OVERNIGHT HEALTH: Obama plan nixes health benefits for immigrants in the pipeline

By Elise Viebeck and Sam Baker - 01/29/13 08:00 PM ET

President Obama unveiled his immigration proposal Tuesday, and according to the White House, the plan would bar immigrants with provisional legal status from accessing benefits under the Affordable Care Act. In this way, the plan echoes the principles unveiled Monday by a group of eight bipartisan senators. That plan would also prohibit the immigrants it legalizes from benefiting from federal health programs.

The language is confusing here: both proposals would "legalize" a vast swath of residents who are now undocumented, but instead of joining the ranks of legal permanent residents, these immigrants would have a "provisional" or "probationary" status, apparently barring them from receiving the federal benefits permitted for citizens and most green-card holders. Those benefits include eligibility for the now-in-progress insurance exchanges, related tax credits and Medicaid (after a waiting period).

"Legal immigrants," as the term is traditionally understood, will also be subject to the individual mandate to buy healthcare coverage when it takes effect next year.

To dig a little deeper, the Affordable Care Act states that non-citizens are eligible for its benefits if they are "aliens who are lawfully present" in the country. A 2011 analysis of this language by the Congressional Research Service classified as "lawfully present" legal permanent residents, asylum recipients and refugees, and nonimmigrants, including temporary workers and representatives of foreign governments. The only category classified by the CRS as not lawfully present — that is, not eligible for benefits under healthcare reform — are "unauthorized" ("illegal") aliens.

The proposals from the White House and the Group of Eight lack detail. They outline objectives for immigration reform, but not how they might be accomplished or what laws might be modified to get there. The process, step by step, for undocumented immigrants to acquire a robust legal status still needs to be fleshed out.

Whatever the conclusion, observers can bet on an enormous fight if any of the immigration players stake their acceptance of a deal on healthcare reform benefits for the newly documented. The very suggestion has conservatives reeling, and Sen. Marco Rubio (R-Fla.) signaled Tuesday that he would withdraw his support from a final bill that adds millions of "ObamaCare" beneficiaries.

Read more about Rubio's interview — it was with Rush Limbaugh — at Healthwatch.

Subsidies fight continues: House Republicans on Tuesday reiterated their threat to issue subpoenas in their investigation into the Affordable Care Act's insurance subsidies. Republicans believe the IRS exceeded its legal authority by writing regulations to make the subsidies available in both state-run and federally facilitated exchanges, and have repeatedly asked to review documents about the IRS's decision making process.

They said Tuesday that the agency hasn't provided responsive documents, and has excessively redacted the documents it has provided. Healthwatch has the full story on the latest threat.

Plan B vending machine isn't going anywhere: The FDA has decided not to take regulatory action against a vending machine that dispenses the so-called "morning-after pill," an agency spokeswoman confirmed to Healthwatch on Tuesday.

FDA looked at publicly available information about Shippensburg State University's vending program and spoke with university and campus health officials and decided not to take any regulatory actions, the FDA said.

Read more here.

'Major crisis': Sen. Bernie Sanders (I-Vt.) examined the U.S. primary care shortage in a hearing Tuesday where he called the status quo a "major crisis ... which results in lower quality healthcare for our people and greater expenditures." Sanders said that one in five Americans live in regions with a provider shortage, where their access to primary care is threatened as a result. Taking part in the hearing was the Association of American Medical Colleges, which predicted a shortage of 45,000 primary care physicians and 46,000 specialists by 2020.

State by state

Missouri Gov. Jay Nixon is all about the ACA's Medicaid expansion.

Healthcare cuts take effect this week in Louisiana.

Arkansas legislators want to ban abortion when a fetal heartbeat can be detected.

Reading list

ObamaCare's "sticker shock" is pretty modest, Jonathan Cohn writes at the New Republic.

The ACA sticker shock from immigration could soar into the hundreds of billions, according to the Washington Examiner's Philip Klein.

The ACLU is suing the Drug Enforcement Agency over its regulation of prescription drugs, Regulatory Focus reports.

Biotechnology firms are spending billions to limit access to generics, The New York Times reports.

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