Sec. 2. Findings; purpose

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Congress finds as follows: Health insurance coverage reduces harmful racial, economic, gender, and health inequities by alleviating cost barriers to, and increasing utilization of, necessary health care services, especially among low-income and underserved populations. Based solely on their immigration status, many immigrants and their families face legal and policy restrictions on their ability to obtain affordable health insurance coverage through Medicaid, the Children’s Health Insurance Program (CHIP), and the health insurance exchanges.

Lack of health insurance coverage contributes to persistent inequities in the prevention, diagnosis, and treatment of health conditions. This leads to negative health outcomes for immigrants and their families, especially Black, Indigenous, Latinx, Asian, Pacific Islander, and other Immigrants of Color. Black immigrant women often cite cost as a major barrier to health care. Many who are undocumented forgo doctor visits altogether due to the financial burden in addition to consistent racial bias by medical practitioners and racism in health care.

Nearly half of immigrant women are of reproductive age. Immigrant women, lesbian, gay, bisexual, transgender, and queer (LGBTQ) immigrants, and immigrants with disabilities disproportionately live in households with low incomes and lack health insurance coverage. Legal and policy barriers to affordable health insurance coverage significantly exacerbate their risk of negative pregnancy-related and other reproductive and sexual health outcomes, with lasting health and economic consequences for immigrant women, LGBTQ immigrants, immigrants with disabilities, and their families and society as a whole.

Immigrants who identify as LGBTQ experience compounding discrimination from health care providers and systems based on race and ethnicity, primary language, immigration status, sexual orientation, and gender identity. Nearly one in five transgender patients have been refused care due to their gender non-conforming status, and providers have denied care to undocumented immigrants because of immigration status. These inequities are exacerbated by legal and policy barriers that restrict access to health coverage on the basis of immigration status, exposing LGBTQ immigrant communities to disproportionate gaps in affordable, comprehensive health care.

These compounding barriers are especially harmful for LGBTQ immigrants who are escaping interpersonal and state violence due to their sexual orientation and gender identity. Denying health insurance coverage or imposing waiting periods for health insurance coverage on the basis of immigration status unfairly hinders immigrants’ ability to reach and maintain their optimal levels of health and undermines the economic well-being of their families. International human rights standards hold that governments have an affirmative obligation to ensure that everyone, including immigrants, can access safe, respectful, culturally and linguistically appropriate, and high-quality pregnancy-related care, including postpartum care, free from discrimination or violence.

Medicaid is the nation’s single largest payer for pregnancy-related care. Nevertheless, barriers to health coverage persist for pregnant and postpartum people, particularly immigrants. Immigrants—especially Black, Indigenous, Latinx, Asian, and Pacific Islander immigrants—are among those most harmed by the United States’ pregnancy-related morbidity and mortality epidemic, which is the worst among high-income nations. Black people are more than three times more likely than white people to suffer pregnancy-related death, and twice as likely to suffer maternal morbidity.

Indigenous people are more than two times more likely than white people to die from a pregnancy-related death. The majority of United States pregnancy-related deaths are preventable. Lack of access to health care, immigration status, poverty, and exposure to racism, sexism, and xenophobia in and beyond the health care system contribute to the disproportionately high number of pregnancy-related deaths among BIPOC birthing and postpartum people. Unnecessary barriers that limit pregnant and postpartum immigrants’ access to health care undermine their health, safety, and human rights.

One in seven United States residents is foreign-born, approximately one in four children in the United States has at least one immigrant parent, and the population of immigrant families in the United States is expected to continue to grow in the coming years. It is therefore in our collective public health and economic interest to remove legal and policy barriers to affordable health insurance coverage that are based on immigration status. Although individuals granted relief under the Deferred Action for Childhood Arrivals

(DACA)program are authorized to live and work in the United States, they have been unfairly excluded from the definitions of lawfully present and lawfully residing for purposes of health insurance coverage provided through the Department of Health and Human Services, including Medicaid, CHIP, and the health insurance exchanges. Since immigration law evolves constantly, new immigration categories for individuals with federally authorized presence in the United States may be created. Some States continue to unwisely restrict Medicaid access for immigrants who have long resided in the United States, fueling significant health inequities and increasing health care costs for individuals and the public. Congress restored Medicaid eligibility for individuals living in the United States under the Compacts of Free Association as part of bipartisan legislation in December 2020 and should build on that success by ensuring all immigrants can access care. It is the purpose of this Act to— ensure that all individuals who are lawfully present in the United States are eligible for all federally funded health care programs; advance the ability of undocumented individuals to obtain health insurance coverage through the health insurance exchanges established under part II of the Patient Protection and Affordable Care Act, Public Law 111–148 ; eliminate the authority for States to restrict Medicaid eligibility for lawful permanent residents; and eliminate other barriers to accessing Medicaid, CHIP, and other medical assistance.

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Pub. L. 111-148

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Sec. 2

Findings; purpose

Pub. L.Pub. L. 111-148

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