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Speaker Pelosi Rejects Obama Proposal to Bar Illegal Aliens from Using Their Own Funds to Purchase Health Insurance, but a Looming GOP Procedural Motion Imperils Both Illegal
and Legal Immigrants' Access to Health Insurance
By Micheal E. Hill
Saturday, November 7, 2009 - 4:45 pm EST
The House of Representatives has begun its debate on a landmark health care reform  bill that would require every person in the United States to purchase health insurance, establish a new entitlement to federal health care affordability subsidies for lower income individuals and families, and enact significant new consumer reforms to protect the rights and benefits of the insured.
For the most part, the House health care reform bill would provide legal immigrants with the same access to its benefits that U.S. citizens would enjoy, while barring federal health care affordability subsdies to persons who are not lawfully present in the United States. However, from an immigration perspective, the measure has become more notorious for what it does not do. It does not contain a controversial provision advanced by President Barack Obama that would bar illegal immigrants from purchasing health insurance products with their own funds. It does not extend to health insurance benefits an existing five-years-after-entry bar for legal immigrants who seek access to public benefit programs. And while it would impose a citizenship and immigration status verification regime on individuals before they could access federal health insurance affordability subsidies, immigration restrictionists complain that the regime is too weak and that it should be extended to all aspects of health insurance.
The procedural framework that the House Democratic Leadership has devised for today's floor debate will not permit Members of Congress to offer any amendments to the bill's immigration-related provisions. However, notwithstanding that framework, a looming Republican procedural motion could imperil both legal immigrants' access to health insurance and the ability of illegal immigrants to use their own funds to purchase unsubsidized health insurance products.
Today's House floor action is taking place in connection with H.R. 3962, the "Affordable Health Care for America Act". House floor debate on the measure is expected to take most of the afternoon and extend into the early evening. The House could begin casting key votes on the measure beginning sometime after 6:00 pm EST. However, it is possible that the House Democratic Leadership will postpone votes into tomorrow, or later, if it needs more time to convince enough Members to support the bill.
Outcome in Doubt
The outcome of today's House floor action is in considerable doubt. This doubt exists, in part, because of a deal that the House Democratic Leadership made late last night with the U.S. Catholic bishops to permit an amendment to be offered to the bill that would bar federal funding for abortion. That deal has given pro-choice advocates in Congress heartburn and could cause some of them to vote against the bill. Another significant reason for doubt about the bill's prospects is that if the looming GOP procedural motion centers on immigration and renders the bill unnacceptable to members of the Congressional Hispanic Caucus (CHC), it could cause a signifcant number of the 27 CHC Members to vote against the bill, an eventuality that would likely leave the bill short of the 218 votes that are needed to pass it.
Negotiations Over Eligibilty of Undocumented Aliens to Purchase Health Insurance With Their Own Funds
Prior to yesterday, the biggest unresolved immigration issue in connection with the House health care reform bill was the question of whether the bill should include an Obama-inspired provision that would bar illegal immigrants from using their own funds to purchase health insurance products that are listed on health insurance exchanges. Speaker of the House Nancy Pelosi (D-CA) finally decided yesterday that the bill would not contain such a provision. The Speaker's decision, when coupled with a deal that was reached last night to permit pro-life Democrats to offer an anti-abortion floor amendment to the measure, removed the two biggest obstacles that had emerged to bringing the Health Care reform bill before the full House of Representatives for its consideration.
The Speaker's decision to reject a provision barring illegal immigrants from using their own funds to purchase health insurance represents a victory for the Congressional Hispanic Caucus. The CHC had weighed in heavily in what turned out to be a successful effort to prevent the Speaker from inserting the Obama inspired provision into the House health care reform bill. However, the CHC victory would well be short-lived. It is widely believed that House Republicans will attemt to use procedural tools that are at their disposal to insert a number of anti-immigrant provisions into the bill prior to the vote on final passage of the measure. Should Republicans succeed in doing so, it will present a delimna to CHC Members, who may feel pressure to vote against final passage of the Health Care Reform Bill.
The CHC addressed the issue of the eligibility of illegal immigrants to purchase health insurance with their own funds in three separate forums over the last week. The first was at a Thursday, November 5, 2009, meeting between the CHC and House Democratic Congressional Campaign Committee (DCCC) Chairman Chris Van Hollen (D-MD), who has been a leading advocate for inserting the Obama-inspired proposal into the House health care reform bill. The second was at a meeting on that same day between four senior members of the CHC and President Obama. And the third was at a meeting between Speaker Pelosi and the CHC that took place on Friday, November 6. It was at the latter meeting that the Speaker revealed her decision to keep the Obama-inspired bar out of the House bill.
