Health Exchange: Leaves Out State's 55,000 Undocumented Immigrants


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By Annika Darling

The Patient Protection and the Affordable Care Act went into effect Oct. 1. While thousands of Americans have already signed up and have already begun reaping the benefits from the new law, there is one group that cannot and will not be able to participate in the program —undocumented immigrants.
Although each state will recognize its own exchanges, across the board no state will recognize undocumented immigrants in regard to the new law. Undocumented immigrants will not be losing their rights to seek medical attention. All the new law states is that health care assistance will not be extended to them. Therefore, this new law will have absolutely no effect on the current state of health care for any of Connecticut’s nearly 55,000 undocumented residents.
Yvette Bello, executive director of the Latino Community Service in Hartford, however,  is hopeful there won’t be too much negative impact on undocumented immigrants. She said, “The undocumented are left out of health reform, but are still left with the same resources as they have now, emergency room care and free clinics, and until funds run out they have community-based health organizations like Latino Community Services that provide comprehensive, culturally specific prevention education, case management and community counseling.”
Even though it seems restrictive, there are still choices for undocumented immigrants post-health care reform. The overwhelming issue seems to be redirecting them from the ER into the clinics and community organizations where they can seek preventative care.
Yanil Teron, at the Center for Latino Progress said, “They don’t lose their rights to go to a hospital or see a doctor, it’s just that they will not be able to participate in insurance assistance.”


The Patient Protection and the Affordable Care Act is also known now as Obamacare. Obamacare, Obama Care and health care reform are all the same thing, though the term Obamacare came from a derogatory reference about the law from Republicans, it now has been widely accepted as the common substitute name for the law.
Signed into law to reform the health care industry by President Barack Obama on March 23, 2010, Obamacare’s goal is to give more Americans access to affordable, quality health insurance and to reduce the growth in health care spending in the U.S.
However, there are many who are concerned it will fall short of this goal, especially when one steps back and considers the impact of undocumented workers, since the law does not take them into account there is a whole sector of the health world that is not going to be fixed by reform.

Questions remain

When the law goes into effect, there will be a huge sum of money taken out of funding emergency rooms, but this is where most undocumented immigrants end up seeking care. With this funding gone, who will then take on the medical burden of undocumented immigrants? While other low-income people will be taken in by Obamacare, and, therefore, able to seek preventative care, rather than ending up in the ER, undocumented immigrants don’t have the same choices.
According to the Congressional Budget Office about 7 million to 8 million undocumented immigrants will remain uninsured under the Affordable Care Act.
Raquel Donoso, CEO of the Latino Community Foundation, said, “A lot of people are not happy that there is this whole segment that is left out of access. There’s a lot of question in terms of what is going to happen and what we are going to do with families that are not covered. I have to say there probably are a lot more questions than there are answers at this point.”
This is what the landscape will look like for undocumented persons with the new health care reform in place:

  • No federal coverage.
  • Not allowed to purchase private health insurance at full cost in state insurance exchange(s).
  • Not eligible for premium tax credits or lower copayments.
  • Exempt from individual mandate.
  • Not eligible for Medicare, non emergency Medicaid, or CHIP.
  • Remain eligible for emergency care under federal law.
  • Eligible for Emergency Medicaid if low-income.

Citizen or lawfully present children of undocumented parents are eligible:

  • To purchase from the state insurance exchange.
  • For premium tax credits and lower copayments.
  • For Medicaid or CHIP.
  • May seek non emergency health services at community health centers or safety-net hospitals.

Advocacy and Solutions

There is a push by several groups ,including the California Endowment, to win immediate health reform benefits for undocumented immigrants, but so far neither Obama, nor Congress, has shown any interest.
Donoso said, “It really is whether or not something can be done around immigration reform, whether or not we can get families on a path to citizenship. Even then in the immigration reform bill it is a long process. It’s not an overnight process. So, where along that process will families be able to access other resources and government services is a big question mark.”
While there are many political obstacles to getting undocumented immigrants better access to health care, Donoso said the new reform itself is an obstacle.
She said, “Honestly, I feel that part of this issue is that there is so much work to be done around who can get coverage that I feel that that’s taking up a lot of time, and so for a lot of it, advocate organizations that are doing that work, they are all focused on getting the word out and trying to get peopled covered. So, the question is: how much can we actually do.”
As it stands, for undocumented workers to be eligible for Obamacare, well they simply have to become documented. Though that’s easier said than done. And there’s a significant waiting period even after one files a petition to become a “”Lawful Prospective Immigrant.” After this, they must hold this newly created status for at least eight years. From there, they are considered a “Legal Permanent Resident,” and they receive a green card. They must hold the green card for at least five years to qualify for public health benefits including the expanded version of Medicaid created by reform.
So, for undocumented immigrants the waiting period to qualify for public benefits could vary anywhere between 10 to 13 years, depending on how you tie into the employment and educational needs of the U.S.
According to a leaked copy of the president’s proposal, undocumented immigrants must get in the “back of the line.” Unfortunately, however, the line most undocumented immigrants are most likely to get into … is the one at the emergency room.


“The really bad part of that,” said Donoso, “is that all over the nation we’ve really been pushing for people not to use the emergency room as first source of care, and to be treated and get care preventatively in order to lower the cost -— emergency care is very expensive. So, that’s the other thing to worry about if that does happen and people are scared to go to their doctor and seek preventative care, at some point they may end up in the emergency room where it’s really expensive.”
Other areas of concern are what will happen to the clinics that are currently serving a vast majority of undocumented and low-income families. As it is, a lot of the clinics are just blanketly serving the community. However, if the low-income families can go to other places and get health insurance, one of the worries is that there will be a feeling that community clinics are only serving undocumented families, which then makes the clinics very vulnerable politically.
Donoso said, “We don’t want clinics to be seen as just providing care to undocumented, so we think there’s kind of an issue there, and what do we do about that.”
Not only are clinics fearful of being stigmatized, but now there is a fear that those without insurance will be assumed to be undocumented. Already as it is there’s a lot of trepidation for families who don’t have all their papers in order to seek services, and this may be the extra stigmatizing factor that really makes it hard for them to seek services when they need it.
For these reasons and more Donoso said it just doesn’t make sense to leave this whole group out. “I know politically that has to be done,” she said, “but for most families and for most people who care about their family’s health it makes more sense for us all to be covered. I think all around it makes for a difficult situation.”


Private health insurance is one option for undocumented immigrants, although the cost may be out of reach for many. Another option is getting health care through community clinics.
In addition, there are 166 medical facilities in the country that must provide free care under the Hill-Burton Act, a federal law that passed in 1946. It authorizes federal funding for public and nonprofit medical facilities, such as acute care general hospitals, special hospitals, nursing homes, public health centers and rehabilitation facilities. You don’t have to be a U.S. citizen to be eligible for Hill-Burton free care, but you must have lived in the United States for at least three months.
However, some people may agree with former President Jimmy Carter ,when after signing a bill effectively denying the right to abortion to women who couldn’t pay for one, he said, “There are many things in life that are not fair.”