A new Biden administration rule will make recipients of Deferred Action for Childhood Arrivals eligible to obtain health insurance plans established by the Affordable Care Act. But former President Donald Trump has mischaracterized the regulation, claiming that it is “giving Obamacare and all free government health care to illegal aliens.”
DACA is a program created by the Obama administration to defer deporting certain individuals who were brought to the United States illegally as children years ago. They are often called “Dreamers,” a reference to legislation that never became law.
The new rule, announced May 3, defines DACA recipients as “lawfully present” in the U.S. for the purpose of enrolling in a qualified health plan through the ACA health insurance exchanges, or an insurance plan through a state-run basic health program. The exchanges and basic health programs are for people who have to get their own insurance. For those who choose to buy a health plan on the exchanges, they also may qualify for federal financial assistance that would lower the cost of that private insurance.
However, the rule does not grant DACA recipients – or anyone living in the U.S. illegally – access to “all free government health care,” as Trump said.
Immigrants who are not lawfully present in the U.S. are ineligible for the health plans created under the ACA. Furthermore, immigrants in the country illegally are still generally not eligible for non-emergency federal health care programs.
DACA and the ACA
Trump made the health care claim during a May 11 campaign speech in Wildwood, New Jersey. He said he would “rescue our health care system from Joe Biden’s migrant invasion.”
That was after Trump’s presidential campaign issued a statement on May 3, the day the new rule was announced, saying that Biden was now forcing Americans to pay for “the healthcare of illegal immigrants.”
It’s true that DACA recipients had been prohibited from signing up for qualified or basic health plans – because the 2010 health care law requires enrollees to be citizens, U.S. nationals or lawfully present in the country. (Healthcare.gov, the site through which people can sign up for ACA exchange plans, lists the legal immigration statuses that are eligible to obtain coverage, such as lawful permanent resident, asylee and refugee.)
Starting on Nov. 1, individuals with DACA status will become eligible to apply for those health plans, when the new rule – finalized by the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services – goes into effect. Those who enroll in a qualified health plan through the ACA marketplace could also be eligible for income-based premium tax credits that would lower their monthly premiums, as well as cost-sharing reductions that lessen out-of-pocket costs for health services.
To qualify for DACA, which was created by executive action in 2012, individuals must meet several criteria. Among other things, they need to have been born on or after June 16, 1981; arrived in the U.S. before they turned 16 years old; and continuously lived in the U.S. since June 15, 2007. They also needed to be a student, high school graduate, General Education Development recipient, or an honorably discharged military or Coast Guard veteran.
As of Dec. 31, there were about 530,000 active DACA recipients in the country, who can renew their status every two years. But the program, which is still being challenged in court, is not processing new initial applications, as ordered by a 2023 court decision.
Trump tried ending DACA, but was blocked by the U.S. Supreme Court in 2020.
CMS estimates that its new policy could result in 100,000 DACA recipients enrolling in health coverage in fiscal year 2025 – 99,000 through an ACA marketplace plan and 1,000 through a state basic health program. Enrollment, or re-enrollment, in basic health plans is estimated to remain at that same level through FY 2028, while marketplace enrollment is expected to drop to 85,000 a year starting in FY 2026.
Those totals are a fraction of the nearly 11 million immigrants living in the U.S. without legal permission, as of Jan. 1, 2022, according to the Office of Homeland Security Statistics.
Currently, only New York and Minnesota have basic health programs, which offer insurance to low-income individuals and families who do not qualify for Medicaid or the Children’s Health Insurance Program, or CHIP. There is no monthly premium for those who qualify for New York’s “essential plan.”
Oregon’s basic health care program is scheduled to launch in July. For qualifying members, the state says there will be no premiums, co-payments, coinsurance or deductibles.
Due to the expected increase in ACA marketplace enrollment, CMS estimates that the federal government will spend an extra $240 million on premium tax credits in FY 2025. After that, the cost is projected to increase to about $300 million a year through FY 2028.
In addition, because the federal government provides money to help states implement their basic health plan programs, increased enrollment in such plans is estimated to cost about $5 million a year from FY 2025 to FY 2028, CMS says. The federal government pays states 95% of what enrollees in basic health plans would have received if they had enrolled in marketplace plans and received tax credits and cost-sharing reductions.
Federal Health Care Programs
Contrary to what Trump claimed, the new rule does not give “all free government health care to illegal aliens.”
Even for DACA recipients, the regulation says that it does not — at this time — make them and other immigrants newly classified as lawfully present eligible for Medicaid and CHIP, low-cost health care programs that can be free for beneficiaries in some cases. (CMS said it is still reviewing public comments it received about a proposal to classify DACA participants as lawfully present and eligible for Medicaid and CHIP.)
The larger population of people illegally residing in the country has long been generally excluded from participating in most health programs provided by the federal government. Emergency medical care is the main exception, as we have written before.
“Facilities such as emergency departments and health centers have obligations to provide care regardless of insurance status, though they may charge for the services they provide,” the Congressional Research Service said in a report updated in December 2022.
In addition, the report said: “Federal programs also support providers that deliver family planning services and those that seek to reduce the transmission of communicable diseases. These programs generally provide services regardless of ability to pay or immigration status. Moreover, federal law provides that public health services related to communicable disease transmission be available to individuals regardless of immigration status.”
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