The Health 202: 'Dreamers' have yet another worry: Losing their health coverage

The Health 202: ‘Dreamers’ have yet another worry: Losing their health coverage


Originally published by The Washington Post

Young immigrants known as "dreamers" may have gotten a respite from the Supreme Court yesterday as it refused to take up their case, pushed by President Trump after a lower court ruled the administration couldn't terminate their legal status in the United States.

But those protected by the Deferred Action for Childhood Arrivals, implemented by then-President Obama, still have plenty to worry about, including a lack of congressional will on the issue.And there's one more thing: dreamers risk losing health coverage if they're protected status isn't renewed along with their work permits.

DACA didn’t significantly expand access to the federal health-care programs that's enjoyed by American citizens -- such as subsidized health coverage in the Obamacare marketplaces. But it did open the door for more young immigrants to obtain coverage through employer plans and a few state Medicaid programs.

Let’s be clear about one thing: dreamers who have managed to get health coverage aren’t going to suddenly lose it on March 5. That deadline is now relatively meaningless, even though that’s the date set by the Trump administration for the end of DACA unless Congress intervenes.

Federal district judges in California and New York have issued nationwide injunctions against ending the program. And yesterday, the Supreme Court essentially bought DACA recipients even more time by declining to hear arguments, meaning young undocumented immigrants can continue applying for permit renewals while the case works its way through the legal system, The Washington Post’s Robert Barnes reports.

“The litigation now will take its usual course, and the issue probably won’t return to the Supreme Court before the next term,” Bob writes. “In the meantime, the White House and Congress can continue to seek a political resolution.”

Trump, who was meeting yesterday with governors at the White House, had this to say: “We’ll see what happens. That’s my attitude.”

But as the shadow of a potential end to DACA encroaches, some dreamers — who were brought illegally to the United States as children by their undocumented parents — have practical concerns like health coverage.

Wild disparities remain between the uninsured rate of undocumented immigrants — 39 percent among the non-elderly, according to the Kaiser Family Foundation — and American citizens, 9 percent of whom lack coverage. Those immigrants who secured DACA status didn’t gain eligibility under federal rules to enroll in Medicaid or buy private plans on the Affordable Care Act’s marketplaces, even if they cover the full cost themselves.

Here's a picture of the problem from the Guttmacher Institute, a pro-abortion rights research group:

And from the Southern Poverty Law Center:

However, the program did allow more of these young people to access employer-sponsored coverage if they were able to find a job with such perks. More than 50 percent of DACA recipients got a job that offered health coverage or other benefits, according to Georgetown University’s Health Policy Institute.

Coverage from these employer-sponsored plans wouldn’t end right away if and when DACA protections are eliminated. But they would wind down if a dreamer had to quick work because of an expiring work permit. DACA work permits are due to expire in a staggered fashion only if Congress and the courts allow the protections to fade away. It appears unlikely Congress will act anytime soon and certainly not this week, as lawmakers return to Washington for just two days.

Another option for dreamers is Medicaid programs in 10 states that have chosen to put their own dollars toward coverage for undocumented immigrants, as state officials are not allowed to use federal Medicaid funds to cover dreamers.

Last month, New York Gov. Andrew M. Cuomo (D) doubled down, announcing that 42,000 dreamers in his state will remain eligible for state-funded Medicaid regardless of whether DACA expires.

“The federal government’s failure to take action to protect DACA recipients is appalling, un-American, unjust and puts hundreds of thousands of children at risk,” Cuomo said at the time. “Here in New York we will do everything in our power to protect DACA recipients and ensure they receive health care.”

California, which also gives DACA recipients access to its Medi-Cal program if the immigrants earn less than 138 percent of the federal poverty level, made a similar move. After Trump’s announcement last fall to end DACA, the state posted this on its website: “There will be no change to the Medi-Cal coverage for DACA recipients (adults or children) in California.”

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