Health care reform and immigration policy reform seem separate, but, in fact, success in achieving the long-term goals of health care reform cannot be achieved without comprehensive immigration reform.
First, one of the key shortcomings of the Affordable Care Act is its exclusion of millions of both legal and undocumented immigrants from its expansions of health insurance coverage. The ACA continues the five-year ineligibility of legal permanent
residents for Medicaid originally enacted in 1996. And while the Obama administration is granting temporary legal status to undocumented youth through the Deferred Action for Childhood Arrivals program, it made these hundreds of thousands of youth ineligible for Medicaid. It will take comprehensive immigration policy reform to restore eligibility for Medicaid for all legal immigrants.
Second, health insurance exchanges must verify the citizenship and immigration status of all applicants. If the exchanges rely on the same Department of Homeland Security verification system currently available to employers, there will be many wrongful denials of coverage due to the notoriously erroneous DHS database. Improving the accuracy of the immigration status verification system can only be addressed through comprehensive immigration reform.
Third, there is continuing misinformation in immigrant communities that using health care can jeopardize one's future immigration status under the "public charge" exclusion in immigration law. California's immigrants are particularly vulnerable to this myth, resulting in the chronic under-enrollment of eligible immigrants in Medi-Cal. A definitive clarification that receiving health insurance or health care services is irrelevant to the public charge exclusion can only be enacted by Congress as part of immigration legislation.
Fourth, health care providers left to care for the uninsured will face heightened political scrutiny as publicly funded organizations who serve immigrants, including undocumented immigrants. In the rhetoric of immigration policy debates, the distinctions between legal and undocumented immigrants are easily obfuscated. Safety-net providers such as community health centers and public hospitals will easily become vulnerable to anti-immigrant-motivated budget cuts.
Finally, health care reform cannot succeed without continued reliance on international medical graduates to provide primary care, especially in underserved areas. Immigration policy fairness should include more pathways for international graduates (and their families) to remain in the U.S. and become permanent members of our health workforce and society. A parallel pathway would be supporting immigrant youth in pursuing health careers since many come from the same underserved communities.