[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]
WHY EXPANDING MEDICAID
TO DACA RECIPIENTS WILL EXACERBATE
THE BORDER CRISIS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH CARE
AND FINANCIAL SERVICES
OF THE
COMMITTEE ON OVERSIGHT
AND ACCOUNTABILITY
HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTEENTH CONGRESS
FIRST SESSION
__________
JULY 18, 2023
__________
Serial No. 118-51
__________
Printed for the use of the Committee on Oversight and Accountability
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available on: govinfo.gov
oversight.house.gov or
docs.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
53-005 PDF WASHINGTON : 2023
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COMMITTEE ON OVERSIGHT AND ACCOUNTABILITY
JAMES COMER, Kentucky, Chairman
Jim Jordan, Ohio Jamie Raskin, Maryland, Ranking
Mike Turner, Ohio Minority Member
Paul Gosar, Arizona Eleanor Holmes Norton, District of
Virginia Foxx, North Carolina Columbia
Glenn Grothman, Wisconsin Stephen F. Lynch, Massachusetts
Gary Palmer, Alabama Gerald E. Connolly, Virginia
Clay Higgins, Louisiana Raja Krishnamoorthi, Illinois
Pete Sessions, Texas Ro Khanna, California
Andy Biggs, Arizona Kweisi Mfume, Maryland
Nancy Mace, South Carolina Alexandria Ocasio-Cortez, New York
Jake LaTurner, Kansas Katie Porter, California
Pat Fallon, Texas Cori Bush, Missouri
Byron Donalds, Florida Shontel Brown, Ohio
Kelly Armstrong, North Dakota Jimmy Gomez, California
Scott Perry, Pennsylvania Melanie Stansbury, New Mexico
William Timmons, South Carolina Robert Garcia, California
Tim Burchett, Tennessee Maxwell Frost, Florida
Marjorie Taylor Greene, Georgia Summer Lee, Pennsylvania
Lisa McClain, Michigan Greg Casar, Texas
Lauren Boebert, Colorado Jasmine Crockett, Texas
Russell Fry, South Carolina Dan Goldman, New York
Anna Paulina Luna, Florida Jared Moskowitz, Florida
Chuck Edwards, North Carolina Vacancy
Nick Langworthy, New York
Eric Burlison, Missouri
Mark Marin, Staff Director
Jessica Donlon, Deputy Staff Director and General Counsel
Tyler Sanderson, Senior Counsel
Mallory Cogar, Deputy Director of Operations and Chief Clerk
Contact Number: 202-225-5074
Julie Tagen, Minority Staff Director
Contact Number: 202-225-5051
------
Subcommittee on Health Care and Financial Services
Lisa McClain, Michigan, Chairwoman
Paul Gosar, Arizona Katie Porter, California Ranking
Virginia Foxx, North Carolina Minority Member
Glenn Grothman, Wisconsin Alexandria Ocasio-Cortez, New York
Russell Fry, South Carolina Jimmy Gomez, California
Anna Paulina Luna, Florida Greg Casar, Texas
Nick Langworthy, New York Summer Lee, Pennsylvania
Eric Burlison, Missouri Jasmine Crockett, Texas
Vacancy Vacancy
C O N T E N T S
----------
Page
Hearing held on July 18, 2023.................................... 1
Witnesses
----------
Dr. Ellen Montz, Deputy Administrator and Director, Center for
Consumer Information and Insurance Oversight, Centers for
Medicare and Medicaid Services
Oral Statement................................................... 4
Written opening statements and statements for the witnesses are
available on the U.S. House of Representatives Document
Repository at: docs.house.gov.
Index of Documents
----------
* Co-Sponsor Hazard Pay; submitted by Rep. Lee.
* Statement for the Record, Center on Budget and Policy
Priorities; submitted by Rep. Lee.
* Statement for the Record, National Immigration Law Center;
submitted by Rep. Lee.
* Statement for the Record, from various organizations;
submitted by Rep. Lee.
* Statement for the Record, FAIR; submitted by Rep. McClain.
* Statement for the Record, National Health Law Program;
submitted by Rep. Porter.
Documents are available at: docs.house.gov.
WHY EXPANDING MEDICAID
TO DACA RECIPIENTS WILL
EXACERBATE THE BORDER CRISIS
----------
Tuesday, July 18, 2023
House of Representatives
Committee on Oversight and Accountability
Subcommittee on Health Care And Financial Services
Washington, D.C.
The Subcommittee met, pursuant to notice, at 2:11 p.m., in
room 2154, Rayburn House Office Building, Hon. Lisa McClain
[Chairwoman of the Subcommittee] presiding.
Present: Representatives McClain, Foxx, Grothman, Luna,
Langworthy, Burlison, Porter, Ocasio-Cortez, Casar, Lee, and
Crockett.
Mrs. McClain. The Subcommittee on Health Care and Financial
Services will come to order. Welcome, everyone.
Without objection, the Chair may declare a recess at any
time.
I recognize myself for the purpose of making an opening
statement.
Today, we are, again, conducting oversight of yet another
disastrous policy by the Biden Administration that will only
exacerbate the crisis along the Southern border. The Centers
for Medicare & Medicaid Services have proposed a rule to extend
Medicaid, CHIP, and Obamacare eligibility, Deferred Action for
Childhood Arrivals, or DACA, recipients in direct contradiction
to congressional intent.
Once again, the Biden Administration officials are seeking
to rewrite laws through agency rulemaking because they know
their policies are not supported by the American people, and
they would not be able to pass in the House nor the Senate.
Instead, they are proposing a rule with dubious legal basis to
provide taxpayer-funded Federal health benefits to individuals
who have entered this country illegally.
Even President Obama understood this much when his
Administration determined in 2012 that DACA recipients should
not be eligible for Medicaid. A Federal judge has already
deemed the entire DACA Program, which was unilaterally created
through nothing more than an emergency memorandum, unlawful.
DHS is currently prohibited from accepting further applications
by a court order. Despite this, the Administration proceeds
with a plan to spend hundreds of millions more of taxpayer
dollars on healthcare benefits for DACA recipients.
CMS' own estimates show that the expansion will increase
state expenditures for Medicaid and CHIP by $40 million, and
Federal expenditures would expand by another $60 million per
year, and that does not include the proposed Obamacare
expansion, which is projected to cost another $15 million per
year. And you know who the Biden Administration expects to pay
for it? The American taxpayers.
Further, the Biden Administration's proposal will
incentivize further illegal immigration. The Biden
Administration has chosen, unfortunately, to prioritize illegal
immigrants over the American people. I simply do not understand
it. These funds could be used to provide better healthcare to
the American people, and that is why we must stop this
Administration from rewarding illegal immigrants at the expense
of American citizens. We must ensure that Americans are being
put first.
By definition, DACA recipients are still and always were
unlawfully present in the United States. The Biden
Administration cannot simply alter that fact. In extending
Federal benefits to illegal immigrants, President Biden is
signaling to the rest of the world that not only will the U.S.
not enforce laws preventing illegal immigration, but illegal
immigrants will be rewarded with Federal benefits. We should
not reward individuals unlawfully present in the United States
with benefits that were created for American citizens and those
who are lawfully present in the country.
