The House Democratic Leadership today defied both President Barack Obama and the Senate Committee on Finance by introducing a health care reform bill that would not bar undocumented aliens from purchasing health insurance in the health insurance exchanges that would be created under the measure.  While the bill, as introduced, does not contain a bar on undocumented aliens' access to health insurance exchanges, Hill insiders warn, that  the measure could be revised to do so before it is passed by the full House of Representatives.

The House Democratic Leadership unveiled the House health care reform bill, which was introduced by Representative John Dingell (D-MI), at a 10:30 am rally on the West Front steps of the U.S. Capitol Building.  The 1,990 page-long bill was introduced as H.R. 3962.

The full House of Representatives is expected to take up the measure next week.

Treatment of Noncitizens in the House Health Care Reform Bill
As introduced, H.R. 3962 is a mash-up of compromised brokered by the House Democratic Leadership and ideas 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.

With regard to immigrants, H.R. 3962 would --

• Health Insurance Mandate.  With respect to immigrants and immigration, the measure would require all residents (with the exception of some nonimmigrants) to maintain health insurance plans and subject those who do not adhere to the mandate to tax penalties.  Even undocumented aliens would be subject to the mandate under H.R. 3962.

• Affordability Credits.  The House bill would provide "affordability credits" to persons who are not poor enougn to qualify for Medicaid but who cannot afford to purchase health insurance on their own.  Legal immigrants would be eligibile 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 eligiblity for affordability tax credits.  T, U, V and K Visa holders would be eligible for affordability credits, despite the fact that they are nonimmigrants.¹

• 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.
  
• Health Insurance Exchanges.  H.R. 3962 would permit all immigrants to participate in the state health insurance exchanges created by the bill, including those not lawfully present.

• 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.

• Reaffirmation of Bar on Providing Medicaid or CHIP Benefits to Illegal Immigrants.  Section 1787 of H.R. 3962 would provide that nothing in Title VII of the bill bill shall change current prohibitions against Federal Medicaid and CHIP payments under titles XIX and XXI of the Social Security Act on behalf of individuals who are not lawfully present in the United States. 
  

Treatment of Noncitizens in the Senate Bill
It was not known at the time of this writing what the specific immigration provisions will be in the bill that Senate Majority Leader Reid will bring before the full Senate. However, it is anticipated that the bill's immigrant provisions will be closely patterned after the measure that the Senate Committee on Finance approved earlier in October.

The Senate Finance Committee bill would--

• Health Insurance Mandate.  mandate that legal immigrants (along with U.S. citizens) either purchase health insurance or be subject to a tax penalty;

• Treatment of Illegal Immigrants Under Mandate.  exempt illegal immigrants from the mandate to purchase health insurance;   

• Illegal Immigrants and Health Insurance Exchanges.  bar illegal immigrants from purchasing health insurance in state or federal health insurance exchanges; 

• Health Insurance Exchanges and Mixed Families.  permit illegal immigrants to purchase health insurance in the exchanges for their U.S. citizen or LPR children; 

• Legal Immigrants and Affordability Credits.  permit legal immigrants to receive affordability tax credits to help them pay for health insurance without regard to the five-year waiting period under the law for Medicaid and the Children's Health Insurance Program (CHIP);

• Illegal Immigrants and Affordability Credits.  bar illegal immigrants from receiving affordability tax credits to help them purchase health insurance;

• Legal Immigrants with Expiring Immigration Status.  bar legal residents from receiving affordability tax credits to help them purchase health insurance if their legal status will expire within a year;

• Calculation of the Federal Poverty Level.  exempt illegal immigrants from the calculation of the Federal Poverty Level for the purposes of the bill; and

• Citizenship and Immigration Status Verification.  impose an immigration status verification regime on all persons --- citizens and noncitizens, alike -- seeking to purchase health insurance in the bill's health insurance exchanges.
  
  

Seeds of an Explosion
The issue of the eligibility of illegal immigrants for benefits and services under the various health insurance reform bills exploded into the public consciousness during the period immediately following a September 10, 2009, address by President Obama before a joint meeting of Congress.  During the President's address to Congress, Representative Joe Wilson (R-SC) interrupted the President during his address and called him a liar for asserting that his health care reform bill would not provide benefits to illegal aliens.  The firestorm that erupted as a result of Representative Wilson's outburst began a national conversation on the subject of immigrant eligibility for health insurance benefits and services that left pro-immigrant advocates deeply troubled.  Participants in that conversation included White House Press Secretary Robert Gibbs, Senate Finance Committee Chairman Max Baucus (D-MT), and Senator Kent Conrad (D-ND).  And that conversation culminated at week's end with a number of assertions by White House Press Secretary Robert Gibbs, Secretary of Health and Human Services Kathleen Sebelius, Chairman Baucus, and others.

One of the great ironies of this year's health insurance reform debate is that it could well leave immigrants worse off than they are under current law.  Barring illegal immigrants from participating in the proposed health insurance exchanges, as the Senate bill would do, could render nearly 5 million persons who currently possess health insurance unable to obtain coverage.  And overly burdensome verification regimes could render many legal immigrants who have unlawfully present family members in danger of losing coverage for their family members.

The U visa was created by the Victims of Trafficking and Violence Prevention Act, enacted in October 2000. It is available to noncitizens who have suffered substantial physical or mental abuse resulting from a wide range of criminal activity, and have been helpful, are being helpful or are likely to be helpful with the investigation or prosecution of the crime. The U visa provides eligible immigrants with authorized stay in the United States and employment authorization.

The K visa is a United States visa for familiy based immigration, used to bring a foreign family member (including fiancés) to live in the United States. A K-visa requires the alien to adjust status once present in the United States.

The V visa is available to certain spouses and minor children of permanent residents that had an immigrant petition (I-130) filed by the sponsor for the beneficiary on or before December 21, 2000; who had been waiting for at least three years since the time the I - 130 was filed.

RELATED DOCUMENTS:

H.R. 3962, the "Affordable Health Care for America Act", introduced on October 29, 2009

Summary of Changes in the House Health Care Reform Bill

House Democrats Reportedly Will Defy President Obama and Senate on Undocumented Aliens' Access to Health Insurance Exchanges

Senate Finance Approves Health Care Bill Containing Restrictions on Immigrants' Access to Health Care and Insurance