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December 20th, 2012
Grijalva Joins Rep. Barbara Lee, 79 Other Democratic Members in Calling on President Obama to Reinstate Health Care to DREAMers


Washington, D.C. – Rep. Raúl M. Grijalva joined Rep. Barbara Lee and 79 other House colleagues Dec. 15 in sending a letter to President Obama calling for the reinstatement of Affordable Care Act eligibility to DREAMAct-eligible youths who have been granted temporary legal status through the administration’s Deferred Action for Childhood Arrivals (DACA)policy.

The federal Center for Medicare & Medicaid Services (CMS) sent a letter to state health officials and Medicaid directors Aug. 28 stating that individuals granted deferred enforcement action through the DACA process were not eligible for federal Medicaid or Children’s Health Insurance Program coverage, which covers pregnant women and lawful resident children under the age of 21.

CMS also released an interim final rule the same day making DACA beneficiaries ineligible for the federally funded Pre-existing Condition Insurance Program (PCIP), barring them from buying health insurance on an exchange, and preventing them from taking advantage of health care premium tax credits.

As the 81-member letter to President Obama states,“There is no principled reason to treat differently young people who received deferred action through DACA and any other person who have received deferred action. The unfairness of singling our DACA beneficiaries is also clear when you consider that many of them will now be studying alongside students with nonimmigrant visas who have not been excluded from the ACA.”

“Illness does not discriminate on the basis of documentation or legal status,” Grijalva said. “The CMS interim rule denying health care coverage to DREAMers will just cost us more money and is fundamentally unfair. It runs counter to the aims of the ACA and our American ideals. DREAMers are Americans in every respect. Our country’s goal is to integrate these young students fully into our national community and social fabric. Denying them access to affordable healthcare runs is simply unacceptable.”

Up to 1.7 million young immigrants stand to potentially benef from deferred action under DACA. An estimated 80,000 of those eligible are Arizonans.

The full text of the letter to President Obama is below, followed by a FAQ explaining the issue from the National Immigration Law Center.


President Barack Obama

The White House

1600 Pennsylvania Avenue, NW

Washington, DC 20500

Dec. 15, 2012

Dear President Obama,


As members of Congress, many of us from the Congressional Black, Hispanic, Asian Pacific American and Progressive Caucuses, we congratulate you on your re-election and thank you for taking the bold step of implementing the Deferred Action for Childhood Arrivals (DACA) policy. Already this considered action has begun to enable thousands of young aspiring Americans to live without fear of deportation and to begin giving back to their communities and our country. A critical first step on the path to reforming our broken immigration system, DACA is dramatically improving the lives of these young people and their families.

DACA has attracted a high number of applicants to date and is strongly supported by the communities we represent. However, we are deeply concerned about the Department of Health and Human Services’ (HHS) decision to issue an Interim Final Rule that will explicitly exclude youth granted deferred action under DACA from key features of the Affordable Care Act (ACA), including participation in the state health insurance exchanges. We believe this rule-making process offered an opportunity for the Department to enable these young people—Americans in every respect except on paper—to access the same range of health care options as the citizens they hope to one day become. Instead, they will be barred even from purchasing coverage in these markets with their own money. Disconcertingly, HHS has also taken action to prevent children and pregnant women who benefited from DACA from securing affordable health insurance under the state option available in Medicaid and the Children’s Health Insurance Program (CHIP). Prior to this August 28, 2012 HHS guidance, federal rules would have allowed DACA individuals, like others granted deferred action, to enroll in these affordable health coverage programs if otherwise eligible.

The Department’s stated explanations for taking these actions is that the decision to implement the DACA policy was not motivated by a desire to make these deserving young people eligible to secure affordable health insurance. That may be true, but it also is entirely beside the point. Indeed, until the Department decided to carve out DACA beneficiaries they were covered like all other persons who have been granted deferred action for reasons that have absolutely nothing to do with the government’s desire to ensure that they have access to affordable health insurance. Nevertheless, that is one of the many things that follows from that grant of deferred action.

There is no principled reason to treat differently young people who received deferred action through DACA and any other person who has received deferred action. The unfairness of singling out DACA beneficiaries is also clear when you consider that many of them will now be studying alongside students with nonimmigrant visas who have not been excluded from the ACA.

The relevant questions in deciding whether to reconsider the Department’s recent actions are whether those actions advance the goals of the ACA and whether they are beneficial to the American people. The answer to those questions is decidedly no. First, they interfere with the cost-effective strategy of including healthy and young individuals in the nation’s risk pool. With up to 1.7 million immigrants potentially benefiting from deferred action under DACA, there are significant costs to leaving immigrants uninsured if they are unable to afford health care on their own, particularly if they turn to hospital emergency rooms and public safety net hospitals for care—ultimately driving up costs in the long run. Second, the actions also run counter to the basic notion that by enabling people to access simple preventative care we can lower long-term costs and improve health care outcomes. Third, by precluding more people from gaining coverage, the Department’s decisions could have negative public health implications. As you know, illness does not discriminate on the basis of documentation or legal status.

We look forward to working with you to reform our broken immigration system so that newly classified immigrants can become full participants in our society, including having access to affordable health care through the ACA. In the meantime, we strongly urge your administration to take the necessary steps to enable these young people who are American in every way but on paper to obtain the basic coverage and care they so clearly need and deserve. We remain committed to ensuring that the Affordable Care Act achieves its goals and hope that we can continue working together to empower immigrant youth to realize their full potential.