The Biden Administration is responsible for one of the
worst crises in the recent memory along our Southwest border.
By extending Federal benefits to illegal immigrants, the Biden
Administration is once again pouring gasoline on an out-of-
control fire that will only incentivize more illegal
immigration, but such reckless tone, tone-deaf policies have
become the status quo for this Administration.
With that, I want to thank Dr. Montz for being here today.
We look forward to your testimony.
Now I yield to the Ranking Member, Ms. Porter for her
opening statement. Ms. Porter?
Ms. Porter. Thank you, Chairwoman McClain. We have done
some really good hearings together this year. We have come
together on a bipartisan basis to uncover the root causes
behind the infant formula shortage, we have pointed out how
bank regulators need oversight, and we have dug into the role
of Chinese money laundering organizations in making the drug
cartels rich. What do all of these things have in common? We
have tackled real problems: deaths from fentanyl, scared
parents unable to feed their babies, risks to our financial
system. We have shown we are willing on a bipartisan basis to
hold powerful people to account. We identified places where we
need guardrails to make our government, our economy, and our
country work better. And though we did not agree on everything,
we came together on the big picture to achieve progress. I am
afraid that none of those things are true for today's hearing.
Today, we are here to discuss the proposed rule from the
Biden and Harris Administration that would expand health
coverage to everyone lawfully present in the United States.
Medicaid and the Affordable Care Act plans are already
available to people who are lawfully present in the U.S., but
under current Federal rules, Dreamers are left out of the
definition of ``lawfully present.'' President Biden's proposed
rule changes that. Why would the President do that? Because,
well, DACA recipients are, in fact, lawfully present in the
United States. How? Because Congress passed the DACA law. There
is not a whole lot else to unpack.
So, what are Republicans trying to do with this hearing? It
is not oversight because the ability to go to the doctor is not
an abuse of power or an evasion of the law. The title of this
hearing gives a clue: ``Why Expanding Medicaid to DACA
Recipients Will Exacerbate the Border Crisis.'' Let us look at
the premise here. First, some facts. Many DACA recipients
already have health coverage through their employers, just like
other working-age Americans. Dreamers work hard, pay taxes, and
they get employer-provided care. So, how many Dreamers would
even get Medicaid under this new rule? About 13,000, about the
size of one small town. And then the other Dreamers would be
able to buy, using their own wages, healthcare on the exchange,
just like anyone else who lives and works here in the United
States, and do so in compliance with the law. Somehow letting
people who legally live in the United States buy healthcare is
going to create a border crisis?
It would be funny to watch this bad argument fall apart if
it were not such a waste of time. This Subcommittee has had
great hearings under Chairwoman McClain's leadership, hearings
that held powerful people accountable, identified missing
guardrails, and improved the lives of the people we serve. This
hearing does not meet those standards because what powerful
people are we holding to account here?
The people who would get healthcare under this rule are not
rich or well connected. These folks are not using their
powerful positions to abuse the system. They are just regular
workers trying to get insurance so they can stay healthy. OK
then. So, what missing guardrails are we identifying? None.
This hearing is not about putting up guardrails, it is about
ripping away a safety net. It is telling people who have
followed the rules of the DACA Program that they cannot access
healthcare. OK, then. So, how does this hearing make life
better for our constituents? All I can say is when you are
making it harder for people to be healthy, you are going to
have a tough sell that you are in it for the people. And
honestly, I think that is why this hearing is framed to be
about the border.
Most Americans want healthy communities. Most Americans
want Dreamers to have a future in our country. But too many
Republican lawmakers do not want either of these things, and
they know they are not going to convince the people by arguing
against popular policies, like accessible healthcare. So
instead, they are bringing in buzzwords like ``border crisis''
to try to save the day. Republicans need to be able to defend
the real reasons that they continue to oppose healthcare
expansion if this is the hearing that they want to have.
Otherwise, I hope we will go back to having serious oversight
hearings. I have seen that the Republicans can do it, and the
American people deserve no less. I yield back.
Mrs. McClain. Thank you, Ms. Porter.
Pursuant to Rule 9(g), the witness will please stand and
raise her right hand.
Do you solemnly swear or affirm that the testimony that you
are about to give is the truth, the whole truth, and nothing
but the truth, so help you God?
Ms. Montz. Aye.
Mrs. McClain. Let the record show the witness has answered
in the affirmative.
We appreciate you being here today and look forward to your
testimony. Let me remind the witness that we have read her
written statement, and it will appear in full in the hearing
record. Please limit your oral statements to 5 minutes.
As a reminder, please press the button on the microphone in
front of you so that it is on, and the Members can hear you.
When you begin to speak, the light in front of you will turn
green. After 4 minutes the light will turn yellow. When the red
light comes on, your 5 minutes has expired, and we would ask
that you would please wrap up.
I recognize Ms. Montz to begin her opening statement.
STATEMENT OF ELLEN MONTZ
DEPUTY ADMINISTRATOR AND DIRECTOR
CENTER FOR CONSUMER INFORMATION
AND INSURANCE OVERSIGHT
CENTERS FOR MEDICARE & MEDICAID SERVICES
Ms. Montz. Good afternoon. Chairs Comer and McClain,
Ranking Members Raskin and Porter, and Members of the
Subcommittee, thank you for the opportunity to provide an
update on the Centers for Medicare & Medicaid Services' work to
expand access to healthcare by reducing barriers for Deferred
Action for Childhood Arrival Recipients.
Over the last decade, DACA has provided peace of mind and
work authorization to more than 800,000 Dreamers. In April
2023, the President announced his intention to expand health
coverage for DACA recipients, and directed the Department of
Health and Human Services to examine options that would allow
DACA recipients to gain eligibility for coverage through health
insurance marketplaces, the basic health program, and some
Medicaid and Children's Health Insurance Programs. Accordingly,
on April 24 of 2023, CMS released a proposed rule which, if
finalized, would remove the current exclusion that treats DACA
recipients differently from other individuals with deferred
action. The proposed change to no longer exclude DACA
recipients from CMS' definitions of lawfully present would
align with the Department of Homeland Security's definition of
``lawful presence'' and DHS' explanation of this definition in
their August 2022 final rule.
Deferred action recipients, including DACA recipients, have
historically been considered lawfully present for purposes of
Social Security benefits, pre-dating the DHS DACA final rule.
Under CMS' proposed rule, DACA recipients would need to meet
all other program eligibility requirements to qualify for
coverage under CMS healthcare programs. As with all other
enrollees, eligibility information, including an individual's
U.S. citizenship or immigration status, would be verified
electronically.
The Affordable Care Act generally requires that in order to
enroll in a qualified health plan through an exchange, an
individual must either be a citizen or national of the United
States or be lawfully present in the United States. The
Children's Health Insurance Reauthorization Act of 2009
provided an option for states to cover additional non-citizen
populations, including coverage of lawfully residing children
and pregnant individuals in Medicaid and CHIP, commonly
referred to as the CHIPRA 214 option.
