority of people that will be affected by these anti-immigrant restrictions. According to a study by the Robert Wood Johnson Foundation, of all low-income, nonelderly adults living in the U.S. today, fully one in six are undocumented or recent documented immigrants.

Even undocumented immigrants who have health insurance face the threat of deportation when they seek care. More than 600 people have been deported from hospitals in the last five years.

AT ITS heart, the Obama health care law protects the status of health care as a commodity to be sold for a profit rather than provided as a human right. Thus, even when the health insurance exchanges kick in next year, there will be multiple tiers when it comes to access to health care.

As now, the wealthy will be able to afford world-class care. Meanwhile, workers who receive health insurance from their employer or from the exchanges set up under the health care law will pay up to 9.5 percent of their income in out-of pocket health care costs--more for family coverage--before their coverage is deemed unaffordable, and various provisions such as subsidies kick in. That's $1 in every $10 in wages disappearing at a time of shrinking or stagnant household income and attacks on the government programs workers rely on.

Even after the law is fully implemented, nearly 30 million people will remain uninsured--a "privilege" that many will pay for in tax penalties.

Millions of undocumented immigrants will be excluded from receiving any government assistance, even as they work and pay taxes--and, if the Gang of Eight proposal passes, pay penalties along the obstacle-strewn "path to citizenship." And another 3 million documented immigrants who live in poverty and who have resided in the U.S. for less than five years won't qualify for the Medicaid benefits they would otherwise receive.

Immigrants--whose labor is critical to the U.S. economy and whose low wages boost record corporate profits--have been condemned to second-class status in yet another area.

Further Reading

From the archives