The executive order President Obama issues this week will give up to 5 million undocumented persons a temporary reprieve from deportation and, in some cases, papers that allow them work legally. The order will not give them access to health benefits through Obamacare.
The New York Times has a story confirming this and, as I write this, it’s the lead item on the Times web page. But it shouldn’t really surprise anybody. Obamacare critics have frequently claimed that the law would mean giving health benefits to undocumented workers. That was the impetus for Representative Joe Wilson’s infamous “you lie!” outburst during Obama’s address to Congress in September, 2009.
As Obama said then, the truth is quite the opposite. By law, only immigrants who have green cards—i.e., those with permanent residency status, usually as part of the process towards obtaining full citizenship—are entitled to enroll in Medicaid or buy subsidized coverage through the new Affordable Care Act marketplaces. And the restrictions go beyond that. Even green card holders can’t get Medicaid until they’ve lived here for five years, although states have the right to waive that for children and pregnant women. Undocumented workers, meanwhile, are barred from buying marketplace coverage even if they are willing to pay the full cost on their own, without the offsetting tax credits. (This briefing from the Kaiser Family Foundation has all the details if you want them.)
Obama’s order will not grant anybody permanent residency status. It simply spares these people from the threat of deportation and allows them to work—and it does so only temporarily. That’s what makes it within the boundaries of law. Some advocates and legal experts say Obama has authority to grant these people access to health benefits. Via the Times:
Stephen W. Yale-Loehr, who teaches immigration law at Cornell, said he believed the president had the legal authority to decide whether the immigrants included in his executive actions qualified for federal health benefits.
“Just as the president has broad discretion to decide whether to allow undocumented individuals to get a temporary reprieve from deportation,” Mr. Yale-Loehr said, “he also has broad authority to decide whether to grant them work authorization and health benefits.”
But policy and legal experts I've consulted aren't so sure. At the very least, they say, the issue is murky. Giving these people access to Medicaid and Obamacare tax credits might require an act of Congress, they say, either to give these people permanent residency status or to change the Affordable Care Act’s provisions.
That’s not necessarily a good thing, by the way. Most Americans are understandably reluctant to spend taxpayer dollars on people who aren’t working with legal papers. But these people live and work in this country. When they get sick or injured, they need medical care—and, frequently, show up at the emergency rooms to get it. As Jason Millman notes at Wonkblog, the federal government already covers some of those costs indirectly through an "emegency Medicaid" provision.
The money our society spends on that care isn’t necessarily as much as it would cost to offer them insurance upfront, but the sums are still significant. Meanwhile, there are all kinds of public health arguments (not to mention moral reasons, if you’re so inclined) why extending these folks insurance would be the right thing to do.