Why Immigrants Struggle to Get Health Coverage

For this week’s installment of Countdown to Coverage 2016 we’re looking at some of the challenges uninsured lawfully present immigrants often face when trying to get health insurance.
Two key reasons why legal immigrants may go without health coverage are confusion about their eligibility to purchase Marketplace health plans, and fear that applying for health insurance will jeopardize undocumented family members or prevent lawfully present family members from gaining citizenship.
Marketplace coverage eligibility expanded for legally present immigrants
Beginning in 1996, Texas banned legal immigrant adults from receiving Medicaid with few exceptions. This historic exclusion of legal immigrants from the Medicaid system may lead some to believe that they are also not eligible for Marketplace plans. Lawfully present immigrants in Texas may not be aware that the Affordable Care Act created new opportunities for them to access affordable health insurance.
Because Texas excludes lawfully present immigrant adults from receiving Medicaid, even immigrants who might otherwise fall into the “Coverage Gap” if they were U.S. citizens are eligible for significant financial assistance to lower their premiums and cost-sharing. While this is an important benefit that can help decrease the rate of uninsured immigrants, we’ll explore some of the procedural hurdles consumers face in a future Countdown to Coverage post.
Fear of jeopardizing undocumented relatives
Immigrant families are often fearful that using official government programs could expose and threaten undocumented relatives living in the U.S.
As a result, legal immigrants may avoid applying for and using health insurance because they fear deportation of family members who are not in the states legally. They may also fear that using government health care programs could block access to legal status or U.S. citizenship.
The U.S. Immigration and Customs Enforcement has issued guidance to reassure families that the agency will not use the information applicants submit for health insurance eligibility for civil immigration enforcement purposes.  There is also guidance clarifying that use of health care will not be a bar to getting a green card or becoming a citizen.
While the Affordable Care Act has provisions meant to make accessing health insurance easier for legal immigrants, including those excluded from Medicaid, the system is still riddled with challenges that contribute to the relatively high rate of uninsured immigrants in Texas.
Health insurance navigators, enrollment assistors and other advocates can be instrumental in getting the word out to immigrant communities about their eligibility for insurance coverage, and make clear that purchasing and using subsidized health insurance will not harm undocumented family members.
In a future Countdown to Coverage post we’ll explore the limitations of the application process on Healthcare.gov, which can increase the obstacles legal immigrants face when buying health insurance.

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