By Elise Viebeck - 01/26/13 11:00 AM EST
Comprehensive immigration reform could make millions of people suddenly eligible for assistance under President Obama's healthcare law, assuming a final deal paves the way for undocumented immigrants to receive papers.
Illegal aliens are now prohibited from purchasing coverage through the Affordable Care Act's insurance exchanges, which will launch next year.
Even young illegal immigrants with "deferred action" status, known as "DREAMers," cannot access the law's benefits.
But the picture could change completely if Hispanic lawmakers get their wish — an overhaul of U.S. immigration policy that includes a path to legalization.
"We have to figure out a way in which [undocumented immigrants] incorporate themselves into the larger workforce, and into our society in general, and not be a burden," said Rep. Luis Gutierrez (D-Ill.), a leader in the immigration debate.
"Do we want them to go to the exchanges? Absolutely we do — if and when they don't have healthcare through their employer," he said.
Immigration is expected to be a major issue for President Obama's second term, and advocates like Gutierrez are pushing hard to make reform a reality.
Recent polls show the public is increasingly on board. According to a CNN/ORC poll from Jan. 21, 53 percent want a path to legalization for illegal immigrants — a major shift from 2011, when most wanted Washington focused on deportations.
The consequences for Obama's signature healthcare law, as well as healthcare providers, could be huge.
Rep. Raul Grijalva (D-Ariz.), a member of the Congressional Hispanic Caucus, said the legalization of undocumented people would benefit hospitals now burdened by uncompensated care.
If nothing changes, undocumented immigrants will be a major share of the uninsured, second only to those who are eligible but do not apply for coverage under the healthcare law in 2014, according to the Urban Institute.
Federal reimbursement for uncompensated care was also slashed under the Affordable Care Act, raising the stakes for hospitals that serve low-income populations.
"I think hospitals and healthcare providers would see it as a huge plus," Grijalva said, referring to an immigration policy that legalizes undocumented people and makes them eligible for federal benefits.
"The bottom line is, these people would be contributing toward their own healthcare and not being dependent. They'd be paying taxes. I'd see that as a plus rather than a negative," he said.
The idea of providing "ObamaCare" benefits to immigrants has long inflamed partisan rancor.
Most famously, it prompted Rep. Joe Wilson (R-S.C.) to shout "You lie!" during Obama's 2009 healthcare address on the House floor, when the president pledged that healthcare reform would not cover undocumented aliens.
Looking ahead, it is possible that immigration changes could upend the law's cost picture, which is already of major concern to critics.
Sarah Hale, director of healthcare policy at the American Action Forum, cautioned that it is far too early to predict whether a new immigration policy would raise the health law's tab.
"There are three or four moving parts that could push the cost one way or the other, like state choices on the Medicaid expansion," she said.
"But if there are a huge swath of people who are newly eligible for an insurance subsidy or for Medicaid, then naturally that is going to impact the budget number."
Grijalva argued that the status quo is unsustainable, no matter what the immigration debate yields.
Most undocumented workers seek care in emergency rooms or storefront clinics, which may not accept credit or insurance, he said.
"All of that, as public health officials say, does not contribute to the overall quality of health in any community," Grijalva said. "And besides, most often, somebody else is paying for it."