How will immigrants fare under Obamacare? It’s complicated

By By Lornet Turnbull

The Seattle Times (MCT)

Published: Tuesday, Sept. 10 2013 6:57 p.m. MDT

Under the ACA, the majority of the state’s uninsured will be required to buy health care coverage, or face a penalty.

They can purchase an individual insurance plan on their own or from the state-administered health-insurance marketplace, the Washington Health Benefit Exchange.

Those with the lowest income — about a third — will qualify for Medicaid, the free or near-free health insurance program that will be expanded under Obamacare to deliver health care to the poorest Americans.

How and where immigrants fit into all this are questions many advocacy groups continue to unravel.

“I don’t think there’s any question the majority of immigrants will benefit from this,” said Jenny Rejeske, policy analyst for the National Immigration Law Center. “It’s going to require vigilance from advocates and people who want this to work. It’s not going to be perfect on day one.”

Mary Wood, section manager at Washington State Health Care Authority, said the rules related to immigrants’ eligibility for Medicaid under ACA haven’t changed: If their immigration status made them ineligible before the law took effect, they’ll remain ineligible.

U.S. citizens and legal permanent residents or green card holders who have been in this country for five years or longer will be treated the same as U.S.-born citizens when it comes to coverage. They can apply for Medicaid under the program’s broadened guidelines if their income is low enough.

Other types of immigrants will also qualify regardless of how long they’ve been in this country: asylum seekers and refugees, special immigrants from Iraq and Afghanistan, victims of trafficking and immigrants who served in the armed services.

They will be among an estimated 250,000 people who state officials estimate will become newly eligible under the expanded Medicaid limits for those with incomes up to 138 percent of the federal poverty level — or $15,856 for a single person.

Meanwhile, other legal immigrants — those with higher incomes or those here for fewer than five years, people temporarily in this country, such as students and work-visa holders, as well as people like Afkas — won’t qualify for Medicaid.

They may, however, purchase insurance from the exchange, using the Washington Healthplanfinder.

Those among them with incomes between 139 and 400 percent of the federal poverty level — $45,960 for a single person — will qualify for subsidies and tax credits to help cover insurance premiums.

And all low-income children, regardless of their immigration status, will be covered under any number of federal and state health care programs.

For adults in the country unlawfully, the government has little to offer.

While most undocumented immigrants work in jobs that do not provide health insurance, it is estimated that 25 percent of them do have coverage.

Still, undocumented immigrants account for about 14 percent of the state’s uninsured. And those with no coverage — an estimated 127,530 in this state — will continue to go bare.

Undocumented adult immigrants now are unable to participate in Medicaid or Medicare and that won’t change. They are also ineligible to purchase from the health exchange. But unlike most other groups, they won’t face a penalty for not having insurance.

There is coverage available for low-income women during their pregnancy — regardless of their immigration status — and like everyone else, undocumented immigrants continue to qualify for emergency care under federal law.

And those whose incomes would otherwise entitle them to Medicaid but for their immigration status can qualify for emergency Medicaid for emergent conditions, such as heart attacks.

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