Column: Trump admin issues new crackdown on immigrants with health insurance mandate 

October 20, 2019 5:30 am

Susan J. Demas

On Oct. 4, the President Trump administration issued a proclamation targeting the health insurance market and legal immigration into the United States. The impact of this action on all health care consumers – immigrants and citizens alike — could be far-reaching.

The recent executive action by the administration leverages the same authority the president used when issuing bans on certain asylum seekers and travelers from select Muslim-majority countries

In this case, the administration seeks to deem anyone applying for an immigrant visa after Nov. 3, a “financial burden” unless they demonstrate they will have health insurance coverage within 30 days of entry or could pay out-of-pocket for their medical costs. 

The Trump administration excludes Medicaid (for adults) and subsidized Affordable Care Act (ACA) Marketplace plans from the list of approved health insurance. But it’s important to note that almost 90% of Marketplace consumers depend on tax credit subsidies to purchase their coverage. 

Plus, despite signing legislation that zeroed out the individual mandate, the president now seeks to establish a health insurance mandate for new immigrants. Many new immigrants, like the majority of Marketplace consumers, will find themselves unable to afford health insurance without subsidies, which will prevent them from obtaining the coverage necessary for their entry in the United States.

The proclamation comes at a time when changes to policies affecting legal immigration are already in the spotlight. The U.S. Department of Homeland Security’s “public charge” rule met strong opposition at each stage of the rulemaking process and garnered over 260,000 public comments (the vast majority in opposition). Last week, a federal judge in New York blocked the law, followed by rulings in several other U.S. District Courts. 

Similar to the public charge rule, this proclamation targets new immigrants with low or moderate incomes and their family members who hope to enter the United States in the future. 

That’s because maintaining health coverage in this country is expensive — particularly for those who are not covered by an employer or public programs like Medicare or Medicaid, or those who do not receive subsidies to purchase coverage through the individual marketplace. 

For some, cost prevents them from purchasing health insurance all together. With fewer people in the insurance market, premiums increase and rates of uncompensated care climb. Although the proclamation does discuss this cycle and the impact on consumers, the Trump administration resolves to scapegoat immigrants for systemic issues that their own health policy decisions have exacerbated.

Instead of supporting and improving the ACA, which dramatically reduced rates of uncompensated care and the uninsured rate among immigrants from 32% to 20% between 2013 and 2017, the Trump administration continues to sabotage the health care law. Many actions have directly targeted the Marketplace and the currently insured; broadening access to “junk” plans, cutting subsidies to marketplace consumers and slashing funding for outreach and in-person assistance are a few examples. 

These decisions have contributed to the first uptick in the rate of uninsured, nationally and in Michigan, since the passage of the ACA in 2010. Moreover, the Trump administration has taken the unprecedented stance to not defend federal law and instead support a lawsuit to overturn the entire act.

Moving forward, we can expect this new proclamation to be challenged in court before its implementation on Nov. 3, just like the many executive actions targeting legal immigration before it.

Yet, similar to the public charge rule, broad executive actions, complex multi-step regulatory changes and word-of-mouth among affected communities may still contribute to confusion and a chilling effect that is real, persistent and harmful. 

In this case, lawfully permanent residents may drop their health insurance coverage altogether, despite being legally enrolled, particularly given the timing. With the timing of this proclamation so near to the Health Insurance Marketplace’s open enrollment period — which begins on Nov. 1 and ends on Dec. 15 — health care advocates must push against the administration’s attempts to disrupt the health insurance market and target a legal path to immigration. 

Let’s defend immigrant neighbors and communities — both present and future. 

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Simon Marshall-Shah
Simon Marshall-Shah

Simon Marshall-Shah is a state policy fellow at the Michigan League for Public Policy. He previously worked in Washington, D.C,. at the Association for Community Affiliated Plans (ACAP), providing federal policy and advocacy support to nonprofit, Medicaid health plans (Safety Net Health Plans) related to the ACA Marketplaces.