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The District of
By way of background, HBX is a private-public partnership established by the
We strongly oppose Presidential Proclamation No. 9945 ("Proclamation") and request it be withdrawn in its entirety. The Proclamation will undermine the District's health insurance coverage gains and access to quality, affordable health care - reversing years of progress. Additionally, the Proclamation contradicts existing federal law -- the Affordable Care Act (ACA), and its issuance is in violation of the Administrative Procedure Act (APA).
The Detrimental Effect on Health Coverage
The Proclamation will adversely impact the District's private individual health insurance market and hurt District residents. The District is ranked second among all states for the lowest uninsured rate and in 2019, the District had the fifth lowest average individual market premiums in the country./2
These gains are put at risk because the Proclamation:
1. Encourages prospective immigrants to purchase junk plans like short-term limited-duration insurance (STLDI);
2. Undermines the purchase of marketplace coverage by requiring health insurance coverage be secured before entry into
3. Seems to change, making worse already problematic guidance recently finalized in the Public Charge rule issued by the
First, the Proclamation lists STLDI as approved coverage to meet the healthcare coverage requirements necessary for certain immigrants to enter
They exclude coverage for preexisting conditions, use medical underwriting to keep people with medical needs out, cap benefits using annual and lifetime dollar limits, and do not cover all of the benefits considered "essential" like mental health and maternity services. Even with these severe limitations, STLDI plans are specifically promoted under the Proclamation. Consequently, rather than protect the health care system and the American taxpayer from the "burdens of uncompensated care," as the Proclamation states, allowing prospective immigrants to purchase such junk plans as opposed to marketplace coverage will likely increase uncompensated care when immigrants need health care services not covered under these junk plans. For the
Second, the Proclamation further undermines the purchase of marketplace coverage by requiring coverage prior to entry. Specifically, while the Proclamation contemplates that unsubsidized private health insurance coverage obtained through a marketplace (like DC Health Link) would qualify as meeting health coverage requirements for entry into the
A person applying for entry into the
Third, this Proclamation and the recent
While the Proclamation states that the visa applicant must be enrolled in unsubsidized coverage, the Public Charge rule views all private coverage (including subsidized private coverage) positively in the asset/resources analysis./7
Importantly, while we oppose the anti-immigrant policies reflected in the Proclamation and the Public Charge Rule, we expect consistency in standards used. The Proclamation adds further confusion and increases the Public Charge Rule's chilling effect.
Contradictory to the ACA
The Proclamation directly conflicts with provisions of the ACA that provide immigrants access to marketplace coverage.
Current federal law, as established by the ACA, allows lawfully present individuals, both immigrants and non-immigrants, to purchase subsidized health insurance coverage through health insurance exchanges./8
In the ACA,
Thus the Proclamation's requirement that immigrants acquire unsubsidized coverage is akin to amending the ACA without
Contrary to the APA
The two-day comment period violates the APA. The President is requiring the
We ask that the Proclamation be withdrawn in its entirety.
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1/ Presidential Proclamation on the Suspension of Entry of Immigrants Who Will Financially Burden the
4/ Comment on Short-Term, Limited-
5/ U.S.C. Sec. 18032(f); 45 C.F.R. 155.305(a).
6/ Supra, note 3.
8/ 26 U.S.C. Sec.18032(f)(3).
9/ 26 U.S.C. Sec.36B(c)(1)(B)("Special rule for certain individuals lawfully present in
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The notice can be viewed at: https://www.regulations.gov/document?D=DOS-2019-0039-0001