HEAL for Immigrant Families Act of 2021

II 117TH CONGRESS 1ST SESSION S. 1660 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 SENATE OF THE UNITED STATES MAY 17, 2021 Mr. BOOKER (for himself, Mr. MARKEY, Mrs. GILLIBRAND, Mr. MERKLEY, Mrs. MURRAY, Ms. HIRONO, Mr. SANDERS, Mr. BLUMENTHAL, and Ms. WARREN) introduced the following bill; which was read twice and referred to the Committee on Finance 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 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1660 IS (1) Health insurance coverage reduces harmful 1 racial, economic, gender, and health inequities by al- 2 leviating cost barriers to, and increasing utilization 3 of, necessary health care services, especially among 4 low-income and underserved populations. 5 (2) Based solely on their immigration status, 6 many immigrants and their families face legal and 7 policy restrictions on their ability to obtain afford- 8 able health insurance coverage through Medicaid, 9 the Children’s Health Insurance Program (CHIP), 10 and the health insurance exchanges. 11 (3) Lack of health insurance coverage contrib- 12 utes to persistent inequities in the prevention, diag- 13 nosis, and treatment of health conditions. This leads 14 to negative health outcomes for immigrants and 15 their families, especially Black, Indigenous, Latinx, 16 Asian, Pacific Islander, and other Immigrants of 17 Color. 18 (4) Black immigrant women often cite cost as 19 a major barrier to health care. Many who are un- 20 documented forgo doctor visits altogether due to the 21 financial burden in addition to consistent racial bias 22 by medical practitioners and racism in health care. 23 (5) Nearly half of immigrant women are of re- 24 productive age. Immigrant women, lesbian, gay, bi- 25 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1660 IS sexual, transgender, and queer (LGBTQ) immi- 1 grants, and immigrants with disabilities dispropor- 2 tionately live in households with low incomes and 3 lack health insurance coverage. Legal and policy bar- 4 riers to affordable health insurance coverage signifi- 5 cantly exacerbate their risk of negative pregnancy- 6 related and other reproductive and sexual health 7 outcomes, with lasting health and economic con- 8 sequences for immigrant women, LGBTQ immi- 9 grants, immigrants with disabilities, and their fami- 10 lies and society as a whole. 11 (6) Immigrants who identify as LGBTQ experi- 12 ence compounding discrimination from health care 13 providers and systems based on race and ethnicity, 14 primary language, immigration status, sexual ori- 15 entation, and gender identity. Nearly one in five 16 transgender patients have been refused care due to 17 their gender non-conforming status, and providers 18 have denied care to undocumented immigrants be- 19 cause of immigration status. These inequities are ex- 20 acerbated by legal and policy barriers that restrict 21 access to health coverage on the basis of immigra- 22 tion status, exposing LGBTQ immigrant commu- 23 nities to disproportionate gaps in affordable, com- 24 prehensive health care. These compounding barriers 25 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1660 IS are especially harmful for LGBTQ immigrants who 1 are escaping interpersonal and state violence due to 2 their sexual orientation and gender identity. 3 (7) Denying health insurance coverage or im- 4 posing waiting periods for health insurance coverage 5 on the basis of immigration status unfairly hinders 6 immigrants’ ability to reach and maintain their opti- 7 mal levels of health and undermines the economic 8 well-being of their families. 9 (8) International human rights standards hold 10 that governments have an affirmative obligation to 11 ensure that everyone, including immigrants, can ac- 12 cess safe, respectful, culturally and linguistically ap- 13 propriate, and high-quality pregnancy-related care, 14 including postpartum care, free from discrimination 15 or violence. Medicaid is the nation’s single largest 16 payer for pregnancy-related care. Nevertheless, bar- 17 riers to health coverage persist for pregnant and 18 postpartum people, particularly immigrants. 19 (9) Immigrants—especially Black, Indigenous, 20 Latinx, Asian, and Pacific Islander immigrants—are 21 among those most harmed by the United States’ 22 pregnancy-related morbidity and mortality epidemic, 23 which is the worst among high-income nations. 