Notably, however, the Obama administration has indicated that immigrants covered under the new policy will continue to be excluded from the ACA's exchanges and tax credits. Similarly, immigrants targeted by the executive action will for the most part remain ineligible for federally funded Medicaid, though some states do provide publicly funded health insurance for some classes of undocumented immigrants. To the extent that work permits lead to an increase in taxes paid by undocumented immigrants, ongoing exclusion of these immigrants from the programs supported by such taxes would be increasingly inequitable.
New England Journal of Medicine: Perspective
N Engl J Med 2015; 372:1187-1189March 26, 2015DOI: 10.1056/NEJMp1414949
by Benjamin D. Sommers, M.D., Ph.D., and Wendy E. Parmet, J.D.
On November 20, 2014, President Barack Obama announced his intention to grant millions of undocumented immigrants a reprieve from the threat of deportation, along with the possibility of legal employment in the United States. The announcement came shortly after midterm elections that saw Republicans take control of the Senate and bolster their majority in the House of Representatives, and it followed more than a year of congressional gridlock over the comprehensive immigration-reform bill passed by the Senate. The subsequent decision by a federal district judge in Texas to put President Obama's plan on hold has cast into doubt a policy that — if ultimately upheld — could have substantial effects on the health care system.
The cornerstone of the President's policy is a plan to allow up to 5 million undocumented immigrants (“covered immigrants”) to live and work in the United States. Modeled on the 2012 Deferred Action for Childhood Arrivals (DACA) program, which applied to young adults who arrived in the United States as children, the new policy will allow many more adults who have been here since 2010 to receive deferred-action status. The population affected by the policy is one that currently experiences major disparities in health care coverage and access. Immigrants are far more likely than native-born residents to be uninsured: among adults, an estimated 40% of legal permanent residents and 71% of undocumented immigrants are uninsured, as compared with 15% of U.S.-born citizens.1 Not surprisingly, health care utilization is far lower among immigrants than among citizens.