Kent1

Janet Kent
Dr. Adrienne Cassel
ENG 1201-ONLINE
July 31, 2016
The Affordable Care Act: Its Significance to Immigrants
When I came to the U.S. in 2013, Obamacare or more properly The Affordable Care Act
was all over the news. This topic has made me curious because health care is important to
everyone. My wish is for everybody in the U.S. to have affordable and quality health
insurance. Because I am studying to be a nurse and am currently working in the medical field,
this topic concerns me more than any other. As an immigrant to this country, I am anxious to see
if this law is beneficial not only to U.S. citizens but also to immigrants who are seeking
citizenship.
I believe immigrants should support the Affordable Care Act because of the new rights,
benefits and protections the law offers: 1.) Ability to buy private health insurance in the
Marketplace, 2.) Eligibility for lower costs on monthly premiums and lower out-of-pocket costs
based on income, 3. Eligibility for coverage through Medicaid and the Childrens Health
Insurance Program (CHIP), if they meet their states income and residency rules, 4.) Medicaid
and CHIP coverage for lawfully residing children and pregnant women, 5.) Access to Emergency
Care.
Lets begin by describing the Affordable Care Act. The Patient Protection and Affordable
Care Act (PPACA) was passed in the senate on December 24, 2009 and passed in the House of
Representatives on March 21, 2010. It was signed into law by President Obama on March 23,
2010 and upheld by the Supreme Court on June 28, 2012. It is a comprehensive healthcare

Kent2

insurance reform act that provides certain benefits to, and requires certain actions from, all
Americans (Katz 7). Two of the main goals of the ACA are to reduce the overall number of
Americans who dont have health insurance and to lower costs associated with health care (Katz
7). Next, lets define what is meant by the word immigrant. An immigrant is a foreign-born
individual living in the United States, regardless of his/her immigration status, including
naturalized citizens, lawfully present non-citizens (people who are on the road to citizenship or
otherwise who have been granted permission to remain in the United States, such as lawful
permanent residents, individuals with work authorization, refugees or people seeking asylum)
and undocumented immigrants (individuals who entered the United States with permission and
subsequently lost their lawful status and those who entered without permission) (Stephens 3).

As of 2005, nearly 40 million immigrants were residing in the United States, accounting
for 13 percent of the total population (Figure 1 from Kaiser Commission). The majority of
immigrants work but generally are employed in jobs or industries that offer lower wages and
provide limited access to employer sponsored insurance (Kaiser Commission).
By 2014, the number had increased a little. The U.S. immigrant population stood at more
than 42.4 million, or 13.3 percent, of the total U.S. population of 318.9 million in 2014,

Kent3

according to the U.S. Census Bureaus 2014 American Community Survey (ACS). In 2014,
approximately 53% of immigrants in the United States had private health insurance (compared to
68% of native born Americans) and 27% had public health insurance coverage (compared to
34% of the native born). Slightly more than one-quarter (27%) were uninsured, compared to 9%
percent of the native born.
Based on Zong and Batalovas research, the ACA has increased health insurance
coverage of immigrants especially noncitizens at a greater rate than the U.S. born population.
From 2013 to 2014, the immigrant uninsured rate fell from 32 percent to 27 percent, compared to
the rate for the native born, which fell from 12 to 9 percent. The improvement in coverage for
immigrants is a result of an increase in both private coverage (from 50 percent to 53 percent) and
public coverage (from 24 percent to 27 percent). Among the foreign born, noncitizens witnessed
a larger drop in the uninsured rate (from 46 percent to 40 percent) than naturalized citizens (from
16 percent to 11 percent).
According to the Kaiser Commission (March 2008), the primary reason most immigrants
come to the U.S. is for employment, not health care. Most non-citizen immigrants (83%) are in
working families and tend to be employed in low wage jobs that do not offer health insurance,
they are much more likely than citizens to be low income and they are significantly less likely to
have employer-based health coverage. They also have more limited access to public health
coverage due to eligibility restrictions.
Immigrants of all backgrounds including more than a million legal residents who are not
citizens had the sharpest rise in coverage rates (Tavernise and Gebeloff). They also said that
Hispanics accounted for nearly a third of the increase in adults with insurance. Low-wage
workers, who did not have enough clout in the labor market to demand insurance, saw sharp

Kent4

increases. Coverage rates jumped for cooks, dishwashers, waiters, as well as for hairdressers and
cashiers. Minorities had large gains, too. The Tavernise and Gebeloff article also mentioned that
illegal immigrants are not eligible for insurance under the law, but legal immigrants can qualify
for subsidies in the insurance exchanges and those who have been in the country for more than
five years can qualify for Medicaid.
Jim Mangria, president of St. Johns Well Child and Family Center, a federally funded
health clinic in South Los Angeles that has enrolled 18,000 new patients under the law, nearly all
of them Hispanic or black and the vast majority in Medicaid has said,
From the vantage point of the poor and working poor, Obamacare has been
profound.
The clinic reported a 44 percent increase in cervical cancer screenings, a 25 percent
increase in tobacco cessation therapy, and a 22 percent increase in the share of patients with
controlled hypertension since 2014, the result, he said, of more patients having insurance.

