Health Center Federal Policy

The Final Push on Immigration Reform

By Joseph Miller, Federal Affairs Intern

Both the Senate and the House are working on immigration bills this week.  As the Senate clears out the final hurdles to passing a comprehensive immigration reform bill, the House is taking a piecemeal approach and trying to move stand-alone bills related to border security, enforcement, visas, and the pathway to citizenship.  Since the Senate is where the bulk of the action is this week, today’s blog will focus on the provisions and politics of S. 744 and we’ll turn our eyes to the House in the next installment.

S. 744: Where Does It Stand?

Monday night the Senate cleared a major procedural hurdle on the Immigration Reform bill.  The vote, known as a cloture vote, was to move ahead with the debate – and thus one step closer to voting on a compromise package of changes to the bill’s border security and other measures.  The compromise package proposed by Senators Hoeven (R-ND) and Corker (R-TN), referred to as the “Border Surge Amendment,” would devote significant resources to doubling the length of fencing along the southern border and creating an additional 20,000 border patrol agents.  This compromise amendment has finally broken the logjam between Senate Democrats and Republicans and thus has finally brought immigration reform truly within reach in the Senate.  If the vote had failed, the bill would essentially have been dead in the water with no room for an agreement from either side.  However, last night’s strong vote count (67-27) would indicate that a broad majority of both Democrats and Republicans are ready to pass comprehensive immigration reform and the Senate is now one important step closer to passing this sweeping legislation by the end of the week.

The final vote on S. 744 is scheduled for this Thursday or Friday, June 27th or 28th, so for the rest of the week we can expect a flurry of amendment activity (over 300 are waiting in the wings!) and floor debate as Senators clear out the remaining points of objection and work out agreements on the rest of the bill.

S. 744: What’s Actually In It?

As we look to a vote on final passage, below is an overview of S. 744, the Senate’s comprehensive the Immigration Reform Bill, noting the key provisions of importance for health centers and their patients.

S. 744 allows the more than 11 million currently undocumented immigrants to achieve legal status through a new pathway to citizenship called Registered Provisional Immigrant (RPI) status.  To be eligible for RPI status, immigrants must:

  • Have been present in the U.S. on or before Dec.31, 2011 and maintained a continuous presence in the U.S. since their arrival and up to the date of their application,
  • Have paid previous federal tax liabilities,
  • Not have been convicted of certain criminal offenses,
  • Not have been an asyllee or refugee here as a lawful non-immigrant (there are special rules for this population), and
  • Pay fees and fines, as well as periodically verifying their continuous employment as condition of maintaining RPI status.

Once an undocumented immigrant has converted to RPI status, they will be legally authorized to work in this country.  However, RPIs will not be eligible for federal means-tested benefits yet will be required to maintain health insurance coverage.  Federal means-tested benefits include: Medicaid, Medicare, SNAP, TANF, SSI, and subsidies to purchase health insurance under the Affordable Care Act.  Individuals in RPI status will be able to purchase health insurance in the private market or through the new health insurance exchanges, however, they will not be able to receive any financial assistance if the premiums and cost-sharing are unaffordable for them.  There are no hardship exceptions.

Ten years after a person is granted RPI status, he or she may convert to Lawful Permanent Resident (LPR), or “green card” status, and ultimately be eligible for citizenship in a total of 13 years if all requirements are met.  That said, as a lawful resident, most individuals will not be eligible for federal benefits until 5 years after they have been granted LPR status, meaning that most currently undocumented immigrants will be required to wait a minimum of 15 years to become eligible for federal health benefits.  They can, however, receive ACA subsidies to purchase coverage in the Exchanges as soon as they become LPRs.

There are slightly shorter timelines for Agricultural Workers and a group that has become known as “DREAM-ers” to achieve legal citizenship status and access federal benefits:

Agricultural Workers who can demonstrate they have either completed 100 work days or 575 hours in the two years prior to the bill’s passage will be eligible for RPI status under the Agricultural Worker Visa (“blue card” status).  After 3-5 years as a blue card holder (depending on how many hours worked) – rather than 10 as an RPI – they may apply for LPR status.  They must then remain in LPR status for at least five years, during which they are ineligible for federal means-tested benefits.  They too, however, immediately become eligible for ACA insurance subsidies for coverage purchased through the Exchanges as soon as they enter LPR status.

“DREAM-ers,” or individuals covered under the DREAM Act, are eligible to become citizens after five years. However, unlike agricultural workers or those in the 10 year RPI status, DREAM-ers can become LPRs after just 5 years in RPI status and may immediately apply for citizenship as soon as they have been granted LPR status, rather than waiting the standard 3 years.  While they too have a 5 year bar on receiving federal means tested benefits while in LPR status, they will, however, be eligible for those federal benefits as soon as they become citizens, regardless of whether it has been 5 years since they entered LPR status.  In addition, just like with regular RPI individuals and blue card holders, DREAMers can receive subsidies to purchase coverage in the new Exchanges as soon as they transition to LPR status.

A few additional provisions of S. 744 of interest to health centers:

  • The bill will allow COFA recipients to again become eligible for federal means-tested benefits, reinstating the Compact of Free Association;
  • It reauthorizes the Conrad State 30 and Physician Access program, which allows immigrant physicians to stay in the U.S. after finishing medical school and serve in a medically underserved or health professions shortage area;
  • It increases the number of employment visas handed out to individuals with higher educations, like physicians, dentists, and nurse practitioners.

One final issue worthy of note is that language incorporating the ICHIA program (which allows states to cover immigrant children and pregnant women under CHIP), is rather ambiguous in its current form as to which categories of LPR v. RPI individuals would be eligible to receive coverage, so we expect to see clarifying language to that effect as the bill moves forward.

While this summary highlights the key provisions impacting health centers and their patients in the bill, there are several excellent resources online for more in-depth analysis.  We recommend the Center on Budget and Policy Priorities’ analysis of the bill here, the National Immigration Law Center’s Summaries here, and the Congressional Budget Office’s estimates on the bill here.  Happy reading and stay tuned to the blog for updates on passage of this much-anticipated legislation.