Dreaming of health care
Despite reports that the Affordable Care Act is in danger of being obliterated after the election, enrollment in the health insurance marketplace reopened Nov. 1 to high demand, with more than 100,000 people signing up for coverage in the first week alone. Anyone without insurance can enroll until the marketplace closes Jan. 31. Those who get covered will still be able to obtain preventive care without added costs, primary care visits, treatment for chronic illnesses, and many other benefits. Marketplace coverage is largely affordable with more than eight in 10 uninsured individuals qualifying for financial help. They won’t suffer discrimination because of their gender or a pre-existing condition — for example, a prior diagnosis of breast cancer. Since the law took effect, 20 million people have gained coverage, bringing the uninsured rate to an all-time low of 8.6 percent. That’s a lot of people to throw overboard without the lifejacket of health care, and it remains to be seen what Congress may propose to deal with the crisis that would ensue if it were repealed.
While we ready ourselves to try to preserve health care access for millions, getting people covered now is not only our moral obligation but will be among our best defenses. We must include those left out who ought to be in, and young immigrants born elsewhere but eligible to stay in the United States are among them. In 2012, President Barack Obama created the Deferred Action for Childhood Arrivals (DACA) program, sheltering from deportation many (often known as DREAMers) who were brought to the U.S. by their parents at an early age. They have known no other home and fervently hope to remain here and live full and productive lives integrated into American society.
Ironically, those able under the president’s program to stay in the United States continue to be denied access to Medicaid, barred from the Children’s Health Insurance Program (CHIP), which covers children of low-income families, and excluded from accessing the health care available in the marketplace through the Affordable Care Act. Others who reside in the United States with lawful status can to obtain health coverage through these programs. Those covered by DACA are the exception.
In the wake of the political victories of staunch opponents of the Affordable Care Act, efforts to improve the law may fall victim to efforts to destroy it. But Obama can lay down a marker and fix the injustice that bars DREAMers from accessing affordable health coverage without a new law. Before leaving office, the president should remove this exception and fully include all who are in the U.S. and deemed “lawfully present” by DACA.
As made clear in a July letter to the White House from 135 national groups, including NCJW, “The restrictions … are a radical and unnecessary departure from established federal rules and practices. Indeed … [those granted] all other forms of deferred action are still considered to be lawfully present for purposes of the ACA, Medicaid, and CHIP.” Of importance to us, it contradicts Jewish values that assert every human being is made in the image of God and thereby entitled to adequate health care.
Those permitted to stay under DACA should be allowed and encouraged to obtain health care coverage through the Affordable Care Act. By definition they are from the prime demographic group that the federal government is seeking to entice to enroll — the healthy young. Without help, critical care will remain out of their reach due to cost, with far-reaching consequences to their health and economic security. Lack of routine preventive care means some will eventually experience more serious medical issues that could have been avoided. Acute illness or accident will bring them to an emergency room for uncompensated care — stressing their family budgets and straining the larger health system, precisely the phenomenon that the Affordable Care Act was designed to avoid.
Commemorating the sixth anniversary of the law, Obama stated, “We have at last succeeded in leaving our kids and grandkids a country where pre-existing conditions exclusions are a thing of the past, affordable options are within our reach, and health care is no longer a privilege, but a right.”
Surely one way to advance the goal of supporting young, striving immigrants is to change the administrative regulations of the Affordable Care Act that exclude DREAMers from federal health care programs. That is indeed within the power of the president to do, and if his legacy is to hold, we urge him to do it immediately.
Nancy K. Kaufman is chief executive officer of the National Council of Jewish Women.