A landmark immigration bill passed by the Senate would create new pathways to citizenship and provide a much-needed boost to the U.S. economy but would do little to ease immigration-related disparities in health care, according to a new report.
"The Senate bill represents the most significant bipartisan effort to reform immigration in many years," says Leighton Ku, PhD, MPH, the author of the new report and the director of the Center for Health Policy Research at the George Washington University School of Public Health and Health Services (SPHHS). "It would modernize the nation's outmoded immigration system and let unauthorized immigrants earn a pathway to citizenship, but when it comes to health care, the bill offers no major changes."
The new report, which was funded in part by the Commonwealth Fund, analyzes the impact of the bill overall and specifically on health care. Ku found that the legislation would help clear the path for new legal immigration and help unauthorized immigrants earn legal status over more than a decade. That in turn, would expand the nation's workforce, bolster the economy and could help reduce the federal deficit, he says. The bill would also limit the future flow of unauthorized immigrants. But the issue brief also says that increasing access to health care for immigrants was not a high priority item in designing the bill, particularly in light of the continuing controversies about health reform.
For example, many not-yet-legal immigrants would be ineligible for most of the reforms under the Affordable Care Act, such as premium assistance or cost sharing subsidies, according to the analysis. Under the Senate bill, these immigrants could gain legal status, but remain ineligible for government assistance in obtaining health insurance or access to health care.
"Experience tells us that legalizing unauthorized immigrants will help them get better jobs in the long run. In turn, this may help them get job-based private health insurance," said Ku, who is also a professor in the Department of Health Policy at SPHHS.
Other key findings of the issue brief:
- Because so many immigrants will remain without health insurance, there will continue to be a strain on the U.S. safety net of health care facilities. It will be important to maintain the nation's health care safety net, which includes community health centers and essential hospitals, to care for those who remain uninsured, including both immigrants and the native-born.
- The Senate bill would also make it easier for physicians and nurses from other countries to gain legal status in the United States—if they agree to provide care in rural or underserved regions. That provision could ease the health care workforce shortages in many parts of the nation.
- Since immigration reform will result in more people entering the United States, there will be a greater need for language assistance to help the newcomers who have a limited ability to speak English. Although federal policy already calls on health care providers to offer translation services, language barriers continue to be a common problem.
The issue brief notes that the bill still faces a rocky road ahead in terms of passage into law. The bill was developed after months of work by the so-called "Gang of Eight" Senators and passed with a strong bipartisan 68 to 32 vote. But the bill has elicited resistance now that the immigration reform debate has moved to the U.S. House of Representatives, Ku says. Despite the momentum that built up around the passage of this bill, the future of immigration reform remains uncertain, Ku says.