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.
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. Like the Hyde amendment’s prohibition on public insurance coverage for abortion care, immigration-related health care eligibility barriers have long curtailed access to abortion. In June 2022, in Dobbs v. Jackson Women’s Health Organization, the Supreme Court of the United States overturned the constitutional right to abortion, exacerbating pre-existing barriers.
In the year since the Dobbs decision was issued, 19 States have banned or restricted abortion—disproportionately impacting 15 million women of color and millions of transgender and nonbinary people. Notably, in 2022, 39 percent of all Latinas living in States that were likely to ban abortion following the Dobbs decision were born outside of the United States—this group includes people with varying citizenship statuses, among whom fear of surveillance may be particularly prevalent, due to disproportionate investigation and surveillance that many immigrant communities already face.
Bans and restrictions on abortion exacerbate the fear of criminalization in immigrant communities, and contribute to a chilling effect that leads many immigrants to forego reproductive health care and coverage of any kind as they navigate these intersecting risks of criminalization. Polling conducted in 2018 found one in four Latina/o voters (24 percent) had a close family member or friend delay or avoid health care because of fear related to discriminatory immigration policies, and one in five (19 percent) said the same about reproductive health care.
Ensuring access to crucial coverage of reproductive and sexual health services such as contraception and pregnancy-related care through Medicaid and the Affordable Care Act is imperative, with only half (52 percent) of immigrants at risk of unintended pregnancy receiving contraceptive care in the previous year. Many immigrants are being denied the basic human right to make the health care decisions they believe are best for them and their families, including abortion care, simply because of their immigration status.
In States along the Southern Border, immigrant communities are subject to interior checkpoints that increase the threat of family separation, deportation, and detention, and compound the harm of abortion restrictions that force people to travel to obtain care. Immigrants living without documentation, in particular, may have no way of obtaining an abortion when immigration enforcement and abortion restrictions combine to prevent them from traveling to a provider. Further, due to the high cost of travel associated with the onslaught of abortion bans, practical support organizations that assist with procedure and travel costs have been experiencing high demand, and struggle with inadequate resources.
Accessing support services can be out of reach for those without reliable technology to research and maintain contact with support services, or who encounter linguistic barriers when support services are not able to provide translators. For many, abortion care will be entirely inaccessible due to these compounding barriers, thus exacerbating the need for accessible reproductive and sexual health services such as contraception and pregnancy-related and post-pregnancy care. 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 nearly four times more likely than White people to suffer pregnancy-related death, and twice as likely to suffer maternal morbidity.
Indigenous people are two and a half 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. Delaying or denying health insurance coverage because of immigration status can impede mental health and substance use prevention and early intervention interventions.
Not acknowledging the impacts of trauma can impact mental health and substance use, and conditions may increase in severity without appropriate and consistent support and treatment. 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. On April 26, 2023, the Centers for Medicare & Medicaid Services
(CMS)published a proposed rule that would modify the definition of lawfully present used to determine eligibility for Patient Protection and Affordable Care Act
(ACA)health plans and certain other health care programs. Codifying these protections in legislation is crucial to ensure individuals granted relief under the Deferred Action for Childhood Arrivals
(DACA)program and those who gain new forms of administrative relief are not similarly excluded in future administrative action. This is even more imperative as more than a quarter of DACA recipients are currently uninsured as they await the finalization of the proposed rule. 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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Sec. 2
Findings; purpose
Pub. L.Pub. L. 111-148
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