By Micheal E. Hill
Monday, November 9, 2009 - 12:05 am EST

The House of Representatives has passed 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.  The House passed the measure late in the evening on Saturday, November 7, 2009, by a vote of 220-215.

For the most part, the House-passed 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 subsidies to persons who are not lawfully present in the United States.  Unlike the health care reform bill that has been reported by the Senate Committee on Finance, the House-passed measure defies the wishes of President Barack Obama by permitting illegal immigrants to purchase health insurance products with their own funds. 

Immigration restrictionists inside and outside of Congress are extraordinarily critical of the House-passed bill's immigration provisions.  They have excoriated the bill because 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.  They also have been extremely critical of the bill for permitting illegal immigrants to use their own funds to purchase health insurance products that are listed on government-run health insurance exchanges.  And, while the bill 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.


Outcome Was in Doubt
For much of the day, the outcome of Saturday's House floor action was in considerable doubt.  That doubt existed, in part, because of a deal that the House Democratic Leadership made late Friday night with the U.S. Conference of Catholic Bishops to permit a floor amendment to be offered to the bill that would bar federal funding for abortion.  The deal gave pro-choice advocates in Congress heartburn, with a number of them threatening to vote against the bill on final passage.  Another significant reason for doubt about the bill's prospects throughout the day on Saturday was the fear that House Republicans would use procedural motions available to them to make immigration changes to the bill that would render it unacceptable to members of the Congressional Hispanic Caucus (CHC).  In the end, the GOP Motion to Recommit the bill did not involve immigration issues.  And while pro-choice Members remained angry about the deal cut by the House Democratic Leadership on abortion, they did not carry out their threats to vote against the bill.

Saturday's House floor action took place in connection with H.R. 3962, the "Affordable Health Care for America Act".  House floor debate on the measure took up most of the day, beginning at about 10:00 am EST and continuing through about 11:15 pm EST. 

Now that the full House of Representatives has passed its version of health care reform legislation, the next step in the process is for the full Senate to take up its version of the measure.  That could occur sometime in the next few weeks.


Negotiations Over Eligibility of Undocumented Aliens to Purchase Health Insurance With Their Own Funds
As last week began, 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 the day before the House took up the bill that it would not contain such a provision.  The Speaker's decision, when coupled with a deal that was reached that same 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. 

• Health Insurance Mandate.  H.R. 3962 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.  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.
  

• 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.
  
  The bill also includes a provision that would subject persons seeking coverage in the high risk pools that are established by the measure to a citizenship and immigration status verification procedure. 

• 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 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. 

Views of the Pro-Immigrant Advocacy Community 
The pro-immigrant advocacy community wanted to see a number of changes to H.R. 3962 in order to make health insurance more accessible to immigrants.  However, in the end, the community focused its efforts on trying to keep the Obama proposal to bar illegal immigrants from using their own funds to purchase health insurance products out of the House bill, as well as preparing to fight what turned out to be a non-existent immigration-related GOP motion to recommit relating to immigrants.


Outlook
Now that the House of Representatives has passed its version of health care reform legislation, the ball moves to the Senate, where immigration is expected to be a hotly contested issue.  There is no reliable word on when the Senate will take up its version of health care reform legislation.