The Future of Coverage

By: Theron Minium

Amid the shifting political landscape for immigration reform, a major topic of discussion for this upcoming presidential election involves federal healthcare coverage for non-US Citizens.  More specifically, the opposing stances taken by presidential candidate frontrunners offer insight into the likelihood of future universal healthcare coverage for undocumented immigrants within the United States.  Along with immigration reform, healthcare under President Obama’s Affordable Care Act (ACA) has been the subject of heated debate from all sides: some supporting it, some supporting changes to it, and still many others in outright opposition of the Act.

The two major political platforms intersect at a crucial point which affects a significant portion of the population: healthcare coverage for immigrants-those under a documented status, and those that reside in the U.S. as undocumented immigrants.  Rapidly rising healthcare costs for U.S. citizens have caused the public to look for something to explain this issue, and many politicians and media outlets have focused squarely on health care coverage for non-U.S. Citizens as the culprit.  What is the economic impact that undocumented immigrant coverage currently has, and what could it be if undocumented immigrants become covered in the future?

Documented immigrants, for purposes of the ACA, are considered to be either “qualified non-citizens” or not. Qualified non-citizens (which include statuses of permanent immigrants such as Lawful Permanent Resident, Asylee, and Refugee) are eligible to be covered under the ACA, and purchase of health care on the ACA’s online Marketplace, as well as access to Medicaid and CHIP.  ACA also offers access to the Marketplace to purchase health insurance to those in valid non-immigration statuses who are not “qualified non-citizens” – such as holders of temporary work visas. Regardless, nearly all immigrant and nonimmigrant statuses have the ability to obtain healthcare coverage if they hold valid immigration documentation from the Department of Homeland Security (green cards, valid I-94s, visas, etc.). For documented non-US Citizens, advancement in their healthcare coverage, particularly those of low-income families, appears successful under the Affordable Care Act, though significant costs of both time and money remain a challenge on the path to U.S. Citizenship.

However, most support the healthcare coverage for documented immigrants, and as it currently stands these documented immigrants have access to at least minimum healthcare coverage. The argument regarding healthcare coverage for undocumented immigrants, however contains much more passion and vitriol, and their future coverage remains unclear.  Currently, undocumented immigrants must be treated by law when they arrive in emergency rooms as well as free local clinics. In 2013, the Center for Immigration Studies estimated that this cost of treatment across the nation was $4.3 billion in one year.  Some argue that this cost shows health care for undocumented immigrants would be foolhardy, but with adequate minimum health care coverage, many of these undocumented individuals would not need to visit the much more expensive emergency rooms on such a regular basis.

In the autumn of President Obama’s tenure, likely the next president will hold the answer to whether or not undocumented immigrants will receive universal healthcare coverage. Most are familiar with the stance of one particular Republican presidential candidate, Donald Trump.  In strong opposition of any healthcare coverage for undocumented immigrants, Mr. Trump would instead strengthen the borders to the south, and punish those that are in the United States illegally or without proper documentation. The frontrunner for the Democratic party, Hillary Clinton, has recently stated that she believes undocumented immigrants should have the ability to purchase healthcare through the ACA.  As of now, only the state of California has taken any significant steps attempting to provide healthcare to undocumented immigrants.  The solution on a national level would undoubtedly be part of a complete overhaul of the ACA if it were to include undocumented immigrants.

Where does undocumented immigrant’s healthcare coverage go from here?  With two individuals as the United States’ possible next president, the future remains as unclear as it ever has.   Healthcare coverage for undocumented immigrants likely rests solely on who is sworn in as our 45th president in January of 2017.


Neal Asbury, The Cost of Permanent Patients, Newsmax Finance, May 9, 2013.

Sarah Ferris, Clinton Shifts Stance on Healthcare for Undocumented Immigrants, The Hill, Oct. 13, 2015.

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