Sergio Ortega, 51, lives in Los Angeles and received a prosthetic leg after an amputation
because of complications related to diabetes. He says he had never been insured before getting
covered by Medicaid in 2014 (Emily Beri for The New York Times)
There is Angela Cruz, 60, a typical example of an immigrant who is a winner under the
law. She had never had health insurance in her 25 years of working in the United States as

Kent5

nanny. One day, when she needed to pay for medicine for a painful bout of kidney stones, she
stopped buying meat and got coverage under the health laws expansion of Medicaid in
California. Another immigrant, Hispanic construction worker Sergio Ortega, 51, said making a
doctors appointment seemed unthinkable without insurance, so he often simply ignored his
health problems. By the time he sought treatment through his new coverage and discovered he
had diabetes, his lower leg had to be amputated.
Research by Pandey and colleagues entitled The Immigrant Health Care Access and the
Affordable Care Act found that immigrants with less than five years stay differed from those
born in the U.S., with immigrants reporting self-rated health as excellent or very good being
lower by 25 percent or more for general, mental and dental health. They also found three key
findings that are relevant in shaping immigrant health care access. First, the impact of
immigration status on perception of unmet health needs, which is important for understanding
health-care-seeking behavior. Second, the powerful influence of race/ethnicity and lack of health
insurance deserves attention because Hispanic immigrants face additional burdens, and this has
substantial bearing on immigrant health care access. Third, public health coverage has been both
ineffective and effective.
According to an ASPE brief issued on April 2012, the 2010 Affordable Care Act (ACA)
includes a number of provisions that will expand access to subsidized health insurance coverage
to the non-elderly population, including immigrants. Major provisions of the ACA include the
expansion of Medicaid up to 133% of the federal poverty level, new state-based health insurance
exchanges combined with insurance market reforms, premium subsidies for individuals with
incomes below 400 % of the Federal Poverty Limit (FPL) and cost sharing subsidies for
individuals with incomes below 250% percent FPL (used to qualify for cost assistance when

Kent6

buying insurance through the State or Federal Health Insurance Marketplace and to help
determine Medicaid and CHIP eligibility) and an individual requirement to obtain health
insurance coverage (Kenney and Huntress).
Dave Ross interviewed President Obama about the ACA last November 2015 and the
president said this:
What I would say to somebody who is listening who doesnt like the Affordable
Care Act is that it has insured millions of people; look at their testimony. It has cost far
less than even I estimated it was going to cost to the federal treasury. So, in a lot of ways,
it is working better than we predicted. And if you dont have health insurance, then just
dont take my word for it. Go look for yourself. If you dont have health insurance and
you get sick, you might lose your house. You might go bankrupt. You might have your
family have to be in the emergency room because you didnt get a checkup and catch a
disease early enough.
The ACA will procure affordable health insurance coverage for the majority of uninsured
citizens and noncitizens. The study findings from Bustamante and Chen suggest that uninsured
individuals reacted differently to the negative consequences of the Great Recession in 2008.
Uninsured U.S. citizens and noncitizens with more than 5 years residence in the U.S. observed
similar responses to this economic shock. By contrast, uninsured recent immigrants who were
not eligible for federal assistance programs and experienced a heterogeneous provision of statebased benefits were less likely to report any health spending, and those who did, spent more.
These findings portray the existing vulnerability of recent immigrants to income shocks such as
economic recessions. Easing existing health insurance exclusion rules for recent immigrants

