It’s all fun and games until someone starts talking about “Obamacare.” Then it gets ugly. The immigration bill winding its way through Congress in a generally bipartisan fashion has met its biggest barrier in the law most closely associated with the president.
At issue is how immigrants transitioning to citizenship would obtain health coverage. Democrats and the White House have conceded to Republicans’ demands that this group should not benefit from the Affordable Care Act. That’s tricky because President Obama’s signature health care law deliberately includes all legal immigrants, including those on temporary visas. (Other safety-net benefits, such as Medicaid, are available to longtime green-card holders only.)
Thus, to comply with the GOP’s insistence on keeping newly legalized immigrants off the public dole, the immigration bill has to modify eligibility under the health care law. Cue Jaws theme.
Republicans have not been shy about aiming to kill the health care law through outright repeal or challenges to its essential components. So it’s no surprise they want newly legalized immigrants to be responsible for their own health care—on the hook for any bills that a hospital, doctor, or private insurer sends them—and they want transitioning immigrants to be penalized if they fall behind on health payments. Deportation is the harshest option, but a likelier scenario is that those with unpaid debts would remain in a probationary status in perpetuity. Citizenship applicants must prove they are not a drain on the public coffers, and health care debt would disqualify them.
“That’s one car accident from disaster, ending any chance of citizenship,” said Jennifer Ng’andu, director of health and civil rights at the National Council of La Raza, a Hispanic advocacy group.
If, despite Republicans’ best efforts, the health care law is in full effect in 2014, immigrants who don’t have employer-sponsored coverage would be allowed to buy insurance on the state-run exchanges. They would not, however, be eligible for any of the subsidies designed to help low-income families. Without the subsidies, sometimes worth thousands of dollars, many immigrants would find buying insurance prohibitively expensive. According to one hypothetical scenario from the Henry J. Kaiser Family Foundation, a person earning $28,735 a year could receive a tax credit of $3,420 to cover the cost of a $5,733 annual premium.
Left-leaning advocates are so disturbed by the prospect of immigrants being excluded from reasonable health care options—and, by extension, citizenship—they are mulling how far they should let the conversation continue before they make a serious fuss. “It’s been difficult for us as an organization about how we talk about what’s good,” said Wendy Cervantes, vice president of immigration and child-rights policy at the children’s group First Focus. “There are really important things in this bill, like the pathway to citizenship, but there are things here that are going to hurt kids down the line.”
Progressives see legalization of the undocumented population as a huge improvement, not just for immigrants but also for the country as a whole. For example, the immigrants most likely to be buying their own insurance are the young and healthy—just the kind of folks the insurance pools need to balance out the high-risk people who tend to populate individual insurance plans.
Yet to even engage in this line of thinking requires an inkling of faith in the health care law, something found almost exclusively among Democrats. It is difficult to overstate Republicans’ antipathy for Obama’s health care program, even if they are fully on board with an immigration overhaul. One such Republican, Sen. Lindsey Graham of South Carolina, tossed off this crack about newly legalized immigrants’ participation in the insurance exchanges: “If they want to buy [the plans] themselves, that’s fine. I don’t care. Good luck finding one.”
Sen. Marco Rubio, R-Fla., who helped draft the Senate immigration bill, said Monday that people who are worried about the impact of a newly legalized population present a “very compelling argument for repealing Obama-care.” On Tuesday, he called for a constitutional amendment to negate the health care law’s individual mandate. On Wednesday, Rubio spent almost two hours in a closed-door meeting with skeptical House conservatives trying to win them over to his immigration legislation. Translation: Obamacare bad; immigration good. It’s not stretching too far to conclude that conservatives supporting immigration reform see the overhaul as one way to mess up Obamacare.
It doesn’t help that leaders in both parties have zero trust in their counterparts across the aisle when it comes to the health care law. Paranoia reigns. House Republicans have called for so many votes to repeal Obama-care that Democratic leaders get suspicious at the slightest whisper of health care language being inserted in an immigration bill, according to one person close to the debate. Is it just another run at repeal? Republicans, meanwhile, believe Obama cares more about courting Hispanics politically and blaming them for failure, than compromising on immigration legislation. So why bother helping him make his flawed health care law work for immigrants?
For anyone who wants the immigration bill to fail, the health care conundrum provides the golden opportunity. “The immigration bill is going to flounder on Obamacare eligibility,” said Dan Stein, president of the Federation for American Immigration Reform, which calls for reduced immigration.
Stein predicts that legalizing unauthorized immigrants would create a long-term philosophical shift toward major “income-transfer programs,” because most of the newly legalized people would be poor. He says Republicans are kidding themselves if they think they can curb that trend by mandating no health care benefits for immigrants. “The Rubio amnesty plan will solidify support for national health care,” Stein said. “It will immunize Obamacare.” That is, unless Obamacare doesn’t kill the immigration effort first.