HEAL for Immigrant Women and Families Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4701 To expand access to health care services, including sexual, reproductive, and maternal health services, for immigrants by removing legal and policy barriers to health insurance coverage, and for other purposes. IN THE HOUSE OF REPRESENTATIVES OCTOBER 16, 2019 Ms. JAYAPAL (for herself, Ms. HAALAND, Ms. BARRAGA´N, Mr. BLUMENAUER, Ms. JUDY CHU of California, Mr. ESPAILLAT, Mr. GALLEGO, Ms. LEE of California, Ms. MOORE, Mrs. NAPOLITANO, Ms. NORTON, Mr. POCAN, Ms. PRESSLEY, Ms. SCHAKOWSKY, Mr. SOTO, Ms. WILSON of Florida, Mr. TAKANO, Mrs. LAWRENCE, Ms. GARCIA of Texas, Mr. JOHNSON of Georgia, Ms. MENG, Ms. ROYBAL-ALLARD, and Mr. GRIJALVA) 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 A BILL To expand access to health care services, including sexual, reproductive, and maternal health services, for immi- grants 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 VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS 2 •HR 4701 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Health Equity and 2 Access under the Law for Immigrant Women and Families 3 Act of 2019’’ or as the ‘‘HEAL for Immigrant Women 4 and Families Act of 2019’’. 5 SEC. 2. FINDINGS; PURPOSE. 6 (a) FINDINGS.—Congress finds as follows: 7 (1) Health insurance coverage reduces harmful 8 disparities by alleviating cost barriers to and in- 9 creasing utilization of necessary health care services, 10 especially among low-income and underserved popu- 11 lations, including women. 12 (2) Based solely on their immigration status, 13 many immigrants and their families face legal and 14 policy restrictions on their ability to obtain afford- 15 able health insurance coverage through Medicaid, 16 the Children’s Health Insurance Program (CHIP), 17 and the health insurance exchanges. 18 (3) Lack of health insurance coverage contrib- 19 utes to persistent disparities in the prevention, diag- 20 nosis, and treatment of negative health outcomes ex- 21 perienced by immigrants and their families. 22 (4) Nearly half of immigrant women are of re- 23 productive age. Immigrant women are also dis- 24 proportionately living in low-income households and 25 lacking health insurance coverage. Legal and policy 26 VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS 3 •HR 4701 IH barriers to affordable health insurance coverage 1 therefore particularly exacerbate their risk of nega- 2 tive sexual, reproductive, and maternal health out- 3 comes, with lasting health and economic con- 4 sequences for immigrant women, their families, and 5 society as a whole. 6 (5) Denying health insurance coverage or im- 7 posing waiting periods for health insurance coverage 8 unfairly hinders the ability of immigrants to attain 9 good health and undermines the economic well-being 10 of their families. 11 (6) The population of immigrant families in the 12 United States is expected to continue to grow. One 13 in seven United States residents is foreign-born, and 14 approximately one in four children in the United 15 States has at least one immigrant parent. It is 16 therefore in the Nation’s shared public health and 17 economic interest to remove legal and policy barriers 18 to affordable health insurance coverage based on im- 19 migration status. 20 (7) Although Deferred Action for Childhood Ar- 21 rivals (DACA) recipients are authorized to live and 22 work in the United States, they have been unfairly 23 excluded from the definition of lawfully present and 24 lawfully residing for purposes of health insurance 25 VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS 4 •HR 4701 IH coverage through the Department of Health and 1 Human Services, including Medicaid and CHIP, and 2 the health insurance exchanges. 3 (8) Immigration law is constantly evolving and 4 new immigration categories for individuals with fed- 5 erally authorized presence in the United States may 6 be created. 7 (b) PURPOSE.—It is the purpose of this Act to— 8 (1) ensure that all individuals who are lawfully 9 present in the United States are eligible for all fed- 10 erally funded health care programs; and 11 (2) advance the ability of undocumented indi- 12 viduals to obtain health insurance coverage through 13 the health insurance exchanges. 