HHS head: Immigration reform would help reach universal health coverage

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Health and Human Services Secretary Sylvia Mathews Burwell says immigration reform would help achieve universal health coverage. 

Asked about the further steps needed to achieve universal coverage, with roughly 30 million people remaining uninsured, Burwell told a roundtable of reporters Friday that immigration reform is one step, along with continued growth in ObamaCare’s marketplaces and Medicaid expansion. 

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“We're continuing, as you can see, with the marketplace, to continue to grow it, Medicaid is the other large population that would make a big difference, and then the third change in terms of things that would contribute to a large number is actually changes in the immigration laws,” Burwell said. 

People in the country illegally are currently barred from enrolling in Medicaid or ObamaCare marketplace coverage, leaving many of them uninsured. 

The Kaiser Family Foundation estimates that about 15 percent of those who are uninsured are ineligible for coverage because of their immigration status — about 4.9 million people.

About 3 million more people are ineligible for coverage because their state declined to expand Medicaid under ObamaCare. About 15 million people are eligible for coverage but have not signed up. 

Burwell spoke to reporters one day after announcing that 12.7 million people signed up through the health law’s marketplaces this year. 

Some insurers have expressed concerns about the marketplaces, particularly that too high a share of sick enrollees is causing them to lose money in the market.

Burwell said, though, that she believes the marketplace is “stable.”

“I believe we have more work to do, but it is stable,” she said. 

She said the administration continues to work with insurers, and pointed to steps like tightening up the rules around extra sign-up periods that insurers say are leading to a sicker mix of people enrolling. 

“They're learning and we're listening and we all are working together,” she said of insurers. 

The percentage of young people, prized by insurers for being healthier and lower-cost, did not grow from last year, remaining at 28 percent. However, Burwell pointed to the 4 million new enrollees as evidence that the mix of people is being refreshed. The newer enrollees are likely to be healthier in part because many were motivated by the threat of the $695 or higher fine for lacking coverage, officials said. 

She also acknowledged some level of uncertainty about the law given the coming end of the Obama administration.

Under the proposed schedule for next year’s ObamaCare sign-up period, the last 12 days would come after a new president is sworn in on Jan. 20. 

“The last 12 days basically, we won't be here,” Burwell said — assuming the proposed schedule is not changed.

Still, she said forces outside of government have been put in motion to help keep sign-ups going. Government’s role, of course, will depend hugely on whether a Democrat or Republican wins the presidency. 

“I think one of the things that's been important is the stakeholder engagement and the engagement of others,” she said. “The fact that CVS and other pharmacies are doing outreach events, I think are the kind of things that will continue.”

And she noted other parts of the law are very hard to take away. 

“Right now in the country, most people think it is an accepted part of healthcare that you can't be kept off for pre-existing conditions, the idea that you're going to roll back anybody whose kid is covered up to 26, as well as the issues of annual and lifetime limits, those things are just I think baked in.”