HEAL for Immigrant Families Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 3149 To expand access to health care services for immigrants by removing legal and policy barriers to health insurance coverage, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 12, 2021 Ms. JAYAPAL (for herself, Ms. BARRAGA´N, Ms. ADAMS, Mr. AUCHINCLOSS, Ms. BASS, Mr. BEYER, Mr. BLUMENAUER, Ms. BONAMICI, Mr. BOWMAN, Ms. BUSH, Mr. CA´RDENAS, Mr. CARSON, Mr. CASTRO of Texas, Ms. CHU, Mr. CICILLINE, Ms. CLARK of Massachusetts, Ms. CLARKE of New York, Mr. COHEN, Mr. CONNOLLY, Mr. CORREA, Mr. DANNY K. DAVIS of Illinois, Mr. DESAULNIER, Mr. DEUTCH, Ms. ESCOBAR, Mr. ESPAILLAT, Mr. GALLEGO, Mr. GARCI´A of Illinois, Ms. GARCIA of Texas, Mr. GOMEZ, Mr. GREEN of Texas, Mr. GRIJALVA, Mrs. HAYES, Ms. JACKSON LEE, Ms. JACOBS of California, Mr. JOHNSON of Georgia, Mr. JONES, Mr. KEATING, Mrs. LAWRENCE, Ms. LEE of California, Ms. LEGER FERNANDEZ, Mr. LEVIN of Michigan, Mr. LIEU, Mr. LOWENTHAL, Mrs. CAROLYN B. MALONEY of New York, Mr. MCGOV- ERN, Mr. MEEKS, Ms. MENG, Ms. MOORE of Wisconsin, Mr. NADLER, Mrs. NAPOLITANO, Ms. NEWMAN, Ms. NORTON, Ms. OCASIO-CORTEZ, Ms. OMAR, Mr. PANETTA, Mr. PAYNE, Mr. PERLMUTTER, Ms. PINGREE, Mr. POCAN, Ms. PRESSLEY, Ms. ROYBAL-ALLARD, Mr. RUSH, Ms. SCAN- LON, Ms. SCHAKOWSKY, Mr. SIRES, Mr. SOTO, Ms. SPEIER, Mr. TAKANO, Ms. TLAIB, Mrs. TORRES of California, Mr. TORRES of New York, Mr. TRONE, Mr. VARGAS, Mr. VEASEY, Mr. VELA, Ms. VELA´ZQUEZ, Ms. WASSERMAN SCHULTZ, Mrs. WATSON COLEMAN, Mr. WELCH, Ms. WILLIAMS of Georgia, and Ms. WILSON of Florida) intro- duced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned VerDate Sep 11 2014 00:43 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H3149.IH H3149 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3149 IH A BILL To expand access to health care services for immigrants by removing legal and policy barriers to health insurance coverage, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Health Equity and 4 Access under the Law for Immigrant Families Act of 5 2021’’ or the ‘‘HEAL for Immigrant Families Act of 6 2021’’. 7 SEC. 2. FINDINGS; PURPOSE. 8 (a) FINDINGS.—Congress finds as follows: 9 (1) Health insurance coverage reduces harmful 10 racial, economic, gender, and health inequities by al- 11 leviating cost barriers to, and increasing utilization 12 of, necessary health care services, especially among 13 low-income and underserved populations. 14 (2) Based solely on their immigration status, 15 many immigrants and their families face legal and 16 policy restrictions on their ability to obtain afford- 17 able health insurance coverage through Medicaid, 18 the Children’s Health Insurance Program (CHIP), 19 and the health insurance exchanges. 20 VerDate Sep 11 2014 00:43 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3149.IH H3149 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3149 IH (3) Lack of health insurance coverage contrib- 1 utes to persistent inequities in the prevention, diag- 2 nosis, and treatment of health conditions. This leads 3 to negative health outcomes for immigrants and 4 their families, especially Black, Indigenous, Latinx, 5 Asian, Pacific Islander, and other Immigrants of 6 Color. 7 (4) Black immigrant women often cite cost as 8 a major barrier to health care. Many who are un- 9 documented forgo doctor visits altogether due to the 10 financial burden in addition to consistent racial bias 11 by medical practitioners and racism in health care. 12 (5) Nearly half of immigrant women are of re- 13 productive age. Immigrant women, lesbian, gay, bi- 14 sexual, transgender, and queer (LGBTQ) immi- 15 grants, and immigrants with disabilities dispropor- 16 tionately live in households with low incomes and 17 lack health insurance coverage. Legal and policy bar- 18 riers to affordable health insurance coverage signifi- 19 cantly exacerbate their risk of negative pregnancy- 20 related and other reproductive and sexual health 21 outcomes, with lasting health and economic con- 22 sequences for immigrant women, LGBTQ immi- 23 grants, immigrants with disabilities, and their fami- 24 lies and society as a whole. 25 VerDate Sep 11 2014 00:43 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3149.IH H3149 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3149 IH (6) Immigrants who identify as LGBTQ experi- 1 ence compounding discrimination from health care 2 providers and systems based on race and ethnicity, 3 primary language, immigration status, sexual ori- 4 entation, and gender identity. Nearly one in five 5 transgender patients have been refused care due to 6 their gender non-conforming status, and providers 7 have denied care to undocumented immigrants be- 8 cause of immigration status. These inequities are ex- 9 acerbated by legal and policy barriers that restrict 10 access to health coverage on the basis of immigra- 11 tion status, exposing LGBTQ immigrant commu- 12 nities to disproportionate gaps in affordable, com- 13 prehensive health care. These compounding barriers 14 are especially harmful for LGBTQ immigrants who 15 are escaping interpersonal and state violence due to 16 their sexual orientation and gender identity. 