Democrats call for DACA health care expansion

A group of 80 Democratic lawmakers is calling on the Biden administration to implement a proposal to expand access to federal health care benefits for people in the Deferred Action for Childhood Arrivals (DACA) program.

In a letter led by Sens. Cory Booker (N.J.), Dick Durbin (Ill.) and Mazie Hirono (Hawaii) and Reps. Joaquín Castro (Texas) and Pramila Jayapal (Wash.), the Democrats asked Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to speed up implementation of a proposed rule to that effect that the Biden administration rolled out in April.

"Despite living in the United States for most of their lives and meeting strict and extensive requirements to obtain deferred action, DACA recipients, who meet other program eligibility criteria, remain ineligible for federally funded health coverage," wrote the lawmakers.

"As a result, DACA recipients are uninsured at three to five times the rate of the general population."

Castro and Booker have previously led similar efforts, including a letter to Health and Human Services Secretary Xavier Becerra in November asking for Affordable Care Act (ACA) and Children's Health Insurance Programs (CHIP) access for DACA recipients.

Both Becerra and Brooks-LaSure lauded the proposal when it was introduced in April.

"Every day, nearly 580,000 DACA recipients wake up and serve their communities, often working in essential roles and making tremendous contributions to our country. They deserve access to health care, which will provide them with peace of mind and security," Becerra said at the time.

The proposed rule would allow DACA beneficiaries to be considered as "lawfully present" in the United States to access some Medicaid and CHIP, Health Insurance Marketplaces and the Basic Health Program, both benefits created by the ACA.

To access ACA benefits, foreign nationals in the United States must be considered lawfully present in the country; other deferred action programs such as Temporary Protected Status (TPS) and Deferred Enforced Departure (DED) qualify for such health care effects.

DACA beneficiaries, also known as Dreamers, are undocumented immigrants who arrived in the country as minors and registered for the program, receiving work permits, deferral from deportation and in some cases advanced parole to travel abroad.

In that sense, DACA offers benefits equivalent to the other programs, with the exception of access to key health care programs.

DACA beneficiaries are also excluded from CHIP and most aspects of Medicaid, unlike recipients of TPS and DED.

"In defining eligibility for these populations, HHS appropriately included recipients of deferred action, consistent with longstanding federal policies for Social Security benefits and driver's licenses under the REAL ID Act. However, when the DACA program was created, HHS excluded its recipients from health coverage. It is long past time to reverse this exclusive, and harmful policy," wrote the lawmakers.

Those disparities spill over into other aspects of DACA recipients' lives, according to the lawmakers.

"As eighty percent of the DACA recipients who do have health care coverage receive it through their employer, DACA recipients are vulnerable to losing their health insurance, as health care access is largely based on their ability to access job opportunities," they wrote.

"Consequently, DACA recipients often do not have the flexibility to pursue different career opportunities, including starting new businesses or participating in continuing education."

And the lawmakers said that excluding DACA beneficiaries from those health care programs also carries broader societal costs, in part because "a large portion of DACA recipients are medical and health professional students."

"Their access to health care during their education is vital to growing the health care workforce," they said.

The lawmakers' letter, which was included as a public comment to the proposed rule, calls for DACA beneficiaries to be able to enroll in the health programs as of November 1, 2023.

If the rule is implemented, DACA recipients will have a 60-day special enrollment period starting on the effective date of the final rule.

—Updated at 5:44 p.m.

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