[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1660 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 1660
To expand access to health care services for immigrants by removing
legal and policy barriers to health insurance coverage, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 17, 2021
Mr. Booker (for himself, Mr. Markey, Mrs. Gillibrand, Mr. Merkley, Mrs.
Murray, Ms. Hirono, Mr. Sanders, Mr. Blumenthal, and Ms. Warren)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To expand access to health care services for immigrants by removing
legal and policy barriers to health insurance coverage, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Equity and Access under the
Law for Immigrant Families Act of 2021'' or the ``HEAL for Immigrant
Families Act of 2021''.
SEC. 2. FINDINGS; PURPOSE.
(a) Findings.--Congress finds as follows:
(1) Health insurance coverage reduces harmful racial,
economic, gender, and health inequities by alleviating cost
barriers to, and increasing utilization of, necessary health
care services, especially among low-income and underserved
populations.
(2) Based solely on their immigration status, many
immigrants and their families face legal and policy
restrictions on their ability to obtain affordable health
insurance coverage through Medicaid, the Children's Health
Insurance Program (CHIP), and the health insurance exchanges.
(3) Lack of health insurance coverage contributes to
persistent inequities in the prevention, diagnosis, and
treatment of health conditions. This leads to negative health
outcomes for immigrants and their families, especially Black,
Indigenous, Latinx, Asian, Pacific Islander, and other
Immigrants of Color.
(4) Black immigrant women often cite cost as a major
barrier to health care. Many who are undocumented forgo doctor
visits altogether due to the financial burden in addition to
consistent racial bias by medical practitioners and racism in
health care.
(5) Nearly half of immigrant women are of reproductive age.
Immigrant women, lesbian, gay, bisexual, transgender, and queer
(LGBTQ) immigrants, and immigrants with disabilities
disproportionately live in households with low incomes and lack
health insurance coverage. Legal and policy barriers to
affordable health insurance coverage significantly exacerbate
their risk of negative pregnancy-related and other reproductive
and sexual health outcomes, with lasting health and economic
consequences for immigrant women, LGBTQ immigrants, immigrants
with disabilities, and their families and society as a whole.
(6) Immigrants who identify as LGBTQ experience compounding
discrimination from health care providers and systems based on
race and ethnicity, primary language, immigration status,
sexual orientation, and gender identity. Nearly one in five
transgender patients have been refused care due to their gender
non-conforming status, and providers have denied care to
undocumented immigrants because of immigration status. These
inequities are exacerbated by legal and policy barriers that
restrict access to health coverage on the basis of immigration
status, exposing LGBTQ immigrant communities to
disproportionate gaps in affordable, comprehensive health care.
These compounding barriers are especially harmful for LGBTQ
immigrants who are escaping interpersonal and state violence
due to their sexual orientation and gender identity.
(7) Denying health insurance coverage or imposing waiting
periods for health insurance coverage on the basis of
immigration status unfairly hinders immigrants' ability to
reach and maintain their optimal levels of health and
undermines the economic well-being of their families.
(8) International human rights standards hold that
governments have an affirmative obligation to ensure that
everyone, including immigrants, can access safe, respectful,
culturally and linguistically appropriate, and high-quality
pregnancy-related care, including postpartum care, free from
discrimination or violence. Medicaid is the nation's single
largest payer for pregnancy-related care. Nevertheless,
barriers to health coverage persist for pregnant and postpartum
people, particularly immigrants.
(9) Immigrants--especially Black, Indigenous, Latinx,
Asian, and Pacific Islander immigrants--are among those most
harmed by the United States' pregnancy-related morbidity and
mortality epidemic, which is the worst among high-income
nations. Black people are more than three times more likely
than white people to suffer pregnancy-related death, and twice
as likely to suffer maternal morbidity. Indigenous people are
more than two times more likely than white people to die from a
pregnancy-related death. The majority of United States
pregnancy-related deaths are preventable. Lack of access to
health care, immigration status, poverty, and exposure to
racism, sexism, and xenophobia in and beyond the health care
system contribute to the disproportionately high number of
pregnancy-related deaths among BIPOC birthing and postpartum
people. Unnecessary barriers that limit pregnant and postpartum
immigrants' access to health care undermine their health,
safety, and human rights.