Although HHS interpreted ``lawfully present'' to exclude
DACA recipients in 2012, we now know how important ensuring
access to health insurance coverage is to the well-being and
productivity of DACA recipients. For example, a 2021 survey of
DACA recipients found that although DACA may facilitate access
to health insurance through employer-based plans, more than
one-third of DACA recipients responded reported that they were
not covered by health insurance. These findings suggest that
without additional health coverage options, many DACA
recipients could be left without access to affordable
healthcare coverage. Individuals without health insurance are
less likely to receive preventive or routine health screenings
and may delay necessary medical care or receive uncompensated
care in emergency rooms. The COVID-19 public health emergency
further highlighted the need for individuals to have access to
high-quality, affordable healthcare coverage.
According to a demographic estimate by the Centers for
Migration Studies, over 200,000 DACA recipients served as
essential health workers during the COVID-19 public health
emergency, including healthcare and in social assistance
occupations. During the height of the pandemic, essential
workers were disproportionately likely to contract COVID-19.
These factors emphasize how increasing access to affordable
health insurance would improve the health and well-being of
many DACA recipients who are currently uninsured. If the rule
is finalized as proposed, it could lead to 129,000 previously
uninsured DACA recipients receiving healthcare coverage.
Including DACA recipients in the definition of ``lawfully
present'' would align with the goals of ACA and CHIPRA,
specifically to reduce the number of people who are uninsured
in the United States and make affordable health insurance
available to more people. Thank you for the opportunity to
testify on this important issue.
Mrs. McClain. Thank you. The Chair now recognizes Mr.
Grothman for 5 minutes, from Wisconsin.
Mr. Grothman. All right. I guess President Biden did run on
giving healthcare to people coming across the border. One of
the arguments against DACA is the idea that once you grant it
once, you are always going to continue granting it, and so far
that is true. Do you feel that free healthcare for people who
at least came here illegally will result in more illegal
immigration, or do you have any study on that or consider
whether that is going to be a factor?
Ms. Montz. This rule relates to our proposal to include
DACA recipients and eligibility----
Mr. Grothman. Right. I know. And by giving DACA recipients
free healthcare, people who came across the border, albeit
maybe with their parents, although not always, illegally, will
this encourage people in the future to come across the border
or bring their children across the border?
Ms. Montz. DACA recipients are a defined population of
individuals who came to the United States as children and have
been residing here since 2007.
Mr. Grothman. Right, right, right. And I think the feeling
in the past is when you give, say, even amnesty, it causes
people abroad to think you are going to get amnesty again. When
I have been at the Southern border, already the Border Patrol
tells me that people are coming here for American healthcare
because they know that America, being so generous, sure, will
give you dialysis whenever if they come here. Do you think this
sends a message, because I assume if it is OK for people to
declare DACA if they came here in 2007, in the next few years,
somebody will say, you know, you are DACA if you came here in
2017. In that regard, don't you feel that this promotes illegal
immigration?
Ms. Montz. I can only speak to what is current law, and
this proposed rule proposes to extend health coverage to DACA
recipients and not other individuals.
Mr. Grothman. Yes. What do you think is the annual cost of
this program?
Ms. Montz. Our proposed rule has estimates included in the
regulatory impact analysis. We estimate that about 129,000
individuals will gain coverage if this rule is finalized. That
is about 13,000 individuals in the 35 states that have chosen
the optional coverage in Medicaid and CHIP, and just over
110,000 in marketplace coverage. As for costs, there are
roughly 35 states that have chosen the option to cover pregnant
individuals and children lawfully present, pregnant individuals
and children, we estimate that to be about $100 million per
year, and for marketplace coverage, we estimate that to be
about $300 million per year.
Mr. Grothman. OK. One of the concerns I have with Medicaid
across the board is it does affect the way people behave in
order to get the benefit, OK? It both discourages work and
discourages marriage. Does that bother you at all that we are
adding another benefit to people who are not going to get it if
they either arrange for their own healthcare through work, or,
like I said, all these income transfer programs discourage
marriage. Have you thought about that or done any analysis to
see how this will affect people's behavior?
Ms. Montz. As I have said, CMS is committed to providing
quality affordable healthcare coverage----
Mr. Grothman. So, you do not care. That is not a concern to
you?
Ms. Montz. What we have seen in the Medicaid Program and
other programs as well is that health insurance allows people
to be better productive in the work force.
Mr. Grothman. Right. You must know. Maybe you do not know,
maybe you do not talk to people. That already in America,
people who want to get on Medicaid, adjust their income so they
get the benefit, correct? Are you aware of that?
Ms. Montz. What I am aware of is that most working-age
individuals who are enrolled in Medicaid are employed, and
those who are not employed----
Mr. Grothman. They may be employed, but they adjust their
income to make sure that they are eligible for this benefit.
Ms. Montz. I am not aware of that.
Mr. Grothman. Correct?
Ms. Montz. I am not aware of that.
Mr. Grothman. OK. Would you agree to limit the program to a
certain cost, or is it going to be the sky is the limit,
however many people take advantage of the program?
Ms. Montz. In our proposed rule, we have proposed to extend
eligibility through the definition of----
Mr. Grothman. So, in other words, it is just changing the
eligibility standards that could cost the government an
unlimited amount of money and that you are not limiting the
amount the taxpayer is going to have to pay?
Ms. Montz. As I said, we have estimated the cost of
proposed changes under the rule.
Mr. Grothman. OK. Thank you.
Mrs. McClain. Thank you, Mr. Grothman. The Chair now
recognizes the gentlewoman from New York. I can never say your
name. I apologize.
Ms. Ocasio-Cortez. Ocasio-Cortez.
Mrs. McClain. Ocasio-Cortez. Thank you----
Ms. Ocasio-Cortez. Thank you. Thank you very much. That is
all right. Thank you so much, Dr. Montz, for joining us here
today. I would be remiss, just for us to put into context what
this hearing is about, we are having a hearing about why we
should not proceed with healthcare coverage and Medicaid
coverage to DACA recipients, people who are lawfully here in
the United States. And we are having this hearing on the heels
of Governor Abbott in Texas issuing an order to Texas troopers
to push children and infants into the Rio Grande River. And now
we are having a hearing today about why we should push people
who were brought here as children off of healthcare coverage.
I cannot proceed without saying that denying healthcare to
anyone, I believe, is morally repugnant, but moreover, I also
want to highlight a little bit of the relationship here that
the United States has with DACA recipients. Dr. Montz, are you
aware of how much in Federal, or state, or local taxes that
DACA recipients pay?
Ms. Montz. I am not.
Ms. Ocasio-Cortez. DACA recipients pay about $6.2 billion
in Federal taxes alone. They pay another $3.3 billion in state
and local taxes each year. And given that, I think it also
further highlights the relationship that the United States has
with DACA recipients, which is that we take, and we take, and
we take. We take taxes. We take their employment. We have
hundreds of thousands of--yes, 345,000 DACA recipients served
as essential workers in 2021 during the COVID pandemic alone.
