[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3799 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 3799

      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 SENATE OF THE UNITED STATES

                              May 21, 2020

  Mr. Booker introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 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 2020'' or as the ``HEAL for 
Immigrant Women and Families Act of 2020''.

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 of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18081) is 
        amended--
                    (A) in subsection (a)--
                            (i) by striking paragraph (1); and
                            (ii) redesignating paragraphs (2), (3), and 
                        (4) as paragraphs (1), (2), and (3), 
                        respectively;
                    (B) in subsection (b)--
                            (i) in paragraph (1)(A), by striking ``and 
                        date of birth'' and inserting ``date of birth, 
                        and social security number (if applicable)'';
                            (ii) by striking paragraph (2); and
                            (iii) by redesignating paragraphs (3) 
                        through (5) as paragraphs (2) through (4), 
                        respectively;
                    (C) in subsection (c)--
                            (i) by striking paragraph (2);
                            (ii) in paragraph (3), by striking 
                        ``subsection (b)(3)(A) provided under paragraph 
                        (3), (4), or (5)'' and inserting ``subsection 
                        (b)(2)(A) provided under paragraph (2), (3), or 
                        (4)''; and
                            (iii) by redesignating paragraphs (3) and 
                        (4) as paragraphs (2) and (3), respectively;
                    (D) in subsection (e)--
                            (i) in paragraph (1), by striking 
                        ``subsection (c)(4)'' and inserting 
                        ``subsection (c)(3)'';
                            (ii) in paragraph (2)--
                                    (I) in subparagraph (A), by 
                                striking ``paragraphs (1), (2), (3), 
                                and (4)'' and inserting ``paragraphs 
                                (1), (2), and (3)''; and
                                    (II) in subparagraph (B), by 
                                striking ``subsection (b)(5)'' and 
                                inserting ``subsection (b)(4)'';
                            (iii) by striking paragraph (3);
                            (iv) by redesignating paragraph (4) as 
                        paragraph (3); and
                            (v) in paragraph (3), as so redesignated--
                                    (I) in subparagraph (A), by 
                                striking ``(other than subsection 
                                (b)(2))''; and
                                    (II) in subparagraph (B)--
                                            (aa) in clause (i)--

                                                    (AA) by striking 
                                                ``Except as provided in 
                                                paragraph (3), the'' 
                                                and inserting ``The''; 
                                                and

                                                    (BB) by striking 
                                                ``paragraphs (2), (3), 
                                                and (4)'' and inserting 
                                                ``paragraphs (1), (2), 
                                                and (3)''; and

                                            (bb) in clause (iv), by 
                                        striking ``subsection (b)(5)'' 
                                        and inserting ``subsection 
                                        (b)(4)''; and
                    (E) in subsection (f)(2)(A), by striking 
                ``subsection (e)(4)(C)'' and inserting ``subsection 
                (e)(3)(C)''.
            (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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