October 7, 2019

Trump admin will deny visas to those without health insurance

Daily Briefing

    President Trump on Friday issued a proclamation that could deny immigrants' visas if they cannot prove they can afford to cover their medical expenses or that they will be enrolled in health coverage.

    According to Politico, the proclamation builds on the Trump administration's final rule that will allow federal officials to consider whether immigrants are receiving or are likely to receive Medicaid or other public benefits when reviewing their residency applications.

    The White House said the proclamation is intended to "protect … health care benefits for American citizens" and prevent uninsured immigrants from becoming a financial burden for hospitals and physicians. The White House said uninsured immigrants contribute to "uncompensated health care costs" and often force providers to charge Americans higher rates for medical services.

    Proclamation details

    The proclamation states, "While our health care system grapples with the challenges caused by uncompensated care, the United States Government is making the problem worse by admitting thousands of aliens who have not demonstrated any ability to pay for their health care costs."

    To address the issue, the proclamation will require that, in order to obtain a visa, immigrants must prove they either will be enrolled in health coverage within 30 days of entering the United States, or they have the financial resources to cover any medical expenses they might incur.

    However, not all health plans will qualify as acceptable health coverage. Under the proclamation,  catastrophic health plans, employer-sponsored health plans, short-term health plans, unsubsidized Affordable Care Act (ACA) exchange plans, certain visitor health plans, Medicare, and TRICARE will be considered valid for visa approval. Medicaid coverage and subsidized exchange plans will not qualify as an eligible form of health insurance to meet the requirements, according to the proclamation.

    The proclamation, which is scheduled to take effect on Nov. 3, will apply to immigrants who are seeking visas to enter the United States. It will not apply to asylum seekers, children, immigrants on temporary visitor visas, lawful permanent residents, refugees, or other immigrants already in the United States.

    Under the proclamation, the secretary of state will have the authority to establish the standards and procedures for immigrants to show they have met the proclamation's new requirements. In addition, the proclamation will allow the HHS secretary to determine other forms of coverage in which immigrants can enroll to meet the requirements.

    Implications

    The proclamation is expected to affect hundreds of thousands of immigrants who enter the United States on visas each year. According to data from the Department of State, the United States in fiscal year 2018 issued about 534,000 visas, which allow immigrants to apply to become permanent U.S. residents.

    The proclamation is expected to make it more difficult for low-income immigrants to enter the United States, the Wall Street Journal reports. According to Politico's "Pulse," the move also could drive more immigrants to short-term health plans, which often provide less comprehensive coverage, leaving patients at risk for unexpected high medical bills and providers treating such patients at risk of lower revenues and more bad debt.

    Reaction

    Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, said the proclamation is a "classic [c]atch-22" for low-income immigrants. He said, "They will need health insurance to be in the country legally [and] the only way they may be able to afford coverage is with ACA subsidies. But, if they buy insurance with ACA subsidies, it won't count as insurance under the proclamation."

    Doug Rand, co-founder of Boundless Immigration, said, "This new attempt at an immigration ban is as shameless as it is stunning. It will be chaotic to implement and guaranteed to separate U.S. citizens from their legal immigrant spouses and other close relatives" (Hesson/Diamond, Politico, 10/4; Hackman/Restuccia, Wall Street Journal, 10/4; Rummler, Axios, 10/4; AP/Modern Healthcare, 10/6; Frazin, The Hill, 10/4; Diamond, "Pulse," Politico, 10/7; Trump proclamation, 10/4).

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