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Does Obamacare give coverage to undocumented immigrants?

When health care reform law passed in March 2010, it generated controversy from some Americans who thought it would use government funds to pay for health care for undocumented immigrants.

Sixty-nine percent of Americans said immigrants should not get health care assistance under the Affordable Care Act before they become citizens, according to a National Journal poll conducted in June 2013.

So does the Affordable Care Act, also known as Obamacare, really change the type of coverage undocumented immigrants can get from the government?

Obamacare and undocumented immigrants

Undocumented immigrants can't receive coverage through Medicare, the Children's Health Insurance Program or Medicaid (for nonemergencies), and that hasn’t changed.

Obamacare undocumented immigrantsDr. Benjamin Sommers, assistant professor at the Harvard School of Public Health, says, "It's a bit of a mixed bag. The law increases funding to community health centers, which provide care for many immigrants, but the law also cuts payments to safety net hospitals, since some of that money will instead go to provide health insurance to citizens and legal immigrants."

The main myth, says Jim Stimpson, an associate professor and director of the Center for Health Policy at University of Nebraska Medical Center, is immigrants “are migrating to the United States to get health care at the expenses of taxpayers, have high levels of uncompensated care, cost the U.S. health care system more than U.S. natives, and are overcrowding our emergency rooms."

In fact, the opposite is true. Sommers says, "Immigrants use fewer health care resources than U.S.-born individuals, are less likely to use the emergency room and are actually healthier than the general population."

For instance, Hispanic immigrants in the United States have a longer life expectancy than white Americans, largely due to their lower smoking rates, according to a study published in Social Science and Medicine in April 2013.

From 2000 to 2009, undocumented immigrants accounted for $15.4 billion in health care spending, and only 7.9 percent of unauthorized immigrants received health care spending from public sources, averaging $140 per person per year, according to a study published in Health Affairs and authored by Stimpson.

Average emergency room expenditures for undocumented immigrants were $54 per year, compared to $138 per year for U.S. natives, the study found.

What medical treatment can undocumented immigrants receive?

Legal immigrants can receive Medicaid after they have lived in the United States for five years, but undocumented immigrants can't.

Medicaid covers emergency medical conditions for undocumented immigrants. This includes childbirth, as well as severe conditions that could lead to serious impairment of a bodily function or serious dysfunction of an organ if left untreated.

Federal law requires hospitals to provide care to anyone with an emergency condition, regardless of immigration status or ability to pay. However, according to a study published in the New England Journal of Medicine in July 2013, the law doesn’t require hospitals to treat non-urgent conditions that may be life-threatening later, or treat complications after patients have been stabilized.  

The study concluded that more undocumented immigrants will qualify for emergency Medicaid as a result of the Affordable Care Act, but that change won't occur in states that have chosen not to expand Medicaid eligibility, including Texas, Pennsylvania and Georgia.

The U.S. Supreme Court ruled that states may opt out of the Medicaid expansion that was part of the Affordable Care Act. Twenty-three states and the District of Columbia plan to expand Medicaid eligibility, while 21 opted out and six are still debating the decision, according to the Kaiser Family Foundation, a nonprofit organization that studies health care issues.

Health insurance exchanges and undocumented immigrants

Under the Affordable Care Act, each state will have a health insurance exchange where consumers can buy individual coverage.

After enrollment begins Oct. 1, legal immigrants will be allowed to use the health insurance exchanges and may receive a federal tax credit to buy coverage, if they meet the income requirements. However, undocumented immigrants can't use the exchanges or qualify for the tax credit.

Certain categories of immigrants will be eligible to buy insurance on the exchanges, including:

  • Green card holders.
  • Asylees (people seeking asylum because they fear being tortured, killed or persecuted in their country of origin due to their political beliefs, religion, race or sexual orientation).
  • Refugees.
  • Cuban and Haitian entrants.
  • Individuals with nonimmigrant status (includes worker visas, student visas and citizens of Micronesia, the Marshall Islands and Palau).
  • Individuals with temporary protected status.

Applicants for insurance on the exchanges may be required to show documentation, such as a green card, reentry permit, refuge travel document, employment authorization card or foreign passport.

Community health centers

The health care reform law increased federal funding to community health centers, also known as federally qualified health centers, by $11 billion over five years. These centers offer preventive and primary health care to patients, regardless of their ability to pay. They provide services for underserved areas or populations, including racial and ethnic minorities.

In addition, there are 166 medical facilities in the country that must provide free care under the Hill-Burton Act, a federal law that passed in 1946. It authorizes federal funding for public and nonprofit medical facilities, such as acute care general hospitals, special hospitals, nursing homes, public health centers and rehabilitation facilities. You don't have to be a U.S. citizen to be eligible for Hill-Burton free care, but you must have lived in the United States for at least three months. 

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