The Supreme Court and Health Care Access for Undocumented Immigrants

The fol­low­ing com­men­tary is re-post­ed from Bioethics Forum, a blog of The Hast­ings Center.

The Supreme Court announced that it will hear a legal chal­lenge to Pres­i­dent Obama’s 2014 exec­u­tive action to pro­tect an esti­mat­ed five mil­lion undoc­u­ment­ed immi­grants from depor­ta­tion and per­mit them to work legal­ly. The imple­men­ta­tion of the Deferred Action for Par­ents of Amer­i­cans and Law­ful Per­ma­nent Res­i­dents (DAPA) pro­gram and an expan­sion of the Deferred Action for Child­hood Arrivals (DACA) pro­gram cre­at­ed through a 2012 exec­u­tive action have been held up in court due to legal action ini­ti­at­ed by the Texas attor­ney general.

Texas and oth­er states have argued that they will suf­fer injury due to the con­se­quences of the exec­u­tive action on state expen­di­tures. Texas, for exam­ple, has restrict­ed dri­vers’ licens­es to immi­grants who are “law­ful­ly present.” Accord­ing to an August 2015 report from the Pew Char­i­ta­ble Trusts, 10 states plus the Dis­trict of Colum­bia issue dri­vers’ licens­es to qual­i­fied dri­vers with­out restric­tions based on immi­gra­tion sta­tus; most states exclude undoc­u­ment­ed immi­grants. Because the process of enroll­ment in a fed­er­al pro­gram such as DAPA or DACA involves a deter­mi­na­tion that an indi­vid­ual is law­ful­ly present, increas­ing the num­ber of immi­grants who are law­ful­ly present also increas­es the num­ber of peo­ple who may be eli­gi­ble for dri­vers’ licenses.

What’s the con­nec­tion to health care access?  For an undoc­u­ment­ed immi­grant, the process of secur­ing relief from depor­ta­tion by secur­ing “deferred action” sta­tus through a mech­a­nism such as DACA or DAPA involves being des­ig­nat­ed by the fed­er­al immi­gra­tion sys­tem as Per­ma­nent­ly Resid­ing under Col­or of Law (PRUCOL). A per­son des­ig­nat­ed as PRUCOL is known to the immi­gra­tion sys­tem and is unlike­ly to be deport­ed. While undoc­u­ment­ed immi­grants are inel­i­gi­ble under fed­er­al law for a range of fed­er­al­ly-fund­ed ben­e­fits, it is up to each state to decide which state-fund­ed ben­e­fits are avail­able to this pop­u­la­tion. Some states have long used PRUCOL as a thresh­old for pro­vid­ing some ben­e­fits to undoc­u­ment­ed immi­grants. Notably, New York and Mass­a­chu­setts per­mit state res­i­dents who are PRUCOL to apply for Medicaid.

The 2012 exec­u­tive action that cre­at­ed DACA also cre­at­ed a large new PRUCOL pop­u­la­tion, rais­ing fresh state-lev­el ques­tions about health care access.  If some undoc­u­ment­ed immi­grants were now eli­gi­ble for state-issued driver’s licens­es, why not also state-fund­ed health insur­ance? In 2013, Cal­i­for­nia answered this ques­tion by extend­ing Medi-Cal  to income-eli­gi­ble res­i­dents enrolled In DACA.  If the 2014 exec­u­tive action is upheld by the Supreme Court (look for argu­ments in April and a deci­sion in June) and imple­ment­ed in the last months of the Oba­ma admin­is­tra­tion, many more undoc­u­ment­ed immi­grants could secure pub­lic health insur­ance in these three large states.

Nan­cy Berlinger is a research schol­ar at The Hast­ings Cen­ter and the co-direc­tor of the Center’s Undoc­u­ment­ed Patients project.

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