They serve in our healthcare systems, they serve our
elderly, they are nursing home workers, and we are having a
hearing today as to why people who are American--they are
American--do not deserve healthcare. They are here lawfully.
They pay more taxes than Facebook does. They pay more taxes
than many of our Federal corporations do. DACA recipients pay
for Members of Congress' healthcare more than Facebook does,
and we are sitting here having a hearing and saying we are
going to return that favor by stripping them of their ability
to engage in Medicaid when they are the ones that are changing
our grandparents' sheets in a nursing home. I cannot believe
this.
The idea that this would somehow act as an incentive when
any DACA eligibility ended in 2007, over a dozen years ago, is
laughable. As is, I believe, the premise that the American
healthcare system is somehow some boon for working-class people
and the best in the world. What in the American exceptionalism
is going on here? I do not know a group of people that
oftentimes are more patriotic to this country than DACA
recipients. They give, and they give, and they give to a
country that does not love them back in their actions. Yet 74
percent of Americans, Republican and Democrat, believe in a
path to citizenship for DACA recipients, for children who were
brought here and made this place their home.
These DACA recipients are emblematic of the American Dream,
they are America's proof of concept, and to strip and undermine
that is to undermine ourselves in this institution. If there is
any individual that believes in stripping Medicaid from DACA
recipients, I would like to know if they are willing to give
the $6.6 billion that DACA recipients pay in Federal taxes back
to them. Are we willing to refund the $3.3 billion in state and
local taxes that they pay back to them so that they can afford
their own healthcare? This should not even be a question right
now, and with that, I yield back.
Mrs. McClain. Thank you. The Chair now recognizes Mr.
Burlison from Missouri.
Mr. Burlison. Thank you, Madam Chair. Thanks for this
hearing. Dr. Montz, is the U.S. Government in debt?
Ms. Montz. I believe we are.
Mr. Burlison. Do you happen to know, off the top of your
head, how much debt that we currently have?
Ms. Montz. I do not.
Mr. Burlison. It is $32.5 trillion. Do you know how much
that is per citizen?
Ms. Montz. I do not.
Mr. Burlison. It is nearly a $100,000 per citizen. Per
taxpayer, it is over $250,000. If the bill came due today,
every taxpaying citizen in the United States would have to fork
up $250,000 because this place blows money, and, you know, have
you ever heard of the economist, Milton Friedman?
Ms. Montz. Yes.
Mr. Burlison. OK. Milton Friedman is famous for quoting,
and his quote about this issue was that he said, ``It is just
obvious, should be self-evident to anybody, that you cannot
have free immigration and a welfare state.'' And why would he
say that?
Ms. Montz. I am not sure.
Mr. Burlison. Because it is basically a run on the
institution. You have individuals who we are now opening up to
be charitable to. You know, at the end of the day, when the
government taxes someone and then takes that money and gives it
to someone, is that charity? Pays for their services, their
healthcare.
Ms. Montz. I believe we have taxes----
Mr. Burlison. Yes, we are being benevolent, right?
Benevolent. The question at hand is not that benevolence cannot
exist in America. The government has a monopoly power on force.
When they tax you, they are forcing you to spend money on the
things that government wants to spend money on. They are
forcing you to be charitable, to be benevolent with your
dollars. I am just beside myself that we would think that this
could occur without continuing to bankrupt a Nation that is on
the tipping point, on the verge.
So, one of my questions has to do with the fact that when
DACA was created under Obama, that he explicitly excluded DACA
recipients from Medicaid, CHIP, and ACA benefits. Why did he do
that?
Ms. Montz. I believe the rule referenced some DHS
memorandum and policymaking.
Mr. Burlison. Well, I do not know that was an answer. You
said that they issued a memorandum.
Ms. Montz. Sorry. The 2012 rule that used HHS' authority to
define lawful presence as it relates to the Affordable Care
Act, and CHIPRA 2009 referenced rulemaking done by the
Department of Homeland Security in its rationale for excluding
DACA recipients from the HHS' definition of lawful presence. As
we have put forward in the proposed rule that we recently put
out here that we are discussing today, we put forth the Biden
Administration's rationale for changing that, for changing that
policy interpretation under our authority.
Mr. Burlison. OK. A question: is DHS currently allowed to
add new applicants to DACA?
Ms. Montz. I would defer to DHS for that answer.
Mr. Burlison. So, the way I understand it, the answer is no
because a Federal judge held that DACA is unlawful. And so, the
question then becomes if it is unlawful, what justification do
you have to add individuals on a program that has been deemed
by the courts to be unlawful?
Ms. Montz. The proposed rule that we put forward reflects
current law in which DACA recipients----
Mr. Burlison. And who directed you on the proposed rule?
Did Congress direct you? Do you have direction from Congress?
Ms. Montz. It is a proposed rule pursuant to HHS' authority
under the Affordable Care Act and CHIPRA 2009.
Mr. Burlison. Did the White House instruct you?
Ms. Montz. Through any general kind of proposed rulemaking
process, HHS, the White House, OMB and other affected Federal
agencies are involved in the----
Mr. Burlison. Thank you. At the end of the day, healthcare
costs a lot of money. This Nation is nearly broke, and there is
not enough to pay for everybody. I yield back.
Mrs. McClain. Thank you. The Chair now recognizes the
gentleman from Texas, Mr. Casar.
Mr. Casar. Thank you. Just to be really clear about what it
is we are debating today, the Biden Administration has chosen
to stop discriminating against DACA recipients so they can buy
health insurance on the exchanges like everybody else. They pay
their taxes, billions in taxes, and thankfully, the Biden
Administration has said we are going to stop discriminating
against DACA recipients just like we are going to treat them
like other legally present people. And Republicans are arguing
that we need to undo this really commonsense change from the
Biden Administration.
And I have been sitting here this whole hearing, and I
still cannot understand from the Republican Majority why they
think that DACA recipients, who are paying billions of dollars
in taxes to pay for healthcare programs, should not have health
insurance and should instead go to the emergency room. So, I
will take this moment just to hear from anybody in the Majority
to hear why, if they are paying billions in taxes, we should
keep discriminating against them.
Or why, if a mom is pregnant, we all chip in, we all
participate because we know we want her to be able to take care
of her kids. That is why moms who are low income can get access
to Medicaid for the folks that are prolife in this group. Why
is it that we want moms, who are legally present in this
country, to not have access to health insurance? That is the
question. It is the only question, if there are any takers.
We have been in bipartisan hearings where we have engaged
productively. This is confounding. I want to hear why a mom who
is legally present, who has paid her taxes, that we make sure
we take care of moms in this country, but then we say, no, DACA
recipients, we are going to take your labor, we are going to
take your talents, we are going to take your sweat, we are
going to take your blood, we are going to accept your
brilliance, your talents, your inventions, but, no, if you get
pregnant, we are not here, you do not need health insurance.
Chairwoman? Anyone?
