A Project of The Annenberg Public Policy Center

Immigrants and Insurance


Several readers have e-mailed us about a report from the Congressional Research Service that they say proves illegal immigrants will have coverage under the proposed House health care plan. In fact, that report says exactly what we concluded yesterday: The bill does not provide coverage for illegal immigrants, but there’s no enforcement mechanism explicitly specified. The newly created Health Choices Commissioner would be responsible for deciding how applicants for the affordability credits would need to prove their eligibility.

The CRS report states, as we have reported, that section "246 would bar unauthorized aliens from receiving any premium or cost-sharing credit." It goes on to address the Republican objections we wrote about in our article on Obama’s health care speech:

CRS, Aug. 25: Some have expressed concerns that since H.R. 3200 does not contain a mechanism to verify immigration status, the prohibitions on certain noncitizens (e.g, nonimmigrants and unauthorized aliens) receiving the credits may not be enforced. However, others note that under §142(a)(3) of the bill, it is the responsibility of the Health Choices Commissioner (Commissioner) to administer the “individual affordability credits under subtitle C of title II, including determination of eligibility for such credits.” Thus, it appears, absent of a provision in the bill specifying the verification procedure, that the Commissioner would be responsible for determining a mechanism to verify the eligibility of noncitizens for the credits.

The Health Choices Commissioner would also be responsible for deciding how and whether credits should be administered to families where some members are unauthorized and others are not, for example a family where a child is born on American soil to a citizen and an unauthorized immigrant spouse.

CRS also found that the bill technically requires illegal immigrants to obtain health insurance, but that’s hardly a benefit and certainly not a cost to taxpayers. In fact, under this interpretation, they could be fined if they fail to obtain it. This is because there is no language distinguishing legal from illegal immigrants in the category of "resident aliens," who are defined for purposes of federal income tax laws as those who have lived in the U.S. at least 31 days in the previous year and 183 days in the previous three years.  

The House bill also contains no restrictions on undocumented immigrants buying insurance policies through the new Health Insurance Exchange if they are not already covered. However, they would have to buy it at their own expense, not with any subsidies paid for by taxpayers, just as they do now. In fact, millions of illegal immigrants have private health insurance now. As we”ve written before, about half of undocumented immigrants already have coverage, according to the nonpartisan Pew Hispanic Center (those who don’t have insurance are usually in jobs that don’t offer it). They receive no government funds for this and cost the taxpayers nothing – and that wouldn’t change under the proposed bill.

If the exchange includes a federal option, illegal immigrants could also participate under the current House bill. But again, this is a matter of paying for their own insurance out of pocket, not receiving taxpayer funds – the federal option is government-administered, but it is not government-subsidized except through the "affordability credits" that the bill says may not be paid to illegal immigrants.

Update, Sept. 12: White House offocials told reporters late on Sept 11 that the president now favors requiring proof of citizenship before someone could purchase insurance through the exchange, MSNBC reported.

According to MSNBC, the White House issued the following "bullet points" outlining its position on the matter:

    • Undocumented immigrants would not be able to buy private insurance on the exchange. Those who are lawfully present in this country would be able to participate.

    • Undocumented immigrants would be able to buy insurance in the non-exchange private market, just as they do today. That market will shrink as the exchange takes hold, but it will still exist and will be subject to reforms such as the bans on pre-existing conditions and caps.

    • Verification will be required when purchasing health insurance on the exchange. One option is the SAVE program (Systematic Alien Verification for Entitlements) which states currently use to make sure that undocumented immigrants don’t participate in safety-net programs for which they are ineligible.

The White House also stated that there would be no change in the present law which compensates hospitals for treating illegal immigrants in emergency rooms.