Senior Policy Analyst
To enroll in health plans sold in the Affordable Care Act (ACA) marketplaces, individuals must verify that they are U.S. citizens or have an immigration status that allows them to live in the United States. The Senate health bill would close the door to many immigrants with lawful immigration status who want to buy insurance plans in the marketplaces. It goes even further than the already harsh House-passed bill to repeal the ACA in preventing people who are in the United States lawfully from obtaining health insurance.
Under the House bill, immigrants who are lawfully present could enroll in marketplace plans but would only be eligible for tax credits to help pay for coverage if their lawful immigration status was among the narrow group of statuses considered “qualified aliens.”
Since the 1996 welfare law, the term “qualified alien” has been used to identify a group of immigrants who may qualify to enroll in certain public benefit programs. Since the vast majority of marketplace enrollees can’t afford coverage without tax credits, the House bill would keep most lawfully present immigrants who don’t have “qualified alien” status from buying marketplace coverage.
The Senate bill goes even further by requiring marketplace enrollees to have their U.S. citizenship or “qualified alien” status verified in order to enroll in marketplace coverage even without tax credits. This shuts the door to marketplace coverage entirely to many immigrants with permission to live in the United States, such as university researchers and students and people in the process of gaining permanent resident status like those who are newly married to U.S. citizens.
One left-out group are individuals from the Federated States of Micronesia, Republic of the Marshall Islands, and Republic of Palau who work and reside in the United States under Compacts of Free Association (COFA). These individuals often live and work in the United States for most of their lives and have families here, often including U.S.-born children. COFA communities, like other lawfully present people, have permission from the federal government to live and work here and pay U.S. taxes but will no longer be able to buy insurance to get access to comprehensive medical services and provide financial security under GOP plans to repeal the ACA.