[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4701 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 4701
To expand access to health care services, including sexual,
reproductive, and maternal health services, for immigrants by removing
legal and policy barriers to health insurance coverage, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 16, 2019
Ms. Jayapal (for herself, Ms. Haaland, Ms. Barragan, Mr. Blumenauer,
Ms. Judy Chu of California, Mr. Espaillat, Mr. Gallego, Ms. Lee of
California, Ms. Moore, Mrs. Napolitano, Ms. Norton, Mr. Pocan, Ms.
Pressley, Ms. Schakowsky, Mr. Soto, Ms. Wilson of Florida, Mr. Takano,
Mrs. Lawrence, Ms. Garcia of Texas, Mr. Johnson of Georgia, Ms. Meng,
Ms. Roybal-Allard, and Mr. Grijalva) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To expand access to health care services, including sexual,
reproductive, and maternal health services, for immigrants by removing
legal and policy barriers to health insurance coverage, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Equity and Access under the
Law for Immigrant Women and Families Act of 2019'' or as the ``HEAL for
Immigrant Women and Families Act of 2019''.
SEC. 2. FINDINGS; PURPOSE.
(a) Findings.--Congress finds as follows:
(1) Health insurance coverage reduces harmful disparities
by alleviating cost barriers to and increasing utilization of
necessary health care services, especially among low-income and
underserved populations, including women.
(2) Based solely on their immigration status, many
immigrants and their families face legal and policy
restrictions on their ability to obtain affordable health
insurance coverage through Medicaid, the Children's Health
Insurance Program (CHIP), and the health insurance exchanges.
(3) Lack of health insurance coverage contributes to
persistent disparities in the prevention, diagnosis, and
treatment of negative health outcomes experienced by immigrants
and their families.
(4) Nearly half of immigrant women are of reproductive age.
Immigrant women are also disproportionately living in low-
income households and lacking health insurance coverage. Legal
and policy barriers to affordable health insurance coverage
therefore particularly exacerbate their risk of negative
sexual, reproductive, and maternal health outcomes, with
lasting health and economic consequences for immigrant women,
their families, and society as a whole.
(5) Denying health insurance coverage or imposing waiting
periods for health insurance coverage unfairly hinders the
ability of immigrants to attain good health and undermines the
economic well-being of their families.
(6) The population of immigrant families in the United
States is expected to continue to grow. One in seven United
States residents is foreign-born, and approximately one in four
children in the United States has at least one immigrant
parent. It is therefore in the Nation's shared public health
and economic interest to remove legal and policy barriers to
affordable health insurance coverage based on immigration
status.
(7) Although Deferred Action for Childhood Arrivals (DACA)
recipients are authorized to live and work in the United
States, they have been unfairly excluded from the definition of
lawfully present and lawfully residing for purposes of health
insurance coverage through the Department of Health and Human
Services, including Medicaid and CHIP, and the health insurance
exchanges.
(8) Immigration law is constantly evolving and new
immigration categories for individuals with federally
authorized presence in the United States may be created.
(b) Purpose.--It is the purpose of this Act to--
(1) ensure that all individuals who are lawfully present in
the United States are eligible for all federally funded health
care programs; and
(2) advance the ability of undocumented individuals to
obtain health insurance coverage through the health insurance
exchanges.
SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR LAWFULLY PRESENT
INDIVIDUALS.
(a) Medicaid.--Section 1903(v)(4) of the Social Security Act (42
U.S.C. 1396b(v)(4)) is amended--
(1) by amending subparagraph (A) to read as follows:
``(A) Notwithstanding sections 401(a), 402(b), 403, and 421 of the
Personal Responsibility and Work Opportunity Reconciliation Act of
1996, payment shall be made under this section for care and services
that are furnished to individuals who are not citizens of the United
States, including aliens described in paragraph (1), if they otherwise
meet the eligibility requirements for medical assistance under the
State plan approved under this title (other than the requirement of the
receipt of aid or assistance under title IV, supplemental security
income benefits under title XVI, or a State supplementary payment) and
are lawfully present in the United States (including such an individual
who is granted deferred action or other federally authorized
presence).'';
(2) in subparagraph (B)--
(A) by striking ``a State that has elected to
provide medical assistance to a category of aliens
under subparagraph (A)'' and inserting ``individuals
provided medical assistance pursuant to subparagraph
(A)''; and
(B) by striking ``such an alien on the basis of
provision of assistance to such category'' and
inserting ``such an individual on the basis of
provision of assistance to such individual''; and
(3) in subparagraph (C)--
(A) by striking ``an election by the State under
subparagraph (A)'' and inserting ``the application of
subparagraph (A)'';
(B) by inserting ``or be lawfully present'' after
``lawfully reside''; and
(C) by inserting ``or present'' after ``lawfully
residing'' each place it appears.
