Cov­er­age co­nun­drum

Im­mi­gra­tion re­form hits health­care road­block

Modern Healthcare - - LATE NEWS - Jessica Zig­mond

As law­mak­ers wres­tle over fed­eral im­mi­gra­tion re­form, some are stuck on how to ad­dress health­care cov­er­age for some 11 mil­lion im­mi­grants liv­ing il­le­gally in the U.S. Congress made progress on the is­sue May 21 when the Se­nate Ju­di­ciary Com­mit­tee passed the Bor­der Se­cu­rity, Eco­nomic Op­por­tu­nity and Im­mi­gra­tion Mod­ern­iza­tion Act.

In ad­di­tion to strength­en­ing bor­der se­cu­rity, the bill pro­vides a reg­is­tered pro­vi­sional im­mi­gra­tion sta­tus. In­di­vid­u­als with­out le­gal per­mis­sion would be al­lowed to live in the coun­try legally for six years while they pur­sue cit­i­zen­ship, with the pos­si­bil­ity of ex­tend­ing for an­other six.

But the bill does not ad­dress how they would re­ceive health­care ser­vices—a stick­ing point that has slowed the ef­forts of a bi­par­ti­san group of eight House mem­bers to agree on im­mi­gra­tion leg­is­la­tion of their own.

Un­der the Se­nate bill, peo­ple given the new le­gal sta­tus could buy cov­er­age in the in­sur­ance mar­ket­places cre­ated by the Pa­tient Pro­tec­tion and Af­ford­able Care Act, ac­cord­ing to the National Im­mi­gra­tion Law Cen­ter. They still would not—as stip­u­lated for nonci­t­i­zens in the Af­ford­able Care Act—get sub­si­dies for the cov­er­age. That raises ques­tions about how they would get in­sur­ance un­til they’re cit­i­zens and who will pay for it. Some House Repub­li­cans, ac­cord­ing to me­dia re­ports, want im­mi­grants to risk de­por­ta­tion if they fail to buy in­sur­ance.

The is­sue is a ma­jor con­cern for hos­pi­tals, es­pe­cially as they pre­pare for an in­flux of pa­tients next year from the state Med­i­caid ex­pan­sions and the in­sur­ance ex­changes.

“They’re not go­ing to pro­vide Med­i­caid ex­pan­sion and sub­si­dies out of the box,” said Tom Nick­els, se­nior vice pres­i­dent of fed­eral re­la­tions at the Amer­i­can Hos­pi­tal As­so­ci­a­tion. “How­ever, there is an ac­knowl­edge­ment in both the House and Se­nate that our mem­bers are still pro­vid­ing ser­vices to this pop­u­la­tion as man­dated by fed­eral law, EMTALA.”

The AHA is work­ing to con­vince lead­ers that any im­mi­gra­tion leg­is­la­tion should in­clude a fund to help hos­pi­tals care for the im­mi­grants on the path to cit­i­zen­ship. Nick­els said it would be sim­i­lar to the $1 bil­lion in­cluded in 2003’s Medi­care Pre­scrip­tion Drug, Im­prove­ment and Mod­ern­iza­tion Act to help hos­pi­tals pay for the emer­gency ser­vices pro­vided to im­mi­grants.

A con­gres­sional aide fa­mil­iar with the ne­go­ti­a­tions among the bi­par­ti­san group in the House said Democrats want to be sure that peo­ple who work in the U.S. don’t have bar­ri­ers to ac­cess­ing af­ford­able health­care. Other House mem­bers are work­ing on im­mi­gra­tion bills, and House Speaker John Boehner (R-Ohio) sig­naled last week that the lower cham­ber “sim­ply won’t take up” the bill emerg­ing in the Se­nate, but rather will pro­duce its own leg­is­la­tion.

Se­nate Ma­jor­ity Leader Harry Reid (D-Nev.) has said he ex­pects to bring the Se­nate bill to the floor for de­bate in June.

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