By Micheal E. Hill
Friday, November 6, 2009 - 3:30 pm EST

Multiple sources on Capitol Hill report that Speaker of the House Nancy Pelosi (D-CA) has told the Congressional Hispanic Caucus (CHC) that she will not ask that the health care reform bill that the House is scheduled to take up tomorrow be modified to include a proposal by President Barack Obama that illegal immigrants be barred from purchasing health insurance with their own funds.  The apparent decision by the Speaker of the House removes a serious obstacle that had developed to House passage of the House health care reform bill.

The CHC addressed the issue of the eligibility of illegal immigrants to purchase health insurance with their own funds in two separate forums yesterday.  The first was at a meeting between the CHC and House Democratic Congressional Campaign Committee (DCCC) Chairman Chris Van Hollen (D-MD), who has been a leading advocate of including the proposal in the House health care reform bill.  The second was at a meeting between four senior members of the CHC and President Obama. 

Speaker Pelosi met with the CHC at 10:00 am EST this morning.  Sources indicate that she told CHC members during that meeting that she does not intend to insert the Obama provision into the bill prior to House consideration of the measure.

If reports of the Speaker's decision are correct, it will mark the third time in a week that the Speaker has been faced with a decision on whether to bar illegal immigrants from using their own funds to purchase health insurance.  She has decided against imposing such a bar on each occasion.

At stake in today's decision by the Speaker are two questions.  First, whether millions of undocumented aliens and their U.S. citizen or legal permanent resident children and spouses should be able to use their own funds to purchase private, unsubsidized health insurance products that are listed on government-run health insurance exchanges.  And second, whether nearly two dozen normally loyal Democratic Members will abandon the party and vote against a measure that has become the party's and the President's highest legislative priority.

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 

• 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.

• 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 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 is 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 is expected to be in force tomorow, there appears to be no way for the pro-immigrant advocacy community to achieve its goal.  Instead, it has concentrated its efforts over the last week to fighting to prevent the provisions in the measure from becoming more restrictive.


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 are expected to file amendments with the House Committee on Rules that would bar illegal immigrants from purchashing health insurance products that are listed in the exchanges, impose a five year-long waiting period for legal immigrants to access health insurance affordability subsidies, and strengthen the citizenship and immigration status verification regimes.


Outlook
The House of Representatives is expected to spend at least six hours debating H.R. 3962, beginning sometime during the day on Saturday, Nocember 7, 2009.  The House will face several important procedural votes at the beginning of its consideration of the measure, and it will face votes on at least two amendments.  Depending on the ouctome of the procedural votes and the state of negoiations that are underway among Democrats who are wavering in their support of the bill, 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.