Health cov­er­age for il­le­gals may fail

Democrats say chance to buy in is moral

The Washington Times Daily - - POLITICS - BY TOM HOW­ELL JR.

Time is run­ning out for the ad­min­is­tra­tion to ap­prove Cal­i­for­nia’s push to al­low il­le­gal im­mi­grants to use its Oba­macare ex­change, likely doom­ing the ef­fort as Pres­i­dent Obama pre­pares to hand the reins over to Pres­i­den­t­elect Don­ald Trump.

The 2010 health law specif­i­cally banned il­le­gal im­mi­grants from sign­ing up for Oba­macare, with Capi­tol Hill Democrats fear­ing at the time that it was too po­lit­i­cally charged.

But Cal­i­for­nia Democrats ar­gue the pol­i­tics have changed, and say deny­ing il­le­gal im­mi­grants a chance to buy into Oba­macare on their own dime is un­fair.

“I know it’s not im­pos­si­ble. Now that our ap­pli­ca­tion is com­plete, we’re go­ing to ex­er­cise any in­flu­ence we have to see if we can make this hap­pen,” said State Sen. Ri­cardo Lara, a Demo­crat who spear­headed leg­is­la­tion to cre­ate the waiver. “I’m go­ing to re­main hope­ful un­til Jan 20.”

Cal­i­for­nia first made its re­quest, known as a “1332 waiver,” ear­lier this year. But the Cen­ters for Medi­care & Med­i­caid Ser­vices sent the ap­pli­ca­tion back as in­com­plete in mid-Novem­ber.

Mr. Lara said they re­sub­mit­ted their pro­posal last week and are hop­ing for a fi­nal ex­pe­dited re­view be­fore Mr. Trump, who has taken a harder stance on il­le­gal im­mi­grants, takes of­fice.

Au­thored by Sen. Ron Wy­den, Ore­gon Demo­crat, the “1332” waiver pro­gram al­lows states to act as lab­o­ra­to­ries for health care re­form start­ing in 2017, free­ing them to go around what Oba­macare pre­scribes while keep­ing the money it would have re­ceived in the form of tax­payer sub­si­dies un­der the law.

Mr. Trump and his tran­si­tion team haven’t sig­naled how they’ll han­dle 1332 waivers, and the team didn’t re­turn re­quests for com­ment for this story.

Yet ap­proval of Cal­i­for­nia’s pro­posal would be at odds with Mr. Trump’s cam­paign rhetoric call­ing for stiffer en­force­ment against il­le­gal im­mi­grants and com­plain­ing about tax­payer­funded ben­e­fits that some­times flow to them.

And Mr. Trump’s pick to be at­tor­ney gen­eral, Sen. Jeff Ses­sions of Alabama, told The Washington Times in Septem­ber that au­tho­riz­ing Cal­i­for­nia’s change would en­cour­age il­le­gal im­mi­gra­tion by al­low­ing peo­ple who aren’t sup­posed to be in the coun­try to ac­cess safety-net pro­grams.

“If the po­lit­i­cal rhetoric is true of the Trump ad­min­is­tra­tion, the least of our wor­ries is this waiver in Cal­i­for­nia,” Mr. Lara said. “We’re go­ing to, again, hope that the waiver gets ap­proved within the Obama ad­min­is­tra­tion.”

Be­sides Cal­i­for­nia, Hawaii and Ver­mont have re­quested less con­tro­ver­sial changes to how Oba­macare’s small busi­ness ex­changes, or SHOPs, are im­ple­mented in their states, while Alaska plans to sub­mit a waiver that would help it sub­si­dize an in­sur­ance mar­ket with few en­rollees and a high num­ber of sick cus­tomers.

Health and Hu­man Ser­vices Depart­ment of­fi­cials de­ter­mined Sept. 26 that Hawaii’s ap­pli­ca­tion was com­plete, trig­ger­ing an of­fi­cial de­ci­sion within 180 days.

A CMS spokesman de­clined to spec­u­late on the fate of Cal­i­for­nia’s waiver, though mul­ti­ple pol­icy an­a­lysts said the prog­no­sis isn’t good for beat­ing the Jan. 20 dead­line.

Col­lect­ing pub­lic com­ments alone could take a month, based on the ex­pe­ri­ence from Hawaii’s ap­pli­ca­tion.

“I don’t think it can move on at this point,” said Cheryl FishPar­cham, who tracks the is­sue as di­rec­tor of ac­cess ini­tia­tives at Fam­i­lies USA, a non­profit that ad­vo­cates for af­ford­able health cov­er­age.

Look­ing ahead, the GOP is eye­ing the 1332 waivers as a tool for mov­ing away from Oba­macare, rather than build on it, as the law’s ar­chi­tects in­tended.

House GOP lead­ers re­cently asked gov­er­nors and state in­sur­ance com­mis­sion­ers if they plan to use the waiver process, and if ex­pe­dited ap­proval from the new ad­min­is­tra­tion would help­ful.

Yet Repub­li­cans might be able to push the en­ve­lope only so far, since the law set down guardrails that say the waivers can­not raise the fed­eral deficit or cover fewer peo­ple than Mr. Obama’s de­sign.

“You can’t just take the money and put it into health sav­ings ac­counts,” said Ti­mothy Jost, a law pro­fes­sor at Washington and Lee Univer­sity in Vir­ginia who tracks the health care law. “You have to cover ef­fec­tively the same num­ber of peo­ple with the same gen­eros­ity of ben­e­fits.”

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