Members of Congress

Co-signers(81): Raúl M. Grijalva; Barbara Lee; Judy Chu; Donna Christensen; Zoe Lofgren; Jan Schakowsky;  Lucille Roybal-Allard; Charles Rangel; Joe Baca; Gwen Moore; Jim Moran; John Conyers; Mike Honda; Linda Sánchez; Luis Gutierrez; Grace Napolitano; Eleanor Holmes Norton; Sam Farr; Yvette Clarke; Jared Polis; Maxine Waters; Henry Waxman; José Serrano; Anna Eshoo; John Lewis; Mel Watt; Jim McGovern; Maurice Hinchey; Jerrold Nadler; Wm. Lacy Clay; Keith Ellison; Lloyd Doggett; Adam Smith; Louise Slaughter; Ed Pastor; Sheila Jackson Lee; Gene Green; Lois Capps; Adam Schiff; Al Green; Elijah Cummings; Donald Payne Jr.; Hank Johnson; Emanuel Cleaver; Karen Bass; Albio Sires; Silvestre Reyes; Ted Deutch; Robert C. “Bobby” Scott; Gregorio Kilili Camacho Sablan; Janice Hahn; Laura Richardson; Mike Thompson; Frank Pallone; Danny Davis; Edolphus Towns; Chaka Fattah; Kathy Castor; Lynn Woolsey; Loretta Sanchez; Jim McDermott; Ben Ray Luján; Joseph Crowley; Mike Quigley; Chellie Pingree; Steve Cohen; Doris Matsui; Corrine Brown; Frederica Wilson; Pete Stark; Eni Faleomavaega; Colleen Hanabusa; Peter Welch; Rush Holt; Marcy Kaptur; Carolyn Maloney; Robert Brady; Earl Blumenauer; Hansen Clarke; Howard Berman; Barney Frank


The Honorable Kathleen Sebelius, Secretary, U.S. Dept. of Health and Human Services

Alejandro Mayorkas, Director, USCIS

Valerie Jarrett, Senior Advisor to the President of the United States

Cecilia Munoz, Director, White House Domestic Policy Council

Jon Carson, Director of the Office of Public Engagement, White House

Cindy Mann, Director, Center for Medicaid and State Operations


Frequently Asked Questions

Before the changes announced on August 28 and implemented August 30, some DACA-eligible individuals would have gained access to more options for affordable and comprehensive health insurance.

·         Youth granted DACA who are under 21 years of age or pregnant and who are otherwise eligible would have been able to apply for free or low-cost health insurance through a state’s Medicaid program or Children’s Health Insurance Program (CHIP) in about half of the states.

o    In some states, pregnant women will continue to have access to federal health insurance coverage under CHIP regardless of their immigration status.

·         After 2014, DACA-eligible individuals would have had additional options to buy affordable health insurance in their state as a result of federal health care reform.

o   As a result of the August 28 changes, DACA-eligible individuals will remain excluded from almost all affordable health insurance options.

§  They will be treated as though they are undocumented, even though they are otherwise considered lawfully present and have access to a work permit and a Social Security number.

§  Unless their state has established a state-funded health coverage program, their only opportunity to access affordable, comprehensive health insurance may be through employment.

BEFORE the Interim Rule, what did DACA-eligible individuals have access to in terms of health care?

Before August 30, 2012, DACA-eligible individuals granted deferred action would have had the same access to health care and health insurance as other individuals granted deferred action. For example, today individuals with deferred action status can:

  • Enroll in low-cost, comprehensive health insurance available through Medicaid or CHIP in about half the states, if they are under age 21 or pregnant.
  • Enroll in a state’s high-risk insurance pool, referred to as the Pre-Existing Condition Insurance Plan (PCIP). This allows U.S. citizens and lawfully present immigrants who are currently uninsured and cannot get health insurance because they have a particular medical condition (such as cancer, high blood pressure, diabetes, depression) to buy more affordable health insurance.

AFTER January 1, 2014, individuals with “non-DACA” deferred action status:

  • Can buy private, comprehensive health insurance if health insurance is not available to them through their school or work. This new way of buying health insurance under federal health care reform, which will become available in 2014, is often referred to as the “health insurance exchanges” or simply as “the Exchange.” Undocumented individuals will not be eligible to buy health insurance through the Exchange.
  • Can apply for financial assistance to pay for the private health insurance purchased through the Exchange. The financial assistance will be provided in the form of federal tax credits, known as “premium tax credits” and “cost-sharing reductions.” The amount of the tax credit will be based on income. As a result, the price of health insurance will vary based on an individual’s or family’s income, so it will be more affordable. See below for more information.
  • Can enroll in a “Basic Health Plan” if their state has one. The Basic Health Plan will be another affordable health insurance option for low-income and working families.
  • Will be required to have health insurance under the “individual mandate” unless it is unaffordable.

AFTER the Interim Rule, what do DACA-eligible individuals have access to in terms of health insurance?

After August 30, 2012, DACA-eligible individuals have the same access to health care and health insurance as undocumented immigrants. For example, individuals granted deferred action under the DACA policy:

  • Can get health insurance through their employer, if it is available.
  • Cannot get comprehensive health insurance under Medicaid or CHIP in their state, unless the state has a separate, state-funded program or has elected the federal option to provide prenatal care regardless of the woman’s immigration status.
  • Cannot apply today for the high-risk insurance pool (the Pre-Existing Condition Insurance Plan, or PCIP), unless the state where they reside has a separate state-funded program.
  • Will not be able to buy private, comprehensive health insurance in the Exchange after January 1, 2014.
  • Will not be eligible for federal tax credits to make private health insurance affordable (even if they are paying federal taxes) in the Exchange.
  • Will likely not be eligible for the Basic Health Plan if their state has this program.
  • After 2014, will likely not be required to have health insurance under the “individual mandate.”

Can buy full-price health insurance outside of the exchanges, if it is available.

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