October 10th, 2009
We write to urge you not to miss using health reform as the opportunity to eliminate barriers that legal immigrants currently have to coverage in Medicaid, CHIP, and Medicare. Thank you for all of your efforts to achieve the critical reforms needed in health care. We share your goal of expanding the number of individuals who have quality, affordable health insurance and reducing the number of uninsured in America.
As you know, current federal law prohibits use of federal Medicaid funds to cover most lawfully present adult immigrants in the U.S. during their first five years here, even when they meet all other eligibility requirements. A similar restriction exists in Medicare that prohibits Lawful Permanent Residents from purchasing Medicare for five years. These arbitrary 5-year waiting periods leave vulnerable, low-income legal immigrants uninsured, requiring them to delay medical care until their condition worsens.
Congress recognized the harm of a waiting period for vulnerable residents and partially addressed the situation by allowing states to opt to cover lawfully residing immigrant children and pregnant women without a five year waiting period in the Children’s Health Insurance Program Reauthorization Act of 2009 (H.R. 2) enacted earlier this year. Although this was a step in the right direction, these children are not guaranteed access to affordable health care and their coverage is vulnerable to budget cuts and changes to state policy. Even in states that are taking up the new option, parents and grandparents of immigrant children remain without access to affordable health care.
The costs of paying for care for legal immigrants who cannot obtain Medicaid, CHIP, and Medicare falls to the states, counties, cities, and other local governments, as well as the hospitals, clinics and other safety-net providers. Hospitals will continue to incur large costs in uncompensated care. Clinics and other safety-net systems are burdened.
Recognizing the importance of providing access to affordable care to all of its residents, many states exclusively use state funds to provide health care to legal immigrants who are otherwise forced to wait years for access to affordable health care due to the existing prohibition on use of federal funds during the five-year waiting period. Those programs are vulnerable to budget cuts and freezes – particularly during challenging economic times. These states have made public-health conscious and compassionate choices to care for their residents. However, a number of states are considering cut backs to these programs due to their budget constraints. State and local governments need fiscal relief in these hard economic times. Even in better times, the programs require states to spend a disproportionate amount of their own funds to pay for programs supported by the federal tax payments made by lawful permanent residents.
We believe it is essential to support changes in health reform legislation to remove the five-year waiting period in Medicaid, CHIP, and Medicare to ensure that legal immigrants are able to obtain affordable coverage though these critical programs.
Doctors for Global Health