(b) CHIP.--Subparagraph (N) of section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
``(N) Paragraph (4) of section 1903(v) (relating to
lawfully present individuals).''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall take effect on the date
of enactment of this Act and shall apply to services furnished
on or after the date that is 90 days after such date of
enactment.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX, or a
State child health plan under title XXI, of the Social Security
Act which the Secretary of Health and Human Services determines
requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirements imposed by the amendments made by this
section, the respective State plan shall not be regarded as
failing to comply with the requirements of such title solely on
the basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE FOR INDIVIDUALS WITH
FEDERALLY AUTHORIZED PRESENCE, INCLUDING DEFERRED ACTION.
(a) In General.--For purposes of eligibility under any of the
provisions described in subsection (b), all individuals granted
federally authorized presence in the United States shall be considered
to be lawfully present in the United States.
(b) Provisions Described.--The provisions described in this
subsection are the following:
(1) Exchange eligibility.--Section 1311 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031).
(2) Reduced cost-sharing eligibility.--Section 1402 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18071).
(3) Premium subsidy eligibility.--Section 36B of the
Internal Revenue Code of 1986 (26 U.S.C. 36B).
(4) Medicaid and chip eligibility.--Titles XIX and XXI of
the Social Security Act, including under section 1903(v) of
such Act (42 U.S.C. 1396b(v)).
(c) Effective Date.--
(1) In general.--Subsection (a) shall take effect on the
date of enactment of this Act.
(2) Transition through special enrollment period.--In the
case of an individual described in subsection (a) who, before
the first day of the first annual open enrollment period under
subparagraph (B) of section 1311(c)(6) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(c)(6))
beginning after the date of enactment of this Act, is granted
federally authorized presence in the United States and who, as
a result of such subsection, qualifies for a subsidy under a
provision described in paragraph (2) or (3) of subsection (b),
the Secretary of Health and Human Services shall establish a
special enrollment period under subparagraph (C) of such
section 1311(c)(6) during which such individual may enroll in
qualified health plans through Exchanges under title I of the
Patient Protection and Affordable Care Act and qualify for such
a subsidy. For such an individual who has been granted
federally authorized presence in the United States as of the
date of enactment of this Act, such special enrollment period
shall begin not later than 90 days after such date of
enactment. Nothing in this paragraph shall be construed as
affecting the authority of the Secretary to establish
additional special enrollment periods under such subparagraph
(C).
SEC. 5. REMOVING CITIZENSHIP AND IMMIGRATION BARRIERS TO ACCESS TO
AFFORDABLE HEALTH CARE UNDER THE ACA.
(a) In General.--
(1) Premium tax credits.--Section 36B of the Internal
Revenue Code of 1986 is amended--
(A) in subsection (c)(1)(B)--
(i) by amending the heading to read as
follows: ``Special rule for certain individuals
ineligible for medicaid due to status''; and
(ii) in clause (ii), by striking ``lawfully
present in the United States, but'' and
inserting ``who''; and
(B) by striking subsection (e).
(2) Cost-sharing reductions.--Section 1402 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071) is amended
by striking subsection (e) and redesignating subsection (f) as
subsection (e).
(3) Basic health program eligibility.--Section
1331(e)(1)(B) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18051(e)(1)(B)) is amended by striking ``lawfully
present in the United States,''.
(4) Restrictions on federal payments.--Section 1412 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18082) is
amended by striking subsection (d) and redesignating subsection
(e) as subsection (d).
(5) Requirement to maintain minimum essential coverage.--
Subsection (d) of section 5000A of the Internal Revenue Code of
1986 is amended by striking paragraph (3) and by redesignating
paragraph (4) as paragraph (3).
(b) Conforming Amendments.--
(1) Establishment of program.--Section 1411(a) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18081(a))
is amended by striking paragraph (1) and redesignating
paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3),
respectively.
(2) Qualified individuals.--Section 1312(f) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18032(f)) is
amended--
(A) in the heading, by striking ``; Access Limited
to Citizens and Lawful Residents''; and
(B) by striking paragraph (3).
(c) Effective Date.--The amendments made by this section shall
apply to years, plan years, and taxable years, as applicable, beginning
after December 31, 2020.
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