House Passes Historic Health Care Reform Bill Containing Both Enhancement to Restrictions on Immigrants' Eligibility for Health Care, Clearing it for President Obama's Signature

The House of Representatives on Sunday passed a landmark health care reform bill containing a number of significant provisions relating to both legal and illegal immigrants' access to health care.   Sunday evening's House action cleared the measure for President Obama's expected signature, which could come within the next 48 hours.

The House debate on the historic measure began early Sunday afternoon, concluding at about 10:30 pm EDT.  Voting ended at about 10:50 pm EDT, with the House passing the measure by a vote of 219-212.  No Republicans voted for the measure.  Only 34 Democrats voted against it. 

While the House action on the health care reform bill has cleared it for the President's signature, the legislative process on health care reform did not end with Sunday evening's vote Congress is expected to spend much of the next week trying to enact a clean-up measure that will make changes to the law that President Obama is expected to sign in the next 12 hours or so.  Shortly after passing the bill, the House passed a clean-up measure making changes to it.  Those changes will have to be ratified before the Senate before they can become law. But regardless of whether the Senate goes on to pass the clean-up measure, the health care reform bill will be law within a matter of days.

Even before Sunday night's final vote on the health care reform bill was cast, the question of whether or not the measure would pass had already been answered.  A dramatic week of uncertainty over whether or not President Obama and the House Democratic Leadership would be able to muster the 216 votes needed for House passage of the measure finally came to a head at around 4:00 pm EDT on Sunday, when the White House cut a deal with Representative Bart Stupak (D-MI) on the question of federal funding for abortion.  That deal helped deliver Representative Stupak and as many as seven of his colleagues into the "Yes" column, ensuring that there would be a sufficient number of votes in the House to pass the bill.

As a general matter, the health care reform bill requires almost everyone living in the United States to purchase a qualified health insurance plan or face a tax penalty.  It also establishes health insurance exchanges, on which private sector insurance companies will list their health insurance products; establishes health affordability tax credits to help persons who cannot afford health insurance purchase it; expands eligibility for Medicaid to a greater number of lower-income persons; and institutes a number of requirements on insurance companies with respect to the benefits that they must offer.

With regard to immigrants, the health care reform bill exempts persons who are not lawfully present in the United States from the measure's general mandate that virtually everyone living lawfully in the United States be covered by a qualified health insurance plan.  The bill also makes legal immigrants eligible for its health care affordability tax credits without having to wait for any length of time after entry to the United States.  And, perhaps most controversially, the measure generally bars aliens who are not lawfully present in the United States from using their own funds to purchase health insurance products that are listed on the Health Insurance Exchange that the bill creates. 

The health care reform bill establishes a new citizenship and immigration status verification regime that is designed to ensure that persons who are not lawfully present in the United States do not receive health insurance products and benefits from which they are barred.  It relies on the recently enacted Children's Health Insurance Program reauthorization bill's mechanism for verification and will subject everyone who purchases health insurance through the exchange, who benefits from an exchange plan, or who receives an affordability tax credit to the new citizenship and immigration status verification regime.


Drama from Hispanic Caucus
The question of how immigrants -- both legal and undocumented -- should be treated under health care reform legislation was the subject of great controversy throughout House and Senate consideration of the measure.

The bill that the House of Representatives passed last November was the most generous to immigrants, refusing to include within it a provision that would bar undocumented aliens from using their own funds to purchase health insurance products listed on health insurance exchanges.  That decision was made after the Congressional Hispanic Caucus (CHC) threatened hours before the November vote to cast their votes against the bill if the provision was included within it.  Needing their votes, Speaker Pelosi defied the wishes of President Obama and declined to put the provision in the bill that passed the House of Representatives.

The Senate, on the other hand, heeded President Obama's wishes and included a provision in its bill barring undocumented aliens from purchasing health insurance with their own funds.  A dramatic showdown was in the ofting on the issue in conference.  However, the death of Senator Edward M. Kennedy (D-MA) and his succession by a conservative Republican deprived Senate Democrats of the 60 votes that would have needed to pass a compromise conference measure.  The lack of 60 votes forced Speaker of the House Nancy Pelosi to accept the Senate bill as-is,  including the controversial provision barring undocumented aliens from purchasing health insurance with their own funds.

The Congressional Hispanic Caucus threatened to vote against the Senate bill because of the provision.  However, in the end, Representative Luis Gutirrez (D-IL) and five of his colleagues in the Congressional Hispanic Caucus (CHC) held a press conference late on Thursday, March 18, at which they announced they would vote in favor of the Senate health care reform bill and the accompaying clean-up reconciliation bill, despite the undocumented alien provisions in it., providing Speaker Pelsoi with a crucial block of 24 votes and enabling her to claim victory on Sunday night.

In explaining his change of position on the Senate health care reform bill, Representative Gutierrez said, “I cannot see that voting against this health care bill is going to bring us any closer to comprehensive immigration reform.” Gutierrez went on to say, “I do see that a success and a victory on health care will allow this president to be strengthened and to be able to carry out with more political capital our ultimate goal.”


Rejection of the Menendez State Medicaid Option Proposal
Rejection of the House provision that would have permitted undocumented aliens to use their own funds to purchase health insurance was not the only setback for immigrants in the health care reform bill. 

The pro-immigrant advocacy community set out at the beginning of the legislative process to include in the bill a provision permitting states to waive a provision in current law that bars most legal immigrants from the Medicaid program until they have been in the United States for five years or more.  Senator Bob Menendez (D-NJ) sought to include such a provision in the Senate health care reform bill during that body's consideration of the measure.  However, Senate Majority Leader Harry Reid (D-NV) refused pleas from pro-immigrant advocates and Senator Menendez to include the provision, known as the State Medicaid Option proposal, in the final version of the health care reform bill that he put before the Senate.  The Majority Leader's decision dealt a fatal blow to efforts to expand legal immigrants' eligibility for the Medicaid program as part of the landmark health care reform bill.