Republican states sue feds over HHS rule mandating DACA coverage

Photo: Pichsakul Promrungsee Eyeem/Getty Images

Fifteen Republican-led states are suing the Biden administration in an attempt to stop the government from opening up the Affordable Care Act to immigrants in the Deferred Action for Childhood Arrivals (DACA) program, saying the recipients are not "legally present" and should not be eligible for Affordable Care Act coverage.

Their challenge was spurred by the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, which in May finalized a rule expanding healthcare access for DACA recipients, with the goal of ensuring they'll no longer be excluded from eligibility to enroll in a Qualified Health Plan through the Affordable Care Act Health Insurance Marketplace, or for coverage through a Basic Health Program.

CMS estimated the rule could lead to 100,000 previously uninsured DACA recipients enrolling in health coverage through marketplaces or a BHP.

Kansas Attorney General Kris Kobach, whose state is part of the lawsuit, said, "Illegal aliens shouldn't get a free pass into our country. They shouldn't receive taxpayer benefits when they arrive, and the Biden-Harris administration shouldn't get a free pass to violate federal law."

According to the complaint, the proposed regulation violates a federal law that prohibits giving public benefits to illegal immigrants, and violates the plain text of the Affordable Care Act.

"In the ACA, Congress limited eligibility to participate in a qualified health plan through a subsidized health exchange to citizens or nationals of the United States and individuals 'lawfully present' in the United States," the complaint reads.

In addition to Kansas, the states joining the suit are North Dakota, Alabama, Idaho, Indiana, Iowa, Missouri, Montana, Nebraska, New Hampshire, Ohio, South Carolina, South Dakota, Tennessee and Virginia.

WHAT'S THE IMPACT?

The Republican reaction to the rule stands in stark contrast to that of congressional Democrats, who in July cosigned a letter to HHS asking the agency to shore up ACA access for DACA recipients.

Lawmakers said in the letter that, while they appreciate the finalization of the regulation that expanded eligibility to DACA recipients, for the expansion to be successful, "HHS must ensure that every newly eligible individual is fully informed and supported during the enrollment process," they wrote.

It is imperative, they said, that DACA recipients are aware that they have a special enrollment period that aligns with the annual open enrollment period, are informed of their eligibility and are able to navigate the registration process.

To accomplish this goal, the Democratic lawmakers suggested that HHS should invest resources into paid media outreach, funding to community organizations to disseminate information, and HHS staff time into a targeted outreach program for newly eligible DACA recipients. 

They also called for robust training for anyone assisting in outreach and enrollment, including call center employees, navigators, certified application counselors, brokers and agents.

THE LARGER TREND

In May HHS and CMS finalized the DACA rule, with the goal of ensuring they'll no longer be excluded from eligibility to enroll in a Qualified Health Plan through the ACA's Health Insurance Marketplace, or for coverage through a Basic Health Program.

CMS estimates this rule could lead to 100,000 previously uninsured DACA recipients enrolling in health coverage through marketplaces or a BHP.

Those without health insurance are less likely to receive preventive or routine health screenings and may delay necessary medical care, incurring high costs and debts when they do seek care, according to CMS.

DACA recipients are currently three times more likely to be uninsured than the general U.S. population, the agency said. DACA recipients who qualify to enroll in a marketplace plan may also qualify for advance payments of the premium tax credit (APTC) and cost-sharing reductions (CSRs) to reduce the cost of their marketplace coverage, depending on their income.
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.