It is shameful. It is absolutely shameful. Providing people
healthcare is not a reward. It is not charity. It is what we do
because people go out and work and participate in society, and
when my seniors need access to Medicare, I do not say this is a
reward or this is charity. I say thank you. This is what we owe
to one another, and we should do the same thing no matter who
you are or where you are born in this country. It is not a
reward. We should just be doing the right thing.
What DACA recipients have been asking for is not charity.
It is for us to stop punishing them. They grew up in this
country, they immigrated here as children, and they have just
said stop punishing us. Let us live like everybody else, and
the DACA recipients who are hearing this and their family
members should know that you have earned it. You should not
have to come and ask us for access to health insurance or to be
treated like everybody else. It is something you earn every
single day by taking care of your family members, by
participating in this country, by taking care of school kids,
or at nursing homes, or building amazing things in this
country. You already have earned it, and it is just us who have
kept you from having it.
But thankfully, the Biden Administration wants to stop this
one little bit of discrimination and we have a whole hearing
about it, and nobody is willing to say why they want to take
health insurance away from a pregnant mom, or why they do not
want to let somebody buy health insurance, why they want to
send them to the emergency room where it is going to cost us
more money and where people will die. We want to stop punishing
people. We need to get to a place where we recognize we
actually grow our economy, grow our tax base by including more
and more people.
Come to Texas, come to a construction site, and tell me
what building gets built without immigrant workers. Tell me
what inventions get invented without immigrant workers. Just
come. But instead, what we see from Governor Abbott is
punishing people and, frankly, killing people because he is
putting drowning devices in the Rio Grande. A trooper just blew
the whistle and said that they are putting out orders that will
kill people. We got to stop punishing people, and we should
just actually answer the hard question, which is why should
politicians keep on running to build their own power by
punishing folks and threatening their lives.
So, I want to thank the Biden Administration for doing the
right thing on this, and I will still be here waiting to hear
just the baseline answer for why we want to take pregnant moms
off of healthcare.
Mrs. McClain. Thank you. And I would like to respond to
that is----
Mr. Casar. Please.
Mrs. McClain [continuing]. We are happy to have that
conversation regarding immigration. And I think Congress is the
appropriate body of the government to have that conversation.
What I think people are irritated with, and I can speak for
myself, what I am irritated with is we have three co-equal
branches of government to do that. We need to have the
appropriate conversations in the appropriate bodies of
government agencies, not by with the swipe of a pen with either
the agency or the executive branch. So again, sir, I am happy
to have those conversations, and that is what----
Mr. Casar. So, Chairwoman, would you--go ahead.
Mrs. McClain. If the gentleman will let me finish in
response to your question. That is why we need to have the
conversations. But what I am tired of is the agencies playing
the end-all be-all and with a swipe of a pen reinterpreting
definitions or just changing the rules, changing the
definitions altogether. I mean, we talk about DACA recipients
being children. The average age is 29. So, sir, again, I think
you bring up a very, very valid point. This is the body to have
those conversations. We have got to stop letting the agencies
run with these. We have to follow the law. We are a land and a
Nation of laws. So, with that, I yield.
Mr. Casar. So, Chairwoman, would you co-sponsor a bill with
me to say pregnant moms legally present in the country should
have access to Medicaid? You know, pregnant moms should not
have gone without health insurance.
Mrs. McClain. And again, sir, I think what we need to get
back to is legally present. I am here----
Mr. Casar. And they are legally present.
Mrs. McClain. If you could let me respond again, sir.
Mr. Casar. Go ahead.
Mrs. McClain. Just finish my response--those are the types
of conversations that we need to have. But what I think people
are sick of is--let us not redefine the definitions, and maybe
we need to spend some time on the definitions. So, again, happy
to have that conversation, but with that, I yield to Mr.
Langworthy from New York. Thank you.
Mr. Casar. If we overturn this rule, we are taking pregnant
moms off Medicaid.
Mr. Langworthy. Thank you very much, Madam Chair, and I
would like to thank Dr. Montz for joining us today to discuss
the proposed CMS rule. This rule has far-reaching implications,
particularly in our home state of New York where Medicaid is
funded through property taxes and many other taxes. New York
state firmly holds its place near the very top of the list that
has the highest property values, and property taxes are a
tremendous burden throughout my district and throughout the
entire state.
The consequences of this entire rule are clear. To increase
Federal spending and inevitable higher costs will burden
hardworking American taxpayers, especially those in New York's
23d congressional District. And while we could engage in
debates about costs and figures, it is essential to take a
closer look at the actual development of these rules and others
like this, just as my colleagues have just discussed. Far too
often, we witness unelected officials within this
Administration, especially in this particular Biden
Administration, pushing their own agenda without giving
consideration to due process or the impact on the American
taxpayer. It is crucial that we hold the government accountable
and ensure that policies are thoroughly examined, transparent
and genuinely beneficial to all of our constituents.
So, Dr. Montz, why did CMS decide to develop this rule, and
what was the rationale to extend benefits to DACA recipients
when the Obama Administration did not do this in 2012?
Ms. Montz. Thank you for that question. The CMS is
committed to expanding quality, affordable health insurance
coverage throughout all of our programs consistent with the
law. To that end, we proposed this rule which would align with
the current definition. The Department of Homeland Security's
longstanding definition of ``lawful presence'' would align HHS'
definition of ``lawfully present'' with that of the Department
of Homeland Security, ensuring that DACA recipients are treated
the same as any other recipients of deferred action under the
law.
The reason why we pursued this proposed change in addition
to those two things I mentioned is, you know, with time and
experience, under the DACA Program, we have learned that while
the majority of DACA recipients receive health insurance
coverage through their employer, still a third of DACA
recipients remain uninsured. And we know that uninsurance can
lead to certainly detrimental impacts to both individuals, but
also our economy.
Mr. Langworthy. So just to be clear, no congressional
authority has been granted to CMS to make this rule change, and
the Biden Administration has not issued an executive order
dictating this rule change?
Ms. Montz. Under this proposed rule, HHS is pursuing this
proposed rule under our authorities, under the Affordable Care
Act and CHIPRA 2009 to define ``lawfully present'' and
``lawfully residing.''
Mr. Langworthy. So, in developing this rule, did CMS seek
feedback from Customs and Border Protection or U.S. Immigration
and Customs Enforcement?
Ms. Montz. Just like any development of a proposed rule,
that rule is looked at by our HHS, OMB, the White House, and
any other affected agencies.
Mr. Langworthy. Yes or no, did you talk to those two
specific agencies?
Ms. Montz. The Department of Homeland Security did review
the role of going through clearance.
Mr. Langworthy. OK. And what was your feedback?
Ms. Montz. I would need to get back to you on the
specifics.
Mr. Langworthy. OK. With my remaining time, I want to shift
and speak about the impacts of this rule and what it would have
on the healthcare systems, especially rural hospitals that are
already overwhelmed. In the Southwest, we have seen immense
stress and overflowed healthcare facilities. Did CMS consider
the impacts that this rule would have on these sorts of
healthcare facilities?
Ms. Montz. In the proposed rule's regulatory impact
analysis, we do note that one benefit of this proposed rule
would be lower uncompensated care costs borne by the healthcare
system that are ultimately borne by local, state, and Federal
Government.
