PHOENIX — President Barack Obama has championed two sweeping policy changes that could transform how people live in the United States: affordable health care for all and a path to citizenship for the 11 million immigrants illegally in the country.
But many immigrants will have to wait more than a decade to qualify for health care benefits under the proposed immigration overhaul being debated by Congress, ensuring a huge swath of people will remain uninsured as the centerpiece of Obama's health care law launches next year.
Lawmakers pushing the immigration bill said adding more recipients to an already costly benefit would make it unaffordable.
Health care analysts and immigration proponents argue that denying coverage will saddle local governments with the burden of uninsured immigrants. They also fear a crisis down the road as immigrants become eligible for coverage, but are older, sicker and require more expensive care. Those placed on provisional status would become the nation's second-largest population of uninsured, or about 25 percent, according to a 2012 study by the Urban Institute.
The Affordable Care Act will make health insurance accessible for millions of uninsured people starting in January through taxpayer-subsidized private policies for middle-class families and expanded access to Medicaid, the program for low-income people funded by federal and state dollars. The proposed immigration overhaul explicitly states immigrants cannot receive Medicaid or receive the health subsidies for more than a decade after they qualify for legal status, and only after certain financial and security requirements have been met.
Immigrants with provisional status may obtain insurance through employers, but many are unskilled and undereducated, and tend to work low-wage jobs at small businesses that don't have to provide the benefit under the health care law. Immigrants illegally in the country also can access community health centers, but the officials who run those clinics said they are overwhelmed by the demand.
Debate over whether immigrants illegally in the country should be eligible for federal benefits nearly sank Obama's health care reform before it was passed by Congress in 2010. For lawmakers pushing immigrationreform, there was no question that immigrants would continue to be excluded.
The issue has received more attention in recent weeks. Some House Republicans have threatened to kill the immigration bill unless immigrants are required to pay for all their health care costs even after they gain legal status.
Pregnant women, children, seniors and the disabled are eligible for emergency Medicaid services regardless of their immigration status.
Immigrants who are U.S. citizens are also affected by the limits on health care access if they provide for family members here illegally.
Opponents said they understand the concerns of immigrants not getting health care, but it becomes an issue of the added expense.
Critics of the decision said immigrants are eager to pay for affordable health care insurance and already support federal benefits by paying sales and income taxes. They note that adults unable to overcome healthemergencies are less likely to contribute to the work force and society.