14 SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR 15 LAWFULLY PRESENT INDIVIDUALS. 16 (a) MEDICAID.—Section 1903(v)(4) of the Social Se- 17 curity Act (42 U.S.C. 1396b(v)(4)) is amended— 18 (1) by amending subparagraph (A) to read as 19 follows: 20 ‘‘(A) Notwithstanding sections 401(a), 402(b), 403, 21 and 421 of the Personal Responsibility and Work Oppor- 22 tunity Reconciliation Act of 1996, payment shall be made 23 under this section for care and services that are furnished 24 to individuals who are not citizens of the United States, 25 VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS 5 •HR 4701 IH including aliens described in paragraph (1), if they other- 1 wise meet the eligibility requirements for medical assist- 2 ance under the State plan approved under this title (other 3 than the requirement of the receipt of aid or assistance 4 under title IV, supplemental security income benefits 5 under title XVI, or a State supplementary payment) and 6 are lawfully present in the United States (including such 7 an individual who is granted deferred action or other fed- 8 erally authorized presence).’’; 9 (2) in subparagraph (B)— 10 (A) by striking ‘‘a State that has elected to 11 provide medical assistance to a category of 12 aliens under subparagraph (A)’’ and inserting 13 ‘‘individuals provided medical assistance pursu- 14 ant to subparagraph (A)’’; and 15 (B) by striking ‘‘such an alien on the basis 16 of provision of assistance to such category’’ and 17 inserting ‘‘such an individual on the basis of 18 provision of assistance to such individual’’; and 19 (3) in subparagraph (C)— 20 (A) by striking ‘‘an election by the State 21 under subparagraph (A)’’ and inserting ‘‘the 22 application of subparagraph (A)’’; 23 (B) by inserting ‘‘or be lawfully present’’ 24 after ‘‘lawfully reside’’; and 25 VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS 6 •HR 4701 IH (C) by inserting ‘‘or present’’ after ‘‘law- 1 fully residing’’ each place it appears. 2 (b) CHIP.—Subparagraph (N) of section 2107(e)(1) 3 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 4 amended to read as follows: 5 ‘‘(N) Paragraph (4) of section 1903(v) (re- 6 lating to lawfully present individuals).’’. 7 (c) EFFECTIVE DATE.— 8 (1) IN GENERAL.—Except as provided in para- 9 graph (2), the amendments made by this section 10 shall take effect on the date of enactment of this Act 11 and shall apply to services furnished on or after the 12 date that is 90 days after such date of enactment. 13 (2) EXCEPTION IF STATE LEGISLATION RE- 14 QUIRED.—In the case of a State plan for medical as- 15 sistance under title XIX, or a State child health plan 16 under title XXI, of the Social Security Act which the 17 Secretary of Health and Human Services determines 18 requires State legislation (other than legislation ap- 19 propriating funds) in order for the plan to meet the 20 additional requirements imposed by the amendments 21 made by this section, the respective State plan shall 22 not be regarded as failing to comply with the re- 23 quirements of such title solely on the basis of its 24 failure to meet these additional requirements before 25 VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS 7 •HR 4701 IH the first day of the first calendar quarter beginning 1 after the close of the first regular session of the 2 State legislature that begins after the date of enact- 3 ment of this Act. For purposes of the previous sen- 4 tence, in the case of a State that has a 2-year legis- 5 lative session, each year of such session shall be 6 deemed to be a separate regular session of the State 7 legislature. 8 SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE 9 FOR INDIVIDUALS WITH FEDERALLY AU- 10 THORIZED PRESENCE, INCLUDING DE- 11 FERRED ACTION. 12 (a) IN GENERAL.—For purposes of eligibility under 13 any of the provisions described in subsection (b), all indi- 14 viduals granted federally authorized presence in the 15 United States shall be considered to be lawfully present 16 in the United States. 17 (b) PROVISIONS DESCRIBED.—The provisions de- 18 scribed in this subsection are the following: 19 (1) EXCHANGE ELIGIBILITY.—Section 1311 of 20 the Patient Protection and Affordable Care Act (42 21 U.S.C. 18031). 22 (2) REDUCED COST-SHARING ELIGIBILITY.— 23 Section 1402 of the Patient Protection and Afford- 24 able Care Act (42 U.S.C. 18071). 