Kent7

could potentially be considered to address coverage gaps that would persist among U.S.
immigrants under the ACA implementation.
Find below the table of the immigrant eligibility for Medicaid and Exchange Coverage in
2014 from Kaiser Commission.
Table 1:
Immigrant Eligibility for Medicaid and Exchange Coverage in 2014
Medicaid
Exchange Coverage
Individuals without affordable employer
U.S.-born and Expands to individuals with incomes up coverage can buy coverage through exchange
to 138% of poverty in states that
marketplaces. Tax credits available to
Naturalized
implement the expansion.
individuals with incomes between 100%400%
Citizens
of poverty who are not eligible for Medicaid.
Many remain subject to a five-year wait
May purchase exchange coverage and receive
before they may enroll or are excluded
tax credits on the same basis as citizens.
from eligibility.
Lawfully
Individuals with incomes below 100% of
States may choose to eliminate the fivePresent
poverty who are ineligible for Medicaid based
year wait for otherwise eligible children
Immigrants
on immigration status may purchase exchange
and pregnant women, but not for other
coverage and receive tax credits.
adults.
Prohibited from purchasing exchange coverage
Undocumented
Remain ineligible for Medicaid.
and receiving tax credits.
Immigrants

Meanwhile the Latino and immigrant community in Illinois are urging everybody to take
advantage of the ACA. Andrew Kovach, Staff Attorney at the Illinois Coalition for Immigrant
and Refugee Rights (ICIRR) said that,
All insurance plans will have to cover doctor visits, hospitalizations, maternity
care, emergency room care, and prescriptions. Financial help is available to find a plan
that fits family budgets. We all win when immigrant families get the health care they
need. Children avoid unnecessary school absences and families are economically stronger
because an illness won't drive them into debt. Our whole economy benefits.

Kent8

The new law will lower costs and allow children to stay on their parents' insurance until
the age of 26. For many in our community who have been denied medical benefits for so long,
the new law means a healthier future. When the state health exchanges open on October 1, I urge
all eligible families to participate." Said George Cardenas from ICIRR.
One of the counterarguments I have heard against ObamaCare is from the Frontline
documentary entitled Obamas Deal (Kirk 2010) and is from Karen Ignagni, president of
Americas Health Insurance said she will support the health care bill only if everyone is required
to buy health insurance. This means that ObamaCare is mandatory or else the people have to pay
penalties. And in the documentary, Joe Wilson, Representative from South Carolina opposes the
bill because he believes the President is lying to those who come to the United States illegally.
California lawmakers tried to extend ObamaCare to illegal immigrants so that they could buy
insurance on the ObamaCare exchange (FoxNews.com June 2016).
Studies show that immigrants are less likely to claim public benefits compared to nativeborn individuals even if they are eligible for a variety of reasons such as unawareness, access
barriers, fear of deportation and a strong belief on self-reliance, which could lead to lower health
spending (Bustamante and Chen).
Achieving high rates of take-up for Medicaid and exchange subsidies among immigrant
families will likely require addressing language barriers to enrollment and addressing issues
facing mixed immigrant status families, in which many children live. Among other things, the
ACA requires health plans in the exchange to provide information in a culturally and
linguistically appropriate manner, which may be critical to achieving higher take-up since many
immigrants live in linguistically isolated households (Kenney and Huntress).

Kent9

According to HealthCare.gov, undocumented immigrants arent eligible to buy

Marketplace health coverage or to receive premium tax credits and other savings on Marketplace
plans. The vast majority of the countrys 11 million illegal immigrants, about 70 percent of
whom are Hispanic, still lack coverage, said Mark Hugo Lopez, director of Hispanic research at
the Pew Research Center.
According to Bruce Japsen in Forbes.com, tens of thousands of undocumented
immigrants across the country who signed up for federally subsidized health coverage under the
ACA in 2015 have been kicked of private insurance plans by the government following review
of their eligibility status. A window into the governments eligibility process for individual
coverage under the law came into public view after health insurance giant Humana disclosed in
its quarterly earnings report that individual commercial membership dropped 11% thanks largely
to a loss of 150,000 members due to their termination by the Centers for Medicare & Medicaid
Services (CMS) for lack of proper immigration documentation and/or income status, the
Louisville based insurer said.
Perhaps the biggest unmet promise of the law is that for many it was supposed to help
those who cannot afford insurance. Alberto Torres, 50, a driver for a garment company in Los
Angeles who could not afford insurance before the law, had signed up for a plan in 2014 for $41
a month. But this year his monthly premium jumped to $106 too much, he said, for his
meager salary.
Im feeling not so good, he said recently, waiting in line for help to look for a less expensive
plan.
High deductibles are another big obstacle. Larry Levitt, a senior vice president of the
Kaiser Family Foundation said,