24 Black people are more than three times more likely 25 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1660 IS than white people to suffer pregnancy-related death, 1 and twice as likely to suffer maternal morbidity. In- 2 digenous people are more than two times more likely 3 than white people to die from a pregnancy-related 4 death. The majority of United States pregnancy-re- 5 lated deaths are preventable. Lack of access to 6 health care, immigration status, poverty, and expo- 7 sure to racism, sexism, and xenophobia in and be- 8 yond the health care system contribute to the dis- 9 proportionately high number of pregnancy-related 10 deaths among BIPOC birthing and postpartum peo- 11 ple. Unnecessary barriers that limit pregnant and 12 postpartum immigrants’ access to health care under- 13 mine their health, safety, and human rights. 14 (10) One in seven United States residents is 15 foreign-born, approximately one in four children in 16 the United States has at least one immigrant par- 17 ent, and the population of immigrant families in the 18 United States is expected to continue to grow in the 19 coming years. It is therefore in our collective public 20 health and economic interest to remove legal and 21 policy barriers to affordable health insurance cov- 22 erage that are based on immigration status. 23 (11) Although individuals granted relief under 24 the Deferred Action for Childhood Arrivals (DACA) 25 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1660 IS program are authorized to live and work in the 1 United States, they have been unfairly excluded 2 from the definitions of lawfully present and lawfully 3 residing for purposes of health insurance coverage 4 provided through the Department of Health and 5 Human Services, including Medicaid, CHIP, and the 6 health insurance exchanges. 7 (12) Since immigration law evolves constantly, 8 new immigration categories for individuals with fed- 9 erally authorized presence in the United States may 10 be created. 11 (13) Some States continue to unwisely restrict 12 Medicaid access for immigrants who have long re- 13 sided in the United States, fueling significant health 14 inequities and increasing health care costs for indi- 15 viduals and the public. 16 (14) Congress restored Medicaid eligibility for 17 individuals living in the United States under the 18 Compacts of Free Association as part of bipartisan 19 legislation in December 2020 and should build on 20 that success by ensuring all immigrants can access 21 care. 22 (b) PURPOSE.—It is the purpose of this Act to— 23 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 7 •S 1660 IS (1) ensure that all individuals who are lawfully 1 present in the United States are eligible for all fed- 2 erally funded health care programs; 3 (2) advance the ability of undocumented indi- 4 viduals to obtain health insurance coverage through 5 the health insurance exchanges established under 6 part II of the Patient Protection and Affordable 7 Care Act, Public Law 111–148; 8 (3) eliminate the authority for States to restrict 9 Medicaid eligibility for lawful permanent residents; 10 and 11 (4) eliminate other barriers to accessing Med- 12 icaid, CHIP, and other medical assistance. 13 SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR 14 LAWFULLY RESIDING INDIVIDUALS. 15 (a) MEDICAID.—Section 1903(v)(4) of the Social Se- 16 curity Act (42 U.S.C. 1396b(v)(4)) is amended— 17 (1) by amending subparagraph (A) to read as 18 follows: 19 ‘‘(A) Notwithstanding sections 401(a), 20 402(b), 403, and 421 of the Personal Responsi- 21 bility and Work Opportunity Reconciliation Act 22 of 1996, a State shall provide medical assist- 23 ance under this title to individuals who are law- 24 fully residing in the United States (including 25 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 8 •S 1660 IS individuals described in paragraph (1), battered 1 individuals described in section 431(c) of such 2 Act, and individuals with an approved or pend- 3 ing application for deferred action or other fed- 4 erally authorized presence), if they otherwise 5 meet the eligibility requirements for medical as- 6 sistance under the State plan approved under 7 this title (other than the requirement of the re- 8 ceipt of aid or assistance under title IV, supple- 9 mental security income benefits under title 10 XVI, or a State supplementary payment).’’; 11 (2) by amending subparagraph (B) to read