(10) One in seven United States residents is foreign-born,
approximately one in four children in the United States has at
least one immigrant parent, and the population of immigrant
families in the United States is expected to continue to grow
in the coming years. It is therefore in our collective public
health and economic interest to remove legal and policy
barriers to affordable health insurance coverage that are based
on immigration status.
(11) Although individuals granted relief under the Deferred
Action for Childhood Arrivals (DACA) program are authorized to
live and work in the United States, they have been unfairly
excluded from the definitions of lawfully present and lawfully
residing for purposes of health insurance coverage provided
through the Department of Health and Human Services, including
Medicaid, CHIP, and the health insurance exchanges.
(12) Since immigration law evolves constantly, new
immigration categories for individuals with federally
authorized presence in the United States may be created.
(13) Some States continue to unwisely restrict Medicaid
access for immigrants who have long resided in the United
States, fueling significant health inequities and increasing
health care costs for individuals and the public.
(14) Congress restored Medicaid eligibility for individuals
living in the United States under the Compacts of Free
Association as part of bipartisan legislation in December 2020
and should build on that success by ensuring all immigrants can
access care.
(b) Purpose.--It is the purpose of this Act to--
(1) ensure that all individuals who are lawfully present in
the United States are eligible for all federally funded health
care programs;
(2) advance the ability of undocumented individuals to
obtain health insurance coverage through the health insurance
exchanges established under part II of the Patient Protection
and Affordable Care Act, Public Law 111-148;
(3) eliminate the authority for States to restrict Medicaid
eligibility for lawful permanent residents; and
(4) eliminate other barriers to accessing Medicaid, CHIP,
and other medical assistance.
SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR LAWFULLY RESIDING
INDIVIDUALS.
(a) Medicaid.--Section 1903(v)(4) of the Social Security Act (42
U.S.C. 1396b(v)(4)) is amended--
(1) by amending subparagraph (A) to read as follows:
``(A) Notwithstanding sections 401(a), 402(b), 403,
and 421 of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996, a State shall
provide medical assistance under this title to
individuals who are lawfully residing in the United
States (including individuals described in paragraph
(1), battered individuals described in section 431(c)
of such Act, and individuals with an approved or
pending application for deferred action or other
federally authorized presence), if they otherwise meet
the eligibility requirements for medical assistance
under the State plan approved under this title (other
than the requirement of the receipt of aid or
assistance under title IV, supplemental security income
benefits under title XVI, or a State supplementary
payment).'';
(2) by amending subparagraph (B) to read as follows:
``(B) No debt shall accrue under an affidavit of
support against any sponsor of an individual provided
medical assistance under subparagraph (A) on the basis
of provision of assistance to such individual and the
cost of such assistance shall not be considered as an
unreimbursed cost.''; and
(3) in subparagraph (C)--
(A) by striking ``an election by the State under
subparagraph (A)'' and inserting ``the application of
subparagraph (A)'';
(B) by inserting ``or be lawfully present'' after
``lawfully reside''; and
(C) by inserting ``or present'' after ``lawfully
residing'' each place it appears.
(b) CHIP.--Subparagraph (O) of section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
``(O) Paragraph (4) of section 1903(v) (relating to
lawfully residing individuals).''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall take effect on the date
of enactment of this Act and shall apply to services furnished
on or after the date that is 90 days after such date of
enactment.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX, or a
State child health plan under title XXI, of the Social Security
Act which the Secretary of Health and Human Services determines
requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirements imposed by the amendments made by this
section, the respective State plan shall not be regarded as
failing to comply with the requirements of such title solely on
the basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE FOR INDIVIDUALS WITH
FEDERALLY AUTHORIZED PRESENCE, INCLUDING DEFERRED ACTION.
(a) In General.--For purposes of eligibility under any of the
provisions described in subsection (b), all individuals granted
federally authorized presence in the United States shall be considered
to be lawfully present in the United States.
(b) Provisions Described.--The provisions described in this
subsection are the following:
(1) Exchange eligibility.--Section 1411 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031).
(2) Reduced cost-sharing eligibility.--Section 1402 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18071).