The Senate Finance Committee-approved version of the health care reform bill includes a provision that would implement the Obama proposal. However, the bill that was introduced in the House does not contain such a provision. The President and his Administration have been pressing the House Democratic Leadership to include the proposal in the House bill. But the CHC has ferociously opposed it.
Some CHC members are angry with the President, whose Administration sparked the debate on whether illegal aliens should be barred from purchasing health insurance with their own funds. They fear that enactment of the proposal could well cause millions of illegal aliens and their U.S. citizen and/or legal permanent resident family members to lose health insurance coverage that they currently have. They argue that it is bad policy both on moral grounds, as well as on financial grounds. They point out that if illegal immigrants are barred from purchasing health insurance with their own funds, they will have to rely on emergency Medicaid, which would wind up being financed by American taxpayers.
Summary of Immigration- and Refugee-Related Provisions
As introduced, H.R. 3962 is a combination of compromises brokered by the House Democratic Leadership and provisions that were contained in bills produced by three House Committees: the House Committee on Ways and Means, House Committee on Energy and Commerce, and House Committee on Education and Labor.
The following summarizes the treatment of noncitizens under the measure --
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Affordability Credits. H.R. 3962 would provide "affordability credits" to persons who are not poor enough to qualify for Medicaid but who cannot afford to purchase health insurance on their own. Legal immigrants would be eligible for affordability tax credits, but under section 347 of the bill, aliens who are not lawfully present and nonimmigrants would not be eligible for such credits. The House bill contains several exceptions to the bar on nonimmigrant eligibility for affordability tax credits. T, U, V and K Visa holders would be eligible for affordability credits, despite the fact that they are nonimmigrants.
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Citizenship and Immigration Status Verification. Section 341(b)(4) of H.R. 3962 would establish a verification regime, based on the regime in the recently enacted Children's Health Insurance Program Reauthorization Act (CHIPRA), for persons who seek to access affordability credits. All persons, including United States citizens, would be required to undergo verification of their citizenship or immigration status.
Under the procedure, a person seeking affordability credits would make a declaration of United States citizenship or of lawful presence. Persons declaring that they are citizens would undergo one verification process. Persons claiming to be lawfully present in the United States would undergo a different process.
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Five-Year Waiting Period for Medicaid and Medicare. H.R. 3962 would maintain current law regarding the eligibility of aliens for Medicaid, Medicare, and the Children's Health Insurance Program (CHIP) unchanged.
Views of the Pro-Immigrant Advocacy Community
The pro-immigrant advocacy community would like to see a number of changes to H.R. 3962 in order to make health insurance more accessible to immigrants. However, the community has become resigned to the fact that the bill, itself, will not be amendable on the House floor. Chief among the pro-immigrant advocacy community's goals was its desire to repeal the five year-long waiting period for legal immigrants to access Medicaid and CHIP, as well as to repeal the sponsor/deeming regime for Medicaid and CHIP that most legal immigrants must adhere to. Given the parliamentary situation that does not permit any immigration-related amendments to the bill, the pro-immigrant advocacy community has concentrated its fire on an expected GOP motion to recommit the bill with instructions to report it back to the House of Representatives containing provisions that would severely restrict legal immigrants' access to health insurance, impose a stringent citizenship and immigration status verification regime on health insurance products, and bar illegal immigrants from using their own funds to purchase health insurance products that are listed on health insurance exchanges.
Concerns of the Immigration Restrictionist Community
The immigration restrictionist community is unhappy with the treatment of immigrants under the House health care reform bill. They contend that the citizenship and immigration status verification regime in the bill is not rigorous enough to ensure that illegal immigrants are prevented from receiving benefits from the bill. They also complain that legal immigrants would be eligible for affordability subsidies immediately upon entry to the United States rather than having to wait for five years after entry. And they oppose permitting illegal immigrants to purchase health insurance products listed on health care exchanges.
Immigration restrictionists in Congress filed a number of amendments with the House Committee on Rules that sought to address their concerns about the bill. However, the House Democratic Leadership did not permit any of their amendments to be offered on the House floor. It is widely anticipated that House Republicans will offer a motion to recommit the bill at the end of the debate, with instructions that it be reported back to the full House of Representatives with provisions that the CHC and pro-immigrant advocates would find highly objectionable.
Outlook
The House of Representatives is expected to spend at least six hours debating H.R. 3962 and the amendments that have been made in order to the bill. The House will face several important procedural votes at the beginning of its consideration of the measure, a critical vote on abortion, and a critical procedural vote on a GOP motion to change the bill just prior to the vote on final passage of the measure. Depending on the ouctome of the procedural votes, the House could vote on the bill either late Saturday evening, sometime on Sunday, or next week.
The outlook for passage of the measure remains cloudy.
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