What’s the news: A Biden administration regulatory change will allow an estimated 100,000 previously uninsured immigrants commonly referred to as “Dreamers,” based on never-passed proposals in Congress called the DREAM Act, to access a qualified health plan or coverage through a Basic Health Program. The change will enable these immigrants to buy coverage through HealthCare.gov and state-based marketplaces where they can qualify for financial help.
“Our country will become healthier and more equitable” under the new rule, said AMA President Jesse M. Ehrenfeld, MD, MPH.
The Deferred Action for Childhood Arrivals (DACA) policy, established in 2012 under then-President Barack Obama, allows some undocumented immigrants brought to the country as children to legally remain and work in the U.S.
A previous decision on DACA recipients found that they did not meet the definition of those “lawfully present” in the country. With the new changes from the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), DACA recipients will be considered “lawfully present” for the purposes of some HHS health programs. While the change does not affect their immigration status, DACA recipients will be able to access health care marketplaces and insurance affordability programs starting this November.
Why it’s important: The change gives what the HHS estimates are 100,000 previously uninsured people the chance to get health care insurance and access affordability programs if they qualify.
“The AMA believes that health care is a basic human right and providing health care services is an ethical obligation of a civil society,” wrote AMA Executive Vice President and CEO James L. Madara, MD, in a letter to HHS and CMS advocating the rule change.
A 2021 HHS survey of DACA recipients showed that 34% of them said “they were not covered by health insurance, 47% attested to having experienced a delay in medical care due to their immigration status, and 67% said that they or a family member were unable to pay medical bills or expenses,” Dr. Madara noted.
In addition to expanding access to health insurance and advancing health equity, the change likely will result in savings.
“Individuals without insurance are less likely to receive preventive or routine health screenings and may delay necessary medical care, often resulting in higher health care costs down the road,” Dr. Ehrenfeld said.
Dr. Madara wrote that there may be further economic benefit to the country in the rule change through the reduced “number of work days missed by DACA recipients, 200,000 of whom serve as front-line health care workers.” He said it also provides stability for these people, and likely will reduce costs in health care exchanges “given that DACA recipients are relatively young and healthy.”
The AMA also supports the extension of eligibility in Medicaid and Children’s Health Insurance Programs to DACA recipients, changes that were proposed but not finalized in the recent rule change.
“While we appreciate resource constraints on state Medicaid agencies, we urge the Administration to finalize these important access expansions in future rulemaking and look forward to engaging on this and other policies that expand access to health care services, particularly for historically marginalized populations,” Dr. Ehrenfeld said.
Learn more: An estimated 27,000 health care workers and support staff depend on the DACA policy for their ability to work in the U.S., a number that includes almost 200 medical students, medical residents and physicians who depend on DACA for their eligibility to practice medicine.
If those trainees and physicians retain their work eligibility, each will care for an average of between 1,533 and 4,600 patients a year. Together, over the course of their careers, they will touch the lives of 1.7 to 5.1 million U.S. patients. Read about the AMA’s work to ensure that members of the health care workforce approved for DACA are able to continue working, learning, training and researching in the United States.
