Governors who reject health insurance
for the poor under the federal health care overhaul could wind up in a
politically awkward position on immigration: A quirk in the law means
some U.S. citizens would be forced to go without coverage, while legal
immigrants residing in the same state could still get it.
It's an unintended consequence of how last year's Supreme Court
decision changed the Medicaid provisions of President Barack Obama's
health care law. The overhaul expanded the federal-state program for
low-income and disabled people. The Supreme Court made the Medicaid
expansion optional for states, which complicated things.
Arizona officials called attention to the problem last week, when
Republican Gov. Jan Brewer opted to accept the Medicaid expansion.
Brewer had been a leading opponent of the overhaul, and her decision
got widespread attention. State budget documents cited the immigration
glitch as one of her reasons.
"If Arizona does not expand, for poor Arizonans below (the federal
poverty line), only legal immigrants, but not citizens, would be
eligible for subsidies," the documents said.
That's because the immigrants would be eligible for
government-subsidized private insurance, while low-income citizens would
not. The Obama administration confirmed Arizona's interpretation.
The gist of what Brewer was saying is that "by rejecting the
expansion, you are essentially rewarding the immigrant population at the
expense of full citizens," said Matt Salo, executive director of the
National Association of Medicaid Directors, a nonpartisan group that
represents the states in Washington.
"The political optics of that could be crushing," he added.
It could take some explaining for Texas Gov. Rick Perry, steadfastly
opposed to what foes dismiss as "Obamacare," and for Florida Gov. Rick
Scott, who is reassessing his position. Both states have large numbers
of uninsured citizens and legal immigrants.
"I think politicians will be under a lot of pressure not to create
these sorts of inequities," said Jennifer Ng'andu, a health policy
expert with the National Council of La Raza, one of the major Latino
advocacy groups. Her group supports the health care law and is urging
every state to accept the Medicaid expansion.
The quirk in the Affordable Care Act was not planned. It came about
on the twisting route that laws follow from Congress to the president's
desk and to the courts.
To be sure, no one is talking about the government buying health
insurance for illegal immigrants. That's not allowed under Medicaid or
Obama's law. Instead, the issue here is between U.S. citizens and legal
immigrants, those who are lawfully present in the country.
Here's the convoluted background:
Starting Jan. 1, 2014, the health care law will offer health
insurance to millions of people now uninsured. Middle-class uninsured
people will be able to get taxpayer-subsidized private policies through
new markets called exchanges. Low-income uninsured people will be
steered to Medicaid, a government program jointly funded by Washington
and the states.
Under previous laws, legal immigrants have to wait five years to
qualify for Medicaid. Ng'andu said Hispanic advocacy groups wanted to
lift that restriction during the 2009 congressional health care debate,
but couldn't get political support. The Medicaid waiting period remained
in place, but a compromise was reached that would allow low-income
legal immigrants to get subsidized private coverage in the new health
insurance exchanges.
The health care law expanded Medicaid to cover millions of low-income
adults who are ineligible under current rules. As written, the law
assumed that every state would accept the Medicaid expansion, with
Washington paying for most of it. So the law stipulated that people
below the federal poverty line — $11, 170 for a single person, $23,050
for a family of four— could not get subsidies for private coverage in
the exchanges. Medicaid was to be their only option.
Legal immigrants here for less than five years remained an exception.
Along came the Supreme Court. It upheld Obama's law, but ruled that
states were free to accept or reject the Medicaid expansion. The court
did not touch the issue of coverage for legal immigrants in the health
insurance exchanges. That provision remained in place.
And that's how the immigration glitch came to be. Poor people in a
state that turns down Obama's Medicaid expansion can only get government
subsidized coverage if they are legal immigrants. U.S. citizens are out
of luck.
So far 11 states have said they're not interested in the Medicaid
expansion. Meanwhile, while 17 states and Washington, DC, say they are
taking it. The rest are weighing their options. The immigration glitch
is now one of those considerations.
Ida
Wood had been living in relative peace as a recluse on a New York hotel
for 24 years when her sister died in 1931 and everything changed. One
of her lawyers, who was unfamiliar with Ms. Wood, worked to figure out
who this 93-year-old woman really was. For one thing, he discovered that
despite her miserly lifestyle, she was quite wealthy.
Need
to go to the bathroom? Better be quick, the clock is ticking. You've got
exactly two minutes, or you'll be fined. Late again, and you'll be fired.