Mr. Langworthy. And all the taxpayers. Dr. Montz, New York
state pays some of the highest taxes in the country for
Medicaid. We spend more than California and Texas combined on
the program. How would you justify to my constituents in
Western New York, which consists of some of the poorest
counties in New York State, that their taxes could go up to pay
for illegal immigrants' health insurance when they are
struggling to pay for their own?
Ms. Montz. What this proposed rule does is propose to
modify HHS' definition of ``lawful presence'' to align with
that longstanding definition for the Department of Homeland
Security. Under the Affordable Care Act, individuals who are
lawfully present are eligible for benefits.
Mr. Langworthy. I yield back, Madam Chair.
Mrs. McClain. Thank you. The Chair now recognizes Ranking
Member Porter.
Ms. Porter. Many Republican lawmakers seem to believe that
President Trump had some great system going at the border when
we had kids being separated from their parents, and families
being housed in inhumane conditions, and Border Patrol agents
put in danger trying to help migrants who are being smuggled by
cartels, and that somehow President Biden changed all that
awesomeness and started a border crisis. We hear this from them
all the time.
Dr. Montz, let us just assume for a moment that there is,
and I do not agree with this, a Biden border crisis. That is,
like, the Republican's reference in this hearing title. When
could that possibly have started? When could the beginning of
Biden border crisis possible have started? When was President
Biden elected, ma'am?
Ms. Montz. I was going say in 2021.
Ms. Porter. January 20, 2021. Would immigration that
happened, let us say, 14 years before that date count as part
of the Biden border crisis?
Ms. Montz. I do not believe so.
Ms. Porter. Dr. Montz, tell us, do you know what date
Dreamers had to be physically present here in the United States
to qualify for DACA?
Ms. Montz. 2007.
Ms. Porter. June 15, 2007. If Dreamers had to be present in
the United States 14 years before President Biden was
inaugurated in order to become DACA recipients, can you tell me
how their immigration in the years before 2007 changed and
created a crisis on or after January 20, 2021?
Ms. Montz. I cannot.
Ms. Porter. So, Republicans really cannot blame the DACA
Program for any of their grievances, legitimate or, in my
opinion, illegitimate, at the border. The DACA Program has
nothing to do with what is happening today at our border. So
then, what Republicans seem to be saying is that if we provide
DACA recipients with healthcare, somehow more people eligible
for DACA might cross the border, that might be some bad
incentive. So, Dr. Montz, can anyone get DACA status who is not
in the United States and has not been living here since 2007?
Like, if someone crosses today, can they get DACA status?
Ms. Montz. I do not believe so.
Ms. Porter. What if they crossed, like, 3 years ago? Can
they get DACA status?
Ms. Montz. I do not believe so.
Ms. Porter. Five years ago?
Ms. Montz. I do not believe so.
Ms. Porter. Ten years ago?
Ms. Montz. Now you are forcing me to do math. I do not
believe so.
Ms. Porter. So, is President Biden expanding who can
receive DACA status as part of his rulemaking?
Ms. Montz. Our rule strictly pertains to eligibility for
CMS health insurance programs.
Ms. Porter. Eligibility for DACA recipients who have all
been here since at least 2007, following the rules, applying
for renewals, going to school, and working. So, I do not get
it, Dr. Montz. Can you think of any connection between how
giving DACA recipients, like children and pregnant women,
healthcare incentivizes new immigrants to cross the border if
they would not even be eligible for this expanded healthcare
that we are talking about?
Ms. Montz. I cannot.
Ms. Porter. So, DACA did not cause a border crisis because
stuff that happened before 2007 does not create a border crisis
today. And two, giving DACA recipients the healthcare that they
need to continue to work, and to earn, and to pay taxes, and to
start businesses, and to flourish is not going to increase
border crossings. This hearing is called ``Why Expanding
Medicaid to DACA Recipients Will Exacerbate the Border
Crisis.'' I am sorry, there is no real connection between
healthcare for DACA recipients who have been here since before
2007 and anything that is happening at our border, just no
connection at all.
I want to close by pointing out, in response to one of my
colleagues on the other side's comment about what border agents
had told him, the Minority has done numerous hours of
questioning of U.S. Border Patrol chief agents. And during all
of those numerous hours of questioning, which are transcribed
interviews that anybody can read, not one U.S. Border Patrol
chief agent mentioned access to healthcare as a reason for
migration to the Southwest border or a concern for border
security. I yield back.
Mrs. McClain. Thank you, Ranking Member Porter. The Chair
now recognizes Dr. Foxx.
Ms. Foxx. Thank you, Madam Chair. You know, I think it is a
stretch to say that there is no connection at all between
people receiving free healthcare in this country who are here
illegally, people here illegally, getting free healthcare and
there not being people thinking, oh, maybe I could get that
free healthcare, too.
Dr. Montz, thank you for being here today. The number of
people illegally crossing the border has dramatically increased
in recent years, nearly 3 million crossings in 2022, a full
million more than occurred in 2021, which was itself a record
year for crossings. Do you think that this unilateral expansion
of Medicaid by CMS could lead to an additional increase in
illegal immigration?
Ms. Montz. It is the Department of Homeland Security's
longstanding policy that individuals that are subject to
deferred action are considered lawfully present in this
country. What our proposed rule does is propose to modify the
definition of ``lawfully present'' as it relates to our CMS
healthcare programs to ensure that DACA recipients, who are
individuals who came to the United States as children and have
resided here----
Ms. Foxx. OK. Just answer my question. So, it is the
Department of Homeland Security's considered opinion that they
can change the definition of who is legal and who is illegal in
this country. Is that what you are saying?
Ms. Montz. I could not speak for the Department of Homeland
Security. What I can say is that under this proposed rule, HHS
is using its authority under the Affordable Care Act and CHIPRA
2009 to propose----
Ms. Foxx. Just like the Administration thought it had the
authority to pay off student loans under a law passed in 2011.
So, would it be fair to call the prospect of receiving free
healthcare and other benefits an incentive for people to
illegally cross into the United States?
Ms. Montz. Under our proposed rule that focuses on DACA
recipients, individuals would have had to have resided in the
United States since 2007.
Ms. Foxx. OK. So, DACA was ruled unlawful by the Fifth
Circuit Court in October 2022. In that case, the state of Texas
argued DACA was not only unlawful, but that the program cost
the state hundreds of million dollars in healthcare and welfare
costs. Can you tell me how much we can expect this unilateral
expansion of Medicaid to cost both the states themselves and
the Federal Government?
Ms. Montz. Our proposed rule includes a regulatory impact
analysis, and we estimate for the roughly 35 states that have
taken up the option to cover lawfully present pregnant women
and children in the Medicaid and CHIP Program, that that would
cost about $100 million total a year.
Ms. Foxx. OK. Well, that is what I understand too, that it
would be about $100 million, but, again, that it is a program
that we believe is illegal. Just last week, this Committee
passed the Unfunded Mandates Accountability and Transparency
Act, UMATA, a bill I introduced, which aims to prevent exactly
this scenario where the Federal Government passes significant
costs onto the states, $40 million, we believe, in this case.