17 (7) Denying health insurance coverage or im- 18 posing waiting periods for health insurance coverage 19 on the basis of immigration status unfairly hinders 20 immigrants’ ability to reach and maintain their opti- 21 mal levels of health and undermines the economic 22 well-being of their families. 23 (8) International human rights standards hold 24 that governments have an affirmative obligation to 25 VerDate Sep 11 2014 00:43 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3149.IH H3149 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3149 IH ensure that everyone, including immigrants, can ac- 1 cess safe, respectful, culturally and linguistically ap- 2 propriate, and high-quality pregnancy-related care, 3 including postpartum care, free from discrimination 4 or violence. Medicaid is the nation’s single largest 5 payer for pregnancy-related care. Nevertheless, bar- 6 riers to health coverage persist for pregnant and 7 postpartum people, particularly immigrants. 8 (9) Immigrants—especially Black, Indigenous, 9 Latinx, Asian, and Pacific Islander immigrants—are 10 among those most harmed by the United States’ 11 pregnancy-related morbidity and mortality epidemic, 12 which is the worst among high-income nations. 13 Black people are nearly four times more likely than 14 white people to suffer pregnancy-related death, and 15 twice as likely to suffer maternal morbidity. Indige- 16 nous people are two and a half times more likely 17 than white people to die from a pregnancy-related 18 death. The majority of United States pregnancy-re- 19 lated deaths are preventable. Lack of access to 20 health care, immigration status, poverty, and expo- 21 sure to racism, sexism, and xenophobia in and be- 22 yond the health care system contribute to the dis- 23 proportionately high number of pregnancy-related 24 deaths among BIPOC birthing and postpartum peo- 25 VerDate Sep 11 2014 00:43 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3149.IH H3149 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 3149 IH ple. Unnecessary barriers that limit pregnant and 1 postpartum immigrants’ access to health care under- 2 mine their health, safety, and human rights. 3 (10) One in seven United States residents is 4 foreign-born, approximately one in four children in 5 the United States has at least one immigrant par- 6 ent, and the population of immigrant families in the 7 United States is expected to continue to grow in the 8 coming years. It is therefore in our collective public 9 health and economic interest to remove legal and 10 policy barriers to affordable health insurance cov- 11 erage that are based on immigration status. 12 (11) Although individuals granted relief under 13 the Deferred Action for Childhood Arrivals (DACA) 14 program are authorized to live and work in the 15 United States, they have been unfairly excluded 16 from the definitions of lawfully present and lawfully 17 residing for purposes of health insurance coverage 18 provided through the Department of Health and 19 Human Services, including Medicaid, CHIP, and the 20 health insurance exchanges. 21 (12) Since immigration law evolves constantly, 22 new immigration categories for individuals with fed- 23 erally authorized presence in the United States may 24 be created. 25 VerDate Sep 11 2014 00:43 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3149.IH H3149 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 3149 IH (13) Some States continue to unwisely restrict 1 Medicaid access for immigrants who have long re- 2 sided in the United States, fueling significant health 3 inequities and increasing health care costs for indi- 4 viduals and the public. 5 (14) Congress restored Medicaid eligibility for 6 individuals living in the United States under the 7 Compacts of Free Association as part of bipartisan 8 legislation in December 2020 and should build on 9 that success by ensuring all immigrants can access 10 care. 11 (b) PURPOSE.—It is the purpose of this Act to— 12 (1) ensure that all individuals who are lawfully 13 present in the United States are eligible for all fed- 14 erally funded health care programs; 15 (2) advance the ability of undocumented indi- 16 viduals to obtain health insurance coverage through 17 the health insurance exchanges established under 18 part II of the Patient Protection and Affordable 19 Care Act, Public Law 111–148; 20 (3) eliminate the authority for States to restrict 21 Medicaid eligibility for lawful permanent residents; 22 and 23 (4) eliminate other barriers to accessing Med- 24 icaid, CHIP, and other medical assistance. 