(3) Premium subsidy eligibility.--Section 36B of the
Internal Revenue Code of 1986 (26 U.S.C. 36B).
(4) Medicaid and chip eligibility.--Titles XIX and XXI of
the Social Security Act, including under section 1903(v) of
such Act (42 U.S.C. 1396b(v)).
(c) Effective Date.--
(1) In general.--Subsection (a) shall take effect on the
date of enactment of this Act.
(2) Transition through special enrollment period.--In the
case of an individual described in subsection (a) who, before
the first day of the first annual open enrollment period under
subparagraph (B) of section 1311(c)(6) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(c)(6))
beginning after the date of enactment of this Act, is granted
federally authorized presence in the United States and who, as
a result of such subsection, qualifies for a subsidy under a
provision described in paragraph (2) or (3) of subsection (b),
the Secretary of Health and Human Services shall establish a
special enrollment period under subparagraph (C) of such
section 1311(c)(6) during which such individual may enroll in
qualified health plans through Exchanges under title I of the
Patient Protection and Affordable Care Act and qualify for such
a subsidy. For such an individual who has been granted
federally authorized presence in the United States as of the
date of enactment of this Act, such special enrollment period
shall begin not later than 90 days after such date of
enactment. Nothing in this paragraph shall be construed as
affecting the authority of the Secretary to establish
additional special enrollment periods under such subparagraph
(C).
SEC. 5. REMOVING CITIZENSHIP AND IMMIGRATION BARRIERS TO ACCESS TO
AFFORDABLE HEALTH CARE UNDER THE ACA.
(a) In General.--
(1) Premium tax credits.--Section 36B of the Internal
Revenue Code of 1986 is amended--
(A) in subsection (c)(1)(B)--
(i) by amending the heading to read as
follows: ``Special rule for certain individuals
ineligible for medicaid due to status''; and
(ii) by amending clause (ii) to read as
follows:
``(ii) the taxpayer is a noncitizen who is
not eligible for the Medicaid program under
title XIX of the Social Security Act by reason
of the individual's immigration status,''.
(B) by striking subsection (e).
(2) Cost-sharing reductions.--Section 1402 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071) is amended
by striking subsection (e) and redesignating subsection (f) as
subsection (e).
(3) Basic health program eligibility.--Section
1331(e)(1)(B) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18051(e)(1)(B)) is amended by striking ``lawfully
present in the United States,''.
(4) Restrictions on federal payments.--Section 1412 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18082) is
amended by striking subsection (d) and redesignating subsection
(e) as subsection (d).
(5) Requirement to maintain minimum essential coverage.--
Subsection (d) of section 5000A of the Internal Revenue Code of
1986 is amended by striking paragraph (3) and by redesignating
paragraph (4) as paragraph (3).
(b) Conforming Amendments.--
(1) Establishment of program.--Section 1411(a) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18081(a))
is amended by striking paragraph (1) and redesignating
paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3),
respectively.
(2) Qualified individuals.--Section 1312(f) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18032(f)) is
amended--
(A) in the heading, by striking ``; Access Limited
to Citizens and Lawful Residents''; and
(B) by striking paragraph (3).
(c) Effective Date.--The amendments made by this section shall
apply to years, plan years, and taxable years, as applicable, beginning
after December 31, 2021.
SEC. 6. PRESERVING ACCESS TO COVERAGE.
(a) In General.--Nothing in this Act, including the amendments made
by this Act, shall prevent lawfully present noncitizens who are
ineligible for full benefits under the Medicaid program under title XIX
of the Social Security Act from securing a credit for which such
lawfully present noncitizens would be eligible under section
36B(c)(1)(B) of the Internal Revenue Code of 1986 and under the
Medicaid provisions for lawfully present noncitizens, as in effect on
the date prior to the date of enactment of this Act.
(b) Definition.--For purposes of subsection (a), the term ``full
benefits'' means, with respect to an individual and State, medical
assistance for all services covered under the State plan under title
XIX of the Social Security Act that is not less in amount, duration, or
scope, or is determined by the Secretary of Health and Human Services
to be substantially equivalent to the medical assistance available for
an individual described in section 1902(a)(10)(A)(i) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(i)).
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