[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1660 Introduced in Senate (IS)]

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117th CONGRESS
  1st Session
                                S. 1660

  To expand access to health care 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 17, 2021

Mr. Booker (for himself, Mr. Markey, Mrs. Gillibrand, Mr. Merkley, Mrs. 
   Murray, Ms. Hirono, Mr. Sanders, Mr. Blumenthal, and Ms. Warren) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To expand access to health care 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 Families Act of 2021'' or the ``HEAL for Immigrant 
Families Act of 2021''.

SEC. 2. FINDINGS; PURPOSE.

    (a) Findings.--Congress finds as follows:
            (1) Health insurance coverage reduces harmful racial, 
        economic, gender, and health inequities by alleviating cost 
        barriers to, and increasing utilization of, necessary health 
        care services, especially among low-income and underserved 
        populations.
            (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 inequities in the prevention, diagnosis, and 
        treatment of health conditions. This leads to negative health 
        outcomes for immigrants and their families, especially Black, 
        Indigenous, Latinx, Asian, Pacific Islander, and other 
        Immigrants of Color.
            (4) Black immigrant women often cite cost as a major 
        barrier to health care. Many who are undocumented forgo doctor 
        visits altogether due to the financial burden in addition to 
        consistent racial bias by medical practitioners and racism in 
        health care.
            (5) Nearly half of immigrant women are of reproductive age. 
        Immigrant women, lesbian, gay, bisexual, transgender, and queer 
        (LGBTQ) immigrants, and immigrants with disabilities 
        disproportionately live in households with low incomes and lack 
        health insurance coverage. Legal and policy barriers to 
        affordable health insurance coverage significantly exacerbate 
        their risk of negative pregnancy-related and other reproductive 
        and sexual health outcomes, with lasting health and economic 
        consequences for immigrant women, LGBTQ immigrants, immigrants 
        with disabilities, and their families and society as a whole.
            (6) Immigrants who identify as LGBTQ experience compounding 
        discrimination from health care providers and systems based on 
        race and ethnicity, primary language, immigration status, 
        sexual orientation, and gender identity. Nearly one in five 
        transgender patients have been refused care due to their gender 
        non-conforming status, and providers have denied care to 
        undocumented immigrants because of immigration status. These 
        inequities are exacerbated by legal and policy barriers that 
        restrict access to health coverage on the basis of immigration 
        status, exposing LGBTQ immigrant communities to 
        disproportionate gaps in affordable, comprehensive health care. 
        These compounding barriers are especially harmful for LGBTQ 
        immigrants who are escaping interpersonal and state violence 
        due to their sexual orientation and gender identity.
            (7) Denying health insurance coverage or imposing waiting 
        periods for health insurance coverage on the basis of 
        immigration status unfairly hinders immigrants' ability to 
        reach and maintain their optimal levels of health and 
        undermines the economic well-being of their families.
            (8) International human rights standards hold that 
        governments have an affirmative obligation to ensure that 
        everyone, including immigrants, can access safe, respectful, 
        culturally and linguistically appropriate, and high-quality 
        pregnancy-related care, including postpartum care, free from 
        discrimination or violence. Medicaid is the nation's single 
        largest payer for pregnancy-related care. Nevertheless, 
        barriers to health coverage persist for pregnant and postpartum 
        people, particularly immigrants.
            (9) Immigrants--especially Black, Indigenous, Latinx, 
        Asian, and Pacific Islander immigrants--are among those most 
        harmed by the United States' pregnancy-related morbidity and 
        mortality epidemic, which is the worst among high-income 
        nations. Black people are more than three times more likely 
        than white people to suffer pregnancy-related death, and twice 
        as likely to suffer maternal morbidity. Indigenous people are 
        more than two times more likely than white people to die from a 
        pregnancy-related death. The majority of United States 
        pregnancy-related deaths are preventable. Lack of access to 
        health care, immigration status, poverty, and exposure to 
        racism, sexism, and xenophobia in and beyond the health care 
        system contribute to the disproportionately high number of 
        pregnancy-related deaths among BIPOC birthing and postpartum 
        people. Unnecessary barriers that limit pregnant and postpartum 
        immigrants' access to health care undermine their health, 
        safety, and human rights.
            (10) One in seven United States residents is foreign-born, 
        approximately one in four children in the United States has at 
        least one immigrant parent, and the population of immigrant 
        families in the United States is expected to continue to grow 
        in the coming years. It is therefore in our collective public 
        health and economic interest to remove legal and policy 
        barriers to affordable health insurance coverage that are based 
        on immigration status.
            (11) Although individuals granted relief under the Deferred 
        Action for Childhood Arrivals (DACA) program are authorized to 
        live and work in the United States, they have been unfairly 
        excluded from the definitions of lawfully present and lawfully 
        residing for purposes of health insurance coverage provided 
        through the Department of Health and Human Services, including 
        Medicaid, CHIP, and the health insurance exchanges.
            (12) Since immigration law evolves constantly, new 
        immigration categories for individuals with federally 
        authorized presence in the United States may be created.
            (13) Some States continue to unwisely restrict Medicaid 
        access for immigrants who have long resided in the United 
        States, fueling significant health inequities and increasing 
        health care costs for individuals and the public.
            (14) Congress restored Medicaid eligibility for individuals 
        living in the United States under the Compacts of Free 
        Association as part of bipartisan legislation in December 2020 
        and should build on that success by ensuring all immigrants can 
        access care.
    (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;
            (2) advance the ability of undocumented individuals to 
        obtain health insurance coverage through the health insurance 
        exchanges established under part II of the Patient Protection 
        and Affordable Care Act, Public Law 111-148;
            (3) eliminate the authority for States to restrict Medicaid 
        eligibility for lawful permanent residents; and
            (4) eliminate other barriers to accessing Medicaid, CHIP, 
        and other medical assistance.

SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR LAWFULLY RESIDING 
              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, a State shall 
                provide medical assistance under this title to 
                individuals who are lawfully residing in the United 
                States (including individuals described in paragraph 
                (1), battered individuals described in section 431(c) 
                of such Act, and individuals with an approved or 
                pending application for deferred action or other 
                federally authorized presence), 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).'';
            (2) by amending subparagraph (B) to read as follows:
                    ``(B) No debt shall accrue under an affidavit of 
                support against any sponsor of an individual provided 
                medical assistance under subparagraph (A) on the basis 
                of provision of assistance to such individual and the 
                cost of such assistance shall not be considered as an 
                unreimbursed cost.''; 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 (O) of section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
                    ``(O) Paragraph (4) of section 1903(v) (relating to 
                lawfully residing 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 1411 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) by amending clause (ii) to read as 
                        follows:
                            ``(ii) the taxpayer is a noncitizen who is 
                        not eligible for the Medicaid program under 
                        title XIX of the Social Security Act by reason 
                        of the individual's immigration status,''.
                    (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, 2021.

SEC. 6. PRESERVING ACCESS TO COVERAGE.

    (a) In General.--Nothing in this Act, including the amendments made 
by this Act, shall prevent lawfully present noncitizens who are 
ineligible for full benefits under the Medicaid program under title XIX 
of the Social Security Act from securing a credit for which such 
lawfully present noncitizens would be eligible under section 
36B(c)(1)(B) of the Internal Revenue Code of 1986 and under the 
Medicaid provisions for lawfully present noncitizens, as in effect on 
the date prior to the date of enactment of this Act.
    (b) Definition.--For purposes of subsection (a), the term ``full 
benefits'' means, with respect to an individual and State, medical 
assistance for all services covered under the State plan under title 
XIX of the Social Security Act that is not less in amount, duration, or 
scope, or is determined by the Secretary of Health and Human Services 
to be substantially equivalent to the medical assistance available for 
an individual described in section 1902(a)(10)(A)(i) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(A)(i)).
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