as 12 follows: 13 ‘‘(B) No debt shall accrue under an affi- 14 davit of support against any sponsor of an indi- 15 vidual provided medical assistance under sub- 16 paragraph (A) on the basis of provision of as- 17 sistance to such individual and the cost of such 18 assistance shall not be considered as an unreim- 19 bursed cost.’’; and 20 (3) in subparagraph (C)— 21 (A) by striking ‘‘an election by the State 22 under subparagraph (A)’’ and inserting ‘‘the 23 application of subparagraph (A)’’; 24 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 9 •S 1660 IS (B) by inserting ‘‘or be lawfully present’’ 1 after ‘‘lawfully reside’’; and 2 (C) by inserting ‘‘or present’’ after ‘‘law- 3 fully residing’’ each place it appears. 4 (b) CHIP.—Subparagraph (O) of section 2107(e)(1) 5 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 6 amended to read as follows: 7 ‘‘(O) Paragraph (4) of section 1903(v) (re- 8 lating to lawfully residing individuals).’’. 9 (c) EFFECTIVE DATE.— 10 (1) IN GENERAL.—Except as provided in para- 11 graph (2), the amendments made by this section 12 shall take effect on the date of enactment of this Act 13 and shall apply to services furnished on or after the 14 date that is 90 days after such date of enactment. 15 (2) EXCEPTION IF STATE LEGISLATION RE- 16 QUIRED.—In the case of a State plan for medical as- 17 sistance under title XIX, or a State child health plan 18 under title XXI, of the Social Security Act which the 19 Secretary of Health and Human Services determines 20 requires State legislation (other than legislation ap- 21 propriating funds) in order for the plan to meet the 22 additional requirements imposed by the amendments 23 made by this section, the respective State plan shall 24 not be regarded as failing to comply with the re- 25 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 10 •S 1660 IS quirements of such title solely on the basis of its 1 failure to meet these additional requirements before 2 the first day of the first calendar quarter beginning 3 after the close of the first regular session of the 4 State legislature that begins after the date of enact- 5 ment of this Act. For purposes of the previous sen- 6 tence, in the case of a State that has a 2-year legis- 7 lative session, each year of such session shall be 8 deemed to be a separate regular session of the State 9 legislature. 10 SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE 11 FOR INDIVIDUALS WITH FEDERALLY AU- 12 THORIZED PRESENCE, INCLUDING DE- 13 FERRED ACTION. 14 (a) IN GENERAL.—For purposes of eligibility under 15 any of the provisions described in subsection (b), all indi- 16 viduals granted federally authorized presence in the 17 United States shall be considered to be lawfully present 18 in the United States. 19 (b) PROVISIONS DESCRIBED.—The provisions de- 20 scribed in this subsection are the following: 21 (1) EXCHANGE ELIGIBILITY.—Section 1411 of 22 the Patient Protection and Affordable Care Act (42 23 U.S.C. 18031). 24 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 11 •S 1660 IS (2) REDUCED COST-SHARING ELIGIBILITY.— 1 Section 1402 of the Patient Protection and Afford- 2 able Care Act (42 U.S.C. 18071). 3 (3) PREMIUM SUBSIDY ELIGIBILITY.—Section 4 36B of the Internal Revenue Code of 1986 (26 5 U.S.C. 36B). 6 (4) MEDICAID AND CHIP ELIGIBILITY.—Titles 7 XIX and XXI of the Social Security Act, including 8 under section 1903(v) of such Act (42 U.S.C. 9 1396b(v)). 10 (c) EFFECTIVE DATE.— 11 (1) IN GENERAL.—Subsection (a) shall take ef- 12 fect on the date of enactment of this Act. 13 (2) TRANSITION THROUGH SPECIAL ENROLL- 14 MENT PERIOD.—In the case of an individual de- 15 scribed in subsection (a) who, before the first day of 16 the first annual open enrollment period under sub- 17 paragraph (B) of section 1311(c)(6) of the Patient 18 Protection and Affordable Care Act (42 U.S.C. 19 18031(c)(6)) beginning after the date of enactment 20 of this Act, is granted federally authorized presence 21 in the United States and who, as a result of such 22 subsection, qualifies for a subsidy under a provision 23 described in paragraph (2) or (3) of subsection (b), 24 the Secretary of Health and Human Services shall 25 VerDate Sep 11 2014 22:23 May 27, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1660.IS S1660 kjohnson on DSK79L0C42PROD with BILLS 12 •S 1 [Text truncated for display. 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