DACA ruling and health coverage in Texas, beyond

A ruling that blocked thousands of undocumented immigrants from enrolling in federally-available health care plans could reverberate on vulnerable groups, by reestablishing a common barrier to medical care.

This week, a federal judge in North Dakota halted a Biden administration policy that would've given Deferred Action for Childhood Arrivals (DACA) recipients a way to access health insurance, the latest blow against the initiative.

The ruling affects a total of 162,000 DACA recipients in the 19 states that sued over the expansion, according to a legal filing. By far, Texas has the most DACA recipients of any state on the list, with more than 87,000 "Dreamers," according to the filing.

Opponents to the health care expansion, including Texas Attorney General Ken Paxton, celebrated the judge's ruling. But advocates say the health care expansion would've provided needed access to vulnerable people.

The National Immigration Law Center, which is defending the Biden administration's rule,said in a statement that the injunction is "disappointing and wrong on the law."

The organization "will continue to fight on behalf of our clients and hundreds of thousands of DACA recipients who have been waiting over a decade to access life-sustaining care under the Affordable Care Act," NILC deputy director Nicholas Espíritu said.

'Ensuring quality health care'

In May, the federal Centers for Medicare & Medicaid Services announced a rule change that allowed "Dreamers" -- DACA recipients brought into the U.S. as children -- to access marketplace health coverage plans. Marketplace plans fall under the umbrella of the Affordable Care Act, commonly known as Obamacare.

Marketplace plans require enrollees to be U.S. citizens or nationals, or be "lawfully present" in the country, yet the May rule expanded the definition of "lawfully present" to include Dreamers.

Before the change, DACA recipients could not access federally available health plans, including marketplace plans as well as Medicaid, although some states provide access through state-based plans.

At the time, the Biden administration hailed the rule change as a part of its "ongoing commitment to ensuring affordable, quality health care for all."

The rule was scheduled to take effect on Nov. 1. But a coalition of 19 states, including Texas, sued over the rule change in North Dakota federal court. The states argued the new rule is "both contrary to law and arbitrary and capricious."

Judge Daniel M. Traynor, who was appointed by Donald J. Trump in 2020, issued an injunction on Monday that temporarily blocks the rule from being enforced in the states that sued.

In the ruling, Traynor wrote the CMS does not have the authority to change the definition of "lawfully present" in order to expand health care coverage.

"CMS acted contrary to law by redefining who is a qualified alien, a determination that is to be left to Congress," he says.

The risks of delaying care

People in the U.S. who do not have health insurance are much more likely to delay or skip medical care. That also means uninsured people are prone to be hospitalized for preventable health problems, and more likely to die.

Meanwhile, Texas has long had the highest uninsured rate of any state in the country, KFF Health News data shows.

And DACA recipients are far less likely to have health insurance, when compared to U.S.-born residents, according to 2022 data from KFF. Among U.S.-born people aged 15 to 41, 10% are uninsured; yet among eligible DACA recipients, the rate soars to 47%.

Kansas Attorney General Kris Kobach, whose state helped spearhead the legal challenge, celebrated Monday's injunction as a "big win for the rule of law" in a post on X.

A spokesperson for the Centers for Medicare & Medicaid Services, reached by email, declined to answer questions about the injunction.

"CMS is reviewing the court's decision; however, the agency does not comment on litigation," the spokesperson said.

A statement posted on the federal marketplace insurance website says that the "Marketplace is reviewing the court's decision and its impact on consumers ... and will issue further information shortly."