What kind of input did CMS seek from states before advancing
this rulemaking that will cause state budgets an extra $40
million in 2024?
Ms. Montz. Thank you for that question. I would note that
this is a proposed rule and the comment period just closed, and
we are looking at comments that we have received on the rule. I
would also note what I indicated before, which is under CHIPRA
2009, it is a state option to cover lawfully residing pregnant
individuals as well as children, that continue--nothing in the
rule changes. It is a state option.
Ms. Foxx. I have a quick follow-up. In 2012, CMS made a
specific decision not to extend healthcare benefits, like
Medicaid, CHIPS, and the ACA, to DACA recipients. What does the
Agency believe has changed, besides DACA being declared
unlawful, to evidence that such a dramatic expansion of
eligibility? What has changed?
Ms. Montz. Our proposed rule references several reasons why
we are proposing this change. First is that CMS is committed to
expanding access under the law. Second is that the Biden
Administration has indicated commitment to the DACA Program and
DACA recipients. And the Department of Homeland Security
recently published a final rule that reaffirmed that DACA
recipients, like other recipients of deferred action, are
considered lawfully present. One of the reasons why we are
pursuing this rule is to better align with DHS' definition of
``lawfully present.'' And finally, we have through time and
experience come to understand that while the majority of DACA
recipients receive health insurance coverage through their
employers, still a third remain uninsured. And we want to
ensure that DACA recipients are able to keep themselves healthy
and productive in the work force.
Ms. Foxx. Thank you. Madam Chair, I yield back.
Mrs. McClain. Thank you. The Chair now recognizes the
gentlewoman from Pennsylvania, Ms. Lee.
Ms. Lee. Thank you, Madam Chair. Folks, this hearing, like
so many before it, is nothing more than par-for-course fear
mongering by my Republican colleagues. To be very clear, we are
not talking about millions of people at the border, a racist
myth disproven annually at this point. We are talking about
closing a gap in healthcare coverage for about 129,000 people,
people with a legal status in this country.
Healthcare is a human right, and it should be available to
everyone who resides in this country, no matter who they are.
As those of us who care for our fellow man continue to push
toward a Medicare for All system, a stop on the fight is fixing
a technical wrong, which was not extending the Affordable Care
Act to DACA recipients back in 2012. This should be an easy
fix. Healthcare coverage ensures that people are accessing
services before they are critically sick. It encourages the use
of preventative resources, like cancer screenings and routine
vaccinations, something that people who grew up with insurance
often take for granted.
Dr. Montz, what are the collective public health benefits
of expanding healthcare coverage to more people?
Ms. Montz. Thank you for that question. What studies have
indicated and certainly experience shows is that when an
individual is insured, that individual is better able to keep
themselves healthy, for example, go to the doctor to receive
preventive services. Keeping yourself healthy also means that
you can be more productive at your job and the work force for
the economy. Studies have shown that individuals who are
insured have 70 percent lower rates of absenteeism in the work
force. Additionally, from a, you know, global economy
perspective for the United States, being insured means that you
are not incurring uncompensated care costs to the healthcare
system, which, I have said before, are ultimately incurred by
local, state, and Federal Government.
Ms. Lee. Thank you. Our Republican colleagues pretend that
DACA recipients are not already here, paying taxes, picking up
kids from school and accessing our public health system. This
fix not only helps people who have legal status in our country,
but all Americans. We are one of the only Western nations that
does not have universal healthcare. I do not think our system
is as appealing as Republicans are making it out to be.
Further, many DACA recipients receive health insurance through
work and rely on their benefits, just like nearly everyone on
this dais today. Others live in states like California or New
York, states that have successfully allowed DACA recipients to
enroll in Medicaid and other state-funded plans for years.
What we are talking about today is a proposed rule to
extend Affordable Care Act benefits to an estimated 129,000
uninsured DACA recipients. And make no mistake, these
individuals are still getting sick and going to taxpayer-funded
clinics and emergency rooms, but just like everyone else in
this country, they deserve more than just emergency care. They
deserve affordable prescription drugs and access to
comprehensive healthcare and preventative treatments.
Dr. Montz, knowing that many DACA recipients already rely
on our healthcare system, why would it be beneficial to expand
their access to affordable insurance?
Ms. Montz. Thank you for that question. As I said, there
are multiple benefits to being insured versus uninsured,
including healthier, more productive life, your, you know,
limited risk, receiving high medical bills that you are not
able to pay for that then are incurred by the health insurance
system.
Ms. Lee. Let me ask. When we are talking about the
expansion of Medicaid, who would it apply to and about how many
people would that include?
Ms. Montz. Our proposed rule estimates that in the roughly
35 states that have elected this option under CHIPRA 214 to
cover pregnant individuals and children who are lawfully
residing, that that would extend coverage to about 13,000
individuals.
Ms. Lee. Thirteen thousand individuals. Would those states
be required to expand healthcare coverage for Medicaid?
Ms. Montz. The CHIPRA 214 coverage option is an option for
states. They are allowed to cover or not cover lawfully
residing.
Ms. Lee. Thank you. Just to conclude, the Affordable Care
Act takes important steps to ensure that people are not denied
basic healthcare because of their gender, disability status,
zip code, or income, but we still need Medicare for All, and we
will keep fighting for it. But cutting healthcare is par for
the course for the so-called pro-life party. This is just
another attempt to gut and block access to programs that help
keep vulnerable moms and babies alive as our maternal mortality
crisis and rates keep arising. To oppose such a small but
important change shows a blatant disregard for human life
because no one should be without healthcare. I yield back.
Mrs. McClain. Thank you. The Chair now recognizes the
gentlelady from Florida, Mrs. Luna.
Mrs. Luna. The Centers for Medicare and Medical Services
has proposed a new rule that would reinterpret the term
``lawfully present'' to expand taxpayer-funded Federal health
benefits, specifically Medicaid, Affordable Care Act healthcare
coverages, and the Children's Health Insurance Program, to DACA
recipients. Expanding benefits in this way would not deter
illegal immigration. In fact, it encourages more individuals to
take the dangerous trek across our borders illegally. And to
put the cost of illegal immigration into perspective, illegal
immigration has a net cost of approximately $151 billion per
year. This cost is not incurred by illegal aliens that are
coming to United States but instead paid for by hardworking
Americans, while those breaking the law have zero financial
accountability.
This is not the only costs the American taxpayer have taken
on. In fact, the U.S. Government spends more than $23 billion
annually on Federal medical expenditures and which services are
used by illegal aliens to participate. One service costs
taxpayers over $5 billion in medical assistance for those born
of illegal aliens. Even more concerning are the incentives that
those exploiting birth tourism and international commercial
surrogacies receive, which will only worsen our immigration
crisis that we are facing in our country and defraud the
American people. Dr. Montz, are you aware of what birth tourism
is?
Ms. Montz. I am sorry. Could you repeat the question?
Mrs. Luna. Are you aware of what birth tourism is?