25 VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS 8 •HR 4701 IH (3) PREMIUM SUBSIDY ELIGIBILITY.—Section 1 36B of the Internal Revenue Code of 1986 (26 2 U.S.C. 36B). 3 (4) MEDICAID AND CHIP ELIGIBILITY.—Titles 4 XIX and XXI of the Social Security Act, including 5 under section 1903(v) of such Act (42 U.S.C. 6 1396b(v)). 7 (c) EFFECTIVE DATE.— 8 (1) IN GENERAL.—Subsection (a) shall take ef- 9 fect on the date of enactment of this Act. 10 (2) TRANSITION THROUGH SPECIAL ENROLL- 11 MENT PERIOD.—In the case of an individual de- 12 scribed in subsection (a) who, before the first day of 13 the first annual open enrollment period under sub- 14 paragraph (B) of section 1311(c)(6) of the Patient 15 Protection and Affordable Care Act (42 U.S.C. 16 18031(c)(6)) beginning after the date of enactment 17 of this Act, is granted federally authorized presence 18 in the United States and who, as a result of such 19 subsection, qualifies for a subsidy under a provision 20 described in paragraph (2) or (3) of subsection (b), 21 the Secretary of Health and Human Services shall 22 establish a special enrollment period under subpara- 23 graph (C) of such section 1311(c)(6) during which 24 such individual may enroll in qualified health plans 25 VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS 9 •HR 4701 IH through Exchanges under title I of the Patient Pro- 1 tection and Affordable Care Act and qualify for such 2 a subsidy. For such an individual who has been 3 granted federally authorized presence in the United 4 States as of the date of enactment of this Act, such 5 special enrollment period shall begin not later than 6 90 days after such date of enactment. Nothing in 7 this paragraph shall be construed as affecting the 8 authority of the Secretary to establish additional 9 special enrollment periods under such subparagraph 10 (C). 11 SEC. 5. REMOVING CITIZENSHIP AND IMMIGRATION BAR- 12 RIERS TO ACCESS TO AFFORDABLE HEALTH 13 CARE UNDER THE ACA. 14 (a) IN GENERAL.— 15 (1) PREMIUM TAX CREDITS.—Section 36B of 16 the Internal Revenue Code of 1986 is amended— 17 (A) in subsection (c)(1)(B)— 18 (i) by amending the heading to read 19 as follows: ‘‘SPECIAL RULE FOR CERTAIN 20 INDIVIDUALS INELIGIBLE FOR MEDICAID 21 DUE TO STATUS’’; and 22 (ii) in clause (ii), by striking ‘‘lawfully 23 present in the United States, but’’ and in- 24 serting ‘‘who’’; and 25 VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS 10 •HR 4701 IH (B) by striking subsection (e). 1 (2) COST-SHARING REDUCTIONS.—Section 1402 2 of the Patient Protection and Affordable Care Act 3 (42 U.S.C. 18071) is amended by striking sub- 4 section (e) and redesignating subsection (f) as sub- 5 section (e). 6 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 7 Section 1331(e)(1)(B) of the Patient Protection and 8 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 9 amended by striking ‘‘lawfully present in the United 10 States,’’. 11 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 12 Section 1412 of the Patient Protection and Afford- 13 able Care Act (42 U.S.C. 18082) is amended by 14 striking subsection (d) and redesignating subsection 15 (e) as subsection (d). 16 (5) REQUIREMENT TO MAINTAIN MINIMUM ES- 17 SENTIAL COVERAGE.—Subsection (d) of section 18 5000A of the Internal Revenue Code of 1986 is 19 amended by striking paragraph (3) and by redesig- 20 nating paragraph (4) as paragraph (3). 21 (b) CONFORMING AMENDMENTS.— 22 (1) ESTABLISHMENT OF PROGRAM.—Section 23 1411(a) of the Patient Protection and Affordable 24 Care Act (42 U.S.C. 18081(a)) is amended by strik- 25 VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS 11 •HR 4701 IH ing paragraph (1) and redesignating paragraphs (2), 1 (3), and (4) as paragraphs (1), (2), and (3), respec- 2 tively. 3 (2) QUALIFIED INDIVIDUALS.—Section 1312(f) 4 of the Patient Protection and Affordable Care Act 5 (42 U.S.C. 18032(f)) is amended— 6 (A) in the heading, by striking ‘‘; ACCESS 7 LIMITED TO CITIZENS AND LAWFUL RESI- 8 DENTS’’; and 9 (B) by striking paragraph (3). 10 (c) EFFECTIVE DATE.—The amendments made by 11 this section shall apply to years, plan years, and taxable 12 years, as applicable, beginning after December 31, 2020. 13 Æ VerDate Sep 11 2014 04:09 Oct 23, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\H4701.IH H4701 kjohnson on DSK79L0C42 with BILLS