25 VerDate Sep 11 2014 00:43 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3149.IH H3149 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 3149 IH SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR 1 LAWFULLY RESIDING INDIVIDUALS. 2 (a) MEDICAID.—Section 1903(v)(4) of the Social Se- 3 curity Act (42 U.S.C. 1396b(v)(4)) is amended— 4 (1) by amending subparagraph (A) to read as 5 follows: 6 ‘‘(A) Notwithstanding sections 401(a), 7 402(b), 403, and 421 of the Personal Responsi- 8 bility and Work Opportunity Reconciliation Act 9 of 1996, a State shall provide medical assist- 10 ance under this title, to individuals who are 11 lawfully residing in the United States (including 12 individuals described in paragraph (1), battered 13 individuals described in section 431(c) of such 14 Act, and individuals with an approved or pend- 15 ing application for deferred action or other fed- 16 erally authorized presence), if they otherwise 17 meet the eligibility requirements for medical as- 18 sistance under the State plan approved under 19 this title (other than the requirement of the re- 20 ceipt of aid or assistance under title IV, supple- 21 mental security income benefits under title 22 XVI, or a State supplementary payment).’’; 23 (2) by amending subparagraph (B) to read as 24 follows: 25 VerDate Sep 11 2014 00:43 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3149.IH H3149 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 3149 IH ‘‘(B) No debt shall accrue under an affi- 1 davit of support against any sponsor of an indi- 2 vidual provided medical assistance under sub- 3 paragraph (A) on the basis of provision of as- 4 sistance to such individual and the cost of such 5 assistance shall not be considered as an unreim- 6 bursed cost.’’; and 7 (3) in subparagraph (C)— 8 (A) by striking ‘‘an election by the State 9 under subparagraph (A)’’ and inserting ‘‘the 10 application of subparagraph (A)’’; 11 (B) by inserting ‘‘or be lawfully present’’ 12 after ‘‘lawfully reside’’; and 13 (C) by inserting ‘‘or present’’ after ‘‘law- 14 fully residing’’ each place it appears. 15 (b) CHIP.—Subparagraph (N) of section 2107(e)(1) 16 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 17 amended to read as follows: 18 ‘‘(N) Paragraph (4) of section 1903(v) (re- 19 lating to lawfully present individuals).’’. 20 (c) EFFECTIVE DATE.— 21 (1) IN GENERAL.—Except as provided in para- 22 graph (2), the amendments made by this section 23 shall take effect on the date of enactment of this Act 24 VerDate Sep 11 2014 00:43 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3149.IH H3149 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 3149 IH and shall apply to services furnished on or after the 1 date that is 90 days after such date of enactment. 2 (2) EXCEPTION IF STATE LEGISLATION RE- 3 QUIRED.—In the case of a State plan for medical as- 4 sistance under title XIX, or a State child health plan 5 under title XXI, of the Social Security Act which the 6 Secretary of Health and Human Services determines 7 requires State legislation (other than legislation ap- 8 propriating funds) in order for the plan to meet the 9 additional requirements imposed by the amendments 10 made by this section, the respective State plan shall 11 not be regarded as failing to comply with the re- 12 quirements of such title solely on the basis of its 13 failure to meet these additional requirements before 14 the first day of the first calendar quarter beginning 15 after the close of the first regular session of the 16 State legislature that begins after the date of enact- 17 ment of this Act. For purposes of the previous sen- 18 tence, in the case of a State that has a 2-year legis- 19 lative session, each year of such session shall be 20 deemed to be a separate regular session of the State 21 legislature. 22 VerDate Sep 11 2014 00:43 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3149.IH H3149 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 3149 IH SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE 1 FOR INDIVIDUALS WITH FEDERALLY AU- 2 THORIZED PRESENCE, INCLUDING DE- 3 FERRED ACTION. 4 (a) IN GENERAL.—For purposes of eligibility under 5 any of the provisions described in subsection (b), all indi- 6 viduals granted federally authorized presence in the 7 United States shall be considered to be lawfully present 8 in the United States. 9 (b) PROVISIONS DESCRIBED.—The provisions de- 10 scribed in this subsection are the following: 11 (1) EXCHANGE ELIGIBILITY.—Section 1411 o [Text truncated for display. Full text available on Congress.gov.]