President Donald Trump’s new “Presidential Proclamation on the Suspension of Entry of Immigrants Who Will Financially Burden the United States Healthcare System” likely will reduce drastically the number of legal immigrants admitted to the U.S. It is scheduled to go into effect on November 3, 2019.
Exempting refugees and asylees, the Proclamation suspends the entry of aliens who will purportedly “financially burden the United States healthcare system” because such entries are “detrimental to the interests of the United States.” The Proclamation asserts that “lawful immigrants are about three times more likely than United States citizens to lack health insurance.”
While new immigrants are more apt to lack healthcare coverage than U.S. citizens, they are not the most prone to be uninsured. Uninsured U.S. citizens still account “for three-quarters of the total 72.4 million uninsured.” Immigrants lack health insurance for a variety of reasons. Barriers to coverage include wait periods, “fear, confusion about eligibility policies, difficulty navigating the enrollment process, and language and literacy challenges.” The problem of uninsured immigrants can be solved best by eliminating these barriers.
Not having health insurance does not necessarily mean that immigrants are a “financial burden” on the U.S. healthcare system. A Tufts University School of Medicine study asserts that when immigrants arrive in the U.S., they are healthier than most U.S. citizens and do not need or use as much healthcare as native-born Americans. And, if they eventually obtain health insurance, they actually subsidize U.S. citizens because they pay premiums but do not draw as much out of the system. While the data is limited, eliminating the barriers to coverage actually might be more beneficial to the healthcare system than preventing immigration.
On or after November 3, 2019, any foreign national seeking to enter the U.S. from abroad on an immigrant visa (that is, as a Legal Permanent Resident or “Green Card” holder) will have to show to a Consular Officer’s satisfaction that they will be covered by an approved health insurance program within 30 days of entry or that they possess “the financial resources to pay for reasonably foreseeable medical costs.” Approved health insurance coverage will include, among other plans, employer-sponsored plans, unsubsidized health plans offered in State individual markets, catastrophic coverage, a family member’s plan, and visitor health insurance plans. But even those who will be able to gain coverage may not be able to do that within 30 days of entry because, under federal law, group health plans and those offering group health insurance coverage can have waiting periods of as long as 90 days.
Some have estimated that the Proclamation, which does not require Congressional support, could reduce by two-thirds the number of legal immigrants admitted. It likely would have the most drastic effect on low-income people in programs the Administration would like to cut – particularly family-based “chain migration” and the diversity lottery.
Government officials in the State Department and the Center for Consumer Information and Insurance Oversight that oversees the implementation of the Affordable Care Act are “huddling in multiple meetings” to understand how the Proclamation will be enacted. In the meantime, the Proclamation, like the Public Charge Rule, may become the subject of litigation. The Public Charge Rule is on hold due to a court injunction.