This Legislation Could Help Immigrants Access Health Insurance

The HEAL Act would help address disparities in insurance coverage that may be putting immigrants' reproductive health at risk.

[Photo: A young, Latinx patient gets a check-up with a doctor at a clinic.]
Lawmakers and supporters of the HEAL Act say immigrant women of reproductive age are disproportionately affected by these barriers, and reproductive health services have always been a focus of the legislation. Shutterstock

Immigrants to the United States face myriad barriers to accessing health care—but legislation introduced in the U.S. House of Representatives hopes to help change that.

Last Tuesday, Reps. Pramila Jayapal (D-WA) and Deb Haaland (D-NM) reintroduced the “Health Equity and Access under the Law (HEAL) for Immigrant Women and Families Act of 2019.” The bill would restore eligibility for Medicaid and Children’s Health Insurance Program (CHIP) to immigrants whose presence in the United States is federally authorized, including Deferred Action for Childhood Arrivals (DACA) recipients. In 1996, the Personal Responsibility and Work Opportunity and Reconciliation Act imposed a five-year waiting period on these immigrants before they became eligible to apply for federal health-care programs.

The HEAL Act would also allow DACA recipients to buy private insurance coverage on the Affordable Care Act (ACA) marketplaces and receive its subsidies. And it would reinstate Medicaid eligibility for Compact of Free Association (COFA) migrants, who are citizens of the Republic of the Marshall Islands, Federated States of Micronesia, and the Republic of Palau.

Unlike the last iteration of the HEAL Act, sponsored by former-Rep. Michelle Lujan Grisham (D-NM), this bill would expand health-care coverage for undocumented immigrants by allowing them to obtain insurance through ACA exchanges.

Some states have already taken steps to address disparities in health-care access for immigrants. In June, California expanded its Medi-Cal coverage to become the first state to include income-eligible undocumented residents between the ages of 19 and 25. It already covered all income-eligible children. Documented immigrants can qualify for Medi-Cal without the five-year waiting period and can buy private health plans through the ACA health insurance exchange Covered California.

Five other states and the District of Columbia allow state-only funds to cover all income-eligible children under their Medicaid plans, regardless of immigration status. Washington state lawmakers recently proposed expanding the state’s Apple Health coverage to all low-income young adults, regardless of immigration status, but the bill is still in committee.

Lawmakers and supporters of the HEAL Act say immigrant women of reproductive age are disproportionately affected by these barriers, and reproductive health has always been a focus of the legislation. The bill’s text explains that the purpose of the legislation is to expand access to health-care services, including sexual, reproductive, and maternal health services, and that women and low-income people often struggle to access health services.

Thirty-two percent of noncitizen immigrant women of reproductive age were uninsured in 2017 compared to 9 percent of U.S.-born women and 10 percent of naturalized citizens, according to analysis on the bill released last week by the Guttmacher Institute. And it’s worse for low-income noncitizen immigrant women—48 percent of whom were uninsured compared to 16 percent of U.S.-born women and 19 percent of naturalized citizens.

These disparities in insurance coverage may be putting immigrant women’s reproductive health at risk, as well as their families’ health. According to 2018 research from Guttmacher, half of immigrant women at risk of unintended pregnancy received contraceptive care in the previous year. Two-thirds of U.S.-born women did the same. Immigrant women can access Medicaid only for labor and delivery, despite prenatal care being the standard of care for pregnant people.

“No one would ever recommend not getting prenatal care for a pregnant woman,” said Adam Sonfield, senior policy manager at Guttmacher Institute. “There are pretty robust standards for how often you’re supposed to come in for vitamins and tests and scans. It’s all built for the health of the woman and the health of the infant. If you’re not getting the proper vaccinations, for instance, you can transmit some infections to your infant which can have pretty devastating consequences.”

One of the biggest barriers to health care for immigrants is the 1996 law’s five-year-ban, Jayapal told Rewire.News. “Families of color are disproportionately affected and remain completely uninsured,” she said.

These restrictions hurt immigrants’ health, and the costs eventually hit taxpayers when immigrants end up in the emergency room due to health problems that previously went untreated.

“Even if you’re here as a permanent resident, you’re not cared for for five years,” Jayapal said. “You’re here legally and paying into systems but you’re barred from the marketplace. During my time as an activist and organizer, we fought hard to rid that provision from the ACA, but we weren’t able to … If we’re doing this on an emergency basis, there are enormous costs for everyone.”

Jayapal acknowledged that the bill may be challenging to get through the House.

“I think that with anything relating to immigration, it will be a fight,” she said. “It should not be difficult to get rid of the five-year-ban, but in this environment, immigration is so polarized on things that used to be bipartisan, such as asylum seekers and even legal residents …. We have a president who has made it his calling card to be as xenophobic as possible. The hope is that we will get a hearing and will build the support we need to pass it.”

Ann Marie Benitez, senior director of government relations at the National Latina Institute for Reproductive Health (NLIRH), which supports the legislation, said her organization worked with National Asian Pacific American Women’s Forum (NAPAWF) and In Our Own Voice: National Black Women’s Reproductive Justice Agenda to bring 300 activists of color to Washington, D.C., in September. They lobbied lawmakers to support the HEAL Act and the Equal Access to Abortion Coverage in Health Insurance Act (EACH Woman Act), which would end the Hyde Amendment’s discriminatory ban on federal funding for abortions.

NLRIH, NAPAWF, and In Our Own Voice: National Black Women’s Reproductive Justice Agenda are among the 120 organizations who have so far signed on to support the HEAL Act. Other supporting organizations include the Guttmacher Institute, the National Family Planning and Reproductive Health Association, and the American Public Health Association.

“We know that this is something that will take a lot of time and commitment and people power to really move this piece of legislation,” Benitez said. “We are committed to that because … it is going to be a challenge, as is anything when it comes to health care overall. We wanted to build up momentum of this bill for all of our communities and to make sure there is enough strong support congressionally.”

Sonfield said that the effects of letting immigrants and their families go uninsured can’t be understated and reverberate throughout communities.

“By denying insurance coverage to many immigrants, there are negative consequences for their own health, for the health of their families, particularly the kids, for community health, and for their and their families’ economic wellbeing and self-sufficiency,” he said. “It’s much easier to get a family to sign up for insurance altogether than to do it piecemeal. We also know that things like prenatal care matter directly for a kid’s health, and we know that more generally, the parents’ health matters for a kid’s health as well. If you’re not healthy, it’s really hard to care for your kids.”