For many immigrants who are legal permanent residents, the U.S. Supreme Court decision in June 2012 that upheld the Affordable Care Act, popularly known as Obamacare, will change their lives in a meaningful way.
But for the 11.5 million immigrants who are living in the country illegally, nothing about health care will change at all.
Many of the details of the law have yet to be worked out, and more challenges in the courts are virtually certain. But most questions have answers that are only a few computer clicks away.
Even after the Supreme Court’s ruling, the governors of some states say they will not implement some of the the provisions the law requires, defying the court and the Obama administration.
But here is a preliminary look at what’s likely ahead for immigrants as the Affordable Care Act begins to take hold:
Documented immigrants, those with green cards and other permanent residents, are subject to the individual mandate and will be required to buy health insurance beginning in 2014 when the law goes fully into effect. The government will require immigrants to verify their legal status before entering the new health care system.
These legal immigrants will be able to buy their insurance through the exchanges that the states are assigned to set up. Documented immigrants whose incomes fall between certain federal poverty levels will be allowed to apply immediately for government subsidies and credits to help them buy their insurance on the exchanges.
But most documented immigrants will not be allowed to enroll in Medicaid until they have lived in the United States for at least five years. The government will make some hardship exceptions for refugees and asylees.
Those documented immigrants with preexisting conditions will be able to enroll in high-risk pools and receive subsidized premiums.
The children of documented immigrants will receive the same benefits and are subject to the same rules as their parents. The states will still run the Children’s Health Insurance Program (CHIP) and set requirements for children and pregnant women.
The government considers foreign nationals who are here on student and temporary work visas to be “non-immigrants” and they are not subject to the Affordable Care Act.
Undocumented Immigrants Are Excluded
Because they have no legal status, undocumented residents are exempt from the individual mandate to buy health insurance.
Undocumented residents cannot purchase insurance through the exchanges, and they are not eligible for any health care subsidies. People without legal status are also excluded from Medicaid and CHIP.
To receive health care, undocumented immigrants will have to depend on charities and public or not-for-profit hospitals. They will continue to get what care they can from community health centers and other safety-net providers. They will continue to show up in hospital emergency rooms and seek last-resort treatment.
Some comprehensive immigration reform bills that have surfaced in Congress have included plans to integrate the nation’s 11.5 million undocumented residents into the health care system gradually over time.
But those bills haven’t gone anywhere and are unlikely to receive any attention until well after the 2012 election.
Republican Governors Dragging Feet
In all, 26 states with Republican leadership challenged the Obama administration on its health care plan. A growing number of the GOP governors are refusing to begin setting up the insurance exchanges or making other preparations to enact the law, hoping instead that the November 2012 elections will put new leadership in Washington and make the Affordable Care Act go away.
The expansion of Medicaid in the law is expected to provide coverage for 17 million Americans. But states with Republican governors are balking at expanding their Medicaid programs to comply.
“Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program,” said Florida Gov. Rick Scott, saying the law puts too great a burden on the state.
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