100,000 “Dreamers” get an increase in access to health care coverage

What’s the news: A Biden administration regulatory change will allow about 100,000 previously uninsured immigrants commonly called “Dreamers,” based on proposals never before passed in Congress called the DREAM Act, to access a qualified health plan or coverage through a Basic Health Program. The change will allow these immigrants to buy coverage through HealthCare.gov and state-based marketplaces where they can qualify for financial assistance.

“Our country will become healthier and fairer” under the new rule, said AMA President Jesse M. Ehrenfeld, MD, MPH.

The Deferred Action for Childhood Arrivals (DACA) policy, created in 2012 under then-President Barack Obama, allows some undocumented immigrants brought to the country as children to stay legally and work in the US.

A previous ruling on DACA recipients found that they did not meet the definition of those “lawfully present” in the country. With 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 is important: The change gives what HHS estimates is 100,000 previously uninsured people the opportunity to get health care insurance and access affordability programs if they qualify.

“The AMA believes that health care is a basic human right and the provision of health care services is an ethical obligation of a civil society,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a letter to HHS and CMS advocating rule change.

A 2021 HHS survey of DACA recipients found that 34% of them said “they were not covered by health insurance, 47% reported experiencing a delay in medical care because of their immigration status, and 67 % said that they or a family member was unable to pay bills or medical expenses,” noted Dr. Madara.

In addition to expanding access to health insurance and advancing health equity, the change is likely to result in savings.

“Individuals without insurance are less likely to receive preventive or routine health screenings and may delay needed medical care, often resulting in higher health care costs,” said Dr. Ehrenfeld.

Dr. Madara wrote that there could be further economic benefits for the country in the rule change by reducing “the number of work days lost by DACA recipients, 200,000 of whom serve as front-line health care workers.” He said it also provides stability for these people and is likely to reduce costs in health care exchanges “given that DACA recipients are relatively young and healthy.”

The AMA also supports expanding eligibility in the Medicaid and Children’s Health Insurance Programs for DACA recipients, changes that were proposed but not finalized in the last rule change.

“While we appreciate the resource constraints on state Medicaid agencies, we urge the administration to finalize these important access expansions in future rulemaking and look forward to committing to this and other policies that expand access to Medicaid services. health care, especially for historically marginalized populations,” Dr. Ehrenfeld said.

Learn more: About 27,000 health care workers and support staff depend on the DACA policy for their ability to work in the US, 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 doctors retain the right to work, they will each care for an average of 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 American patients. Read about the AMA’s work to ensure that health care workforce members approved for DACA are able to continue to work, learn, train, and research in the United States.