Kent10

If you are living paycheck to paycheck and have nothing in the bank, insurance
with a $3,000 deductible might feel like no insurance at all.
Having insurance does not necessarily mean better health, but experts hope it could start
to ease some of the worst disparities that have kept the United States close to the bottom of
health rankings of rich countries (Tavernise).
The Affordable Care Act explicitly excludes undocumented immigrants, only providing
coverage for U.S. citizens and certain documented immigrants due to 1996 immigration and
welfare reforms that limit the public benefits available to those legal permanent residents who
have been in the US for fewer than five years (Joseph 2016). The ACA has also experienced
implementation setbacks amid legislative attempts to repeal the law and enrollment difficulties
since all of the states have not fully complied. These factors have undermined the policys ability
to extend coverage to uninsured Americans (Joseph 2016).
Some immigrants have benefited because of Medicaid and CHIP services, especially
those who meet the states income and residency rules such as pregnant women and children.
Some are adversely impacted due to high cost premiums that they have to pay monthly. Some
are given the opportunity to buy private health insurance on the Marketplace because of their
residency status. On the other hand, most undocumented immigrants are excluded from having
these privileges. One of the primary reasons I have found that most immigrants come to the U.S.
is for employment and not health care. Employment was the reason why I came here to the
United States. Because if you have a job, you will have the money to pay for further education as
well as health insurance. In order to make this new health care system effective, immigrants
should support this law because, in the end, everybody benefits. However, I also believe some
parts of the law should be repealed especially the aspects that make it too difficult for low

Kent11

income immigrant families who cannot afford to pay their monthly premium. We all want to live
in a healthy community with access to affordable and quality health insurance.

Works Cited
Barnes, N. What does the 2010 Affordable Care Act mean for securing immigrant health in
North America? North American Integration: An Institutional Void in Migration,
Security and Development (2013): 152-174. Academic Search Complete. Web. 8 July
2016.
California Lawmakers Try to Extend ObamaCare to Illegal Immigrants. Foxnews.com. 06 June
2016. Web. 22 July 2016
Coverage for Lawfully Present Immigrants. Healthcare.gov. U.S. Centers for Medicare and
Medicaid Services. 2016. Web. 22 July 2016.
Japsen, Bruce. Undocumented Immigrants Try, But Fail to Get Obamacare. Forbes. 7 Nov.
2015. Web. 8 July 2016.
Joseph, T.D. What Health Care Reform means for Immigrants: Comparing the Affordable Care
Act and Massachusetts Health Reforms. 41.1 (2016: 101-116. Academic Search
Complete. Web. 8 July 2016.
Katz, Michelle. Healthcare Made Easy. Massachusetts: Adams Media, 2015. Print.
Kenney, Genevieve M. and Michael Huntress, The Affordable Care Act: Coverage Implications
and Issues for Immigrant Families. Assistant Secretary for Planning and Evaluation Issue
Brief. April 2012. Web. 8 July 2016.
Obamas Deal. Dir. Michael Kirk. Frontline. PBS. 2010. Documentary.

Kent12

Patient Protection and Affordable Care Act. Salem Press Encyclopedia, January 2016, 5p.
Academic Search Complete. Web. 22 July 2016
Ross, Dave. Interview. Dave Ross Interviews President Obama about the Affordable Care Act.
MyNorthwest.com, Washington D.C. 6 Nov 2015. Radio.
Sanjay, Pandey K. et al. Immigrant Health Care Access and the Affordable Care Act. 74.6
(2014): 749-759. Academic Search Complete. Web. 8 July 2016.
Smith, Jessica C. and Carla Medalla. Health Insurance Coverage in the United States: 2014.
U.S. Census Bureau. Sept 2015. Web. 24 July 2016.
Stephens, Jessica and Samantha Artiga. Key Facts on Health Coverage for Low-Income
Immigrants Today and Under the Affordable Care Act. The Henry J. Kaiser Family
Foundation, March 2013. Web. 8 July 2016.
Tavernise, Sabrina and Robert Gebeloff. U.S. Minorities Gain Under Health Care Act;
Immigrants and the Poor also Saw a Sharp Increase in their Coverage Rates.
International New York Times. International Herald Tribune, 19 April 2016. Web. 8 July
2016.
Vargas, Bustamante A. The Great Recession and Health Spending among Uninsured U.S.
Immigrants: Implications for the Affordable Care Act Implementation. 49:6 (2014):
1900-1924. Academic Search Complete. Web. 8 July 2016.
Zong, Jie and Jeanne Batalova. Frequently Requested Statistics on Immigrants and Immigration
in the United States. Migration Policy Institute. 14 Apr 2016. Web. 24 July 2016.