President Obama's Immigration Plan Bars ACA Benefits for Those With 'Provisional' Status

January 31, 2013 — President Obama on Tuesday released his immigration reform plan, which would prevent immigrants with provisional legal status from gaining access to health benefits under the Affordable Care Act (PL 111-148), including insurance exchanges, related subsidies and Medicaid, The Hill's "Healthwatch" reports.

Under Obama's plan, many of the undocumented immigrants in the U.S. would be offered a "provisional" or "probationary" status, allowing them to stay in the U.S. legally and potentially earn citizenship over time (Baker/Viebeck, "Healthwatch," The Hill, 1/29). However, those individuals would not be eligible for the ACA's benefits and would be exempt from the law's individual mandate while seeking full citizen status (Barr, Modern Healthcare, 1/29).

The ACA states that non-citizens are eligible for benefits under the law if they are "aliens who are lawfully present" in the U.S., according to "Healthwatch." According to an analysis by the Congressional Research Service in 2011, that language means that legal permanent residents, asylum recipients and refugees, and non-immigrants -- such as temporary workers and representatives of foreign governments -- are considered "lawfully present" (Baker/Viebeck, "Healthwatch," The Hill, 1/29).

According to the Washington Post's "Wonkblog," lawfully present immigrants are subject to the ACA's individual mandate. Further, those whose annual incomes are below 400% of the federal poverty level -- or $44,680 for an individual -- qualify for insurance subsidies to purchase coverage through an exchange. They also qualify for Medicaid coverage after five years of legal residence.

Meanwhile, the ACA stipulates that undocumented immigrants are prohibited from receiving federal subsidies to help purchase health coverage and are exempt from the individual mandate. However, they are covered under the ACA's provision banning insurers from denying coverage to individuals with pre-existing conditions (Kliff, "Wonkblog," Washington Post, 1/29).

Lawmakers' Plan

Obama's plan comes one day after a group of bipartisan senators introduced a similar proposal, which also would allow undocumented immigrants to earn a probationary legal status but would block them from receiving benefits through the ACA's insurance exchanges or its Medicaid expansion.

However, Sen. Marco Rubio (R-Fla.) -- one of the eight senators who proposed the bipartisan plan -- on Tuesday suggested that he would withdraw support from any immigration reform deal that extends federal benefits to provisionally legal U.S. residents, The Hill's "Healthwatch" reports.

In an interview on Rush Limbaugh's radio show, Rubio said, "Obamacare is the only federal benefit where you qualify for it not because you have a green card but because you're lawfully present." He added, "That issue needs to be resolved" (Viebeck, "Healthwatch,"The Hill, 1/29).