Ms. Montz. No.
Mrs. Luna. OK. So, birth tourism is when a pregnant woman
will come to the United States, basically about to give birth,
have their child here, they might not be a citizen, and then
ultimately end up leaving the country. Meanwhile, the child
will receive citizenship status, but it is a huge problem in
this country, mainly because what we are finding is other
countries that are more nefarious, like Russia and China, are
exploiting the system. Are you aware that some nations that are
participating in these illegal activities and exploiting birth
tourism and international commercial surrogacy practices are
from Russia and China?
Ms. Montz. I am not aware of that.
Mrs. Luna. Are you aware that these two countries have long
histories of anti-American espionage activities?
Ms. Montz. I would not have any knowledge of that.
Mrs. Luna. You do not know that Russia does not like us?
That is a question.
Ms. Montz. I know that Russia is currently at war with
Ukraine.
Mrs. Luna. So, you do not like Russia, correct?
Ms. Montz. I do not have any particular opinions that
pertain to this hearing.
Mrs. Luna. OK. Are you aware that China does not like the
United States and has engaged in espionage activities against
United States?
Ms. Montz. I do not have any personal professional
knowledge of that.
Mrs. Luna. OK. Well, I suggest you read Breitbart. Do you
believe that allowing these practices puts the national
security of the United States at risk?
Ms. Montz. I do not believe so.
Mrs. Luna. You do not believe that allowing a country that
engages in espionage against the United States, exploiting
birth tourism could potentially open us up for risk?
Ms. Montz. I do not have the professional knowledge to
opine on that issue.
Mrs. Luna. Do you believe that individuals from these
countries and illegal aliens in general should be allowed to
exploit the medical system that you help oversee?
Ms. Montz. Again, I am here to talk about the HHS' proposed
rule to extend benefits to DACA recipients to ensure that their
treatment is in line with other deferred action recipients.
Mrs. Luna. So, you cannot answer the question. Do you have
an opinion on any of that?
Ms. Montz. Again, I am here to talk about the proposed rule
that CMS has put forward. I am happy to take your questions.
Mrs. Luna. OK. What would be your solution then for that
proposed rule?
Ms. Montz. Under the proposed rule, this pertains to DACA
recipients. As you know, DACA recipients are a defined
population of individuals that came to the United States as
children and have been lawfully residing here since 2007.
Mrs. Luna. When Obama created the program in the Rose
Garden?
Ms. Montz. I am not familiar with that.
Mrs. Luna. OK. Can you just briefly tell me about how Nancy
Pelosi treated DACA recipients when given the option to make
them legal?
Ms. Montz. What I can talk about is the proposed rule. What
we have proposed to do is further align HHS' definition of
lawfully present with that of the Department of Homeland
Security's longstanding definition----
Mrs. Luna. And what is that definition?
Ms. Montz. That definition includes all individuals who are
subject to deferred action.
Mrs. Luna. OK. In my opinion, ma'am, you are obviously in
charge of a very important program, but this program was
created with the intent of making it political, and let us be
clear. Whenever they show pictures of DACA recipients, they
typically tend to show Hispanic children when, in actuality, it
is more than just the Hispanic demographic. So, I guess the
question for you would be, you are in charge of a program that
is costing American taxpayers millions and billions of dollars,
and yet you are sitting here refusing to answer questions about
whether or not that is fair or there is certain terminology
being used for these programs.
I guess my suggestion to you is that our rules that we have
in place are in place for a reason, and, ultimately, what ends
up happening is when you have these programs that are
exploited, it does harm people long term. Chairwoman, I yield
my time. Thank you.
Mrs. McClain. Thank you. The Chair now recognizes the
gentlelady from Texas, Ms. Crockett.
Ms. Crockett. It never ceases to amaze me what will come
out of some of my colleagues' mouths. So, it was suggested that
you should read Breitbart, and I could not let it go. And so
just for the general public, because I do not want anybody to
believe this is a good idea, I just got on Google, which if you
have a cellphone, we can all do that. Breitbart News Network is
an American far-right syndicated news opinion and commentary
website founded in mid-2007 by American conservative
commentator, Andrew Breitbart. Breitbart News' content has been
described as misogynistic, xenophobic, and racist by academics
and journalists. So, I do not know that that is where I want
anybody to take their cues from, especially when they are
trying to run this country. That part, and then let me clear up
another little part real quick. DACA is political is what I
heard just now. Just to be clear, you have testified that DACA
recipients are considered to be lawfully present, correct?
Ms. Montz. That is correct. I have said that under the
Department of Homeland Security's longstanding definition, DACA
recipients are considered lawfully present----
Ms. Crockett. Right. They are not considered illegals. They
are considered to be lawfully present, but ``lawfully present''
does not mean that you have the right to vote, correct?
Ms. Montz. I would defer to----
Ms. Crockett. Well, I will give it to you. Only U.S.
citizens can vote, and so, therefore, this idea that it is
political or as if the Biden Administration is about to rack up
some votes, is just another falsehood. In fact, all we continue
to get is half-baked ideas, or half lies, or half-truths,
whichever way you want to look at it. Let us talk about the
half-baked ideas first, though. My colleague, Ms. Lee, brought
up the fact that we are talking about expanding access to
pregnant women and children, correct?
Ms. Montz. In the Medicaid Program, yes.
Ms. Crockett. OK. And this is only in states that have
extended Medicaid, correct?
Ms. Montz. This is under the proposal. This would impact
the roughly 35 states who have chosen the option to cover
lawfully residing pregnant individuals as well as children.
Ms. Crockett. OK. So, we are talking about pregnant women,
and have you heard of the Dobbs decision?
Ms. Montz. I have.
Ms. Crockett. OK. All right. So, we have a party that says,
seemingly, what would Jesus do. Seemingly, that is how they
govern themselves, and so they have decided that all women
should just bear all the children and not have any rights to
decide what they are going to do. And so even under this set of
circumstances, they think that it is great that all women
should just be pregnant, but they do not want them to have any
access to healthcare. That sounds like a half-baked idea to me
to say that forget life when it comes to, say, the life of the
mother, because that is a real thing, because if you have
healthcare, and I do not know how deeply you have delved into
this, but we have been talking, and when I say ``we,'' I mean
the Democrats, have been talking about the fact that we have a
terrible maternal mortality rate in this country. And when you
start talking about people of color or people of lower social
economic means, that rate goes up even more astronomically.
And, so the idea that people are already dying----
Let me be clear. Are there people that tend to be at a
higher risk when they do not have access to healthcare when
they are pregnant?
Ms. Montz. Yes, it is. It is our belief that being insured
leads to better health outcomes.
Ms. Crockett. Thank you. Let us also just talk about these
half-truths. Really they are just full lies. I was trying to be
nice. The reality is that they are trying to make this into the
immigration boogeyman that they always talk about. Yet, we have
yet to have a bill on the Floor that has been proposed in the
form of a policy around immigration. Instead, what they want to
do is continue to treat immigrants as if they are the big, bad
boogeyman.
And so we are sitting here and we are talking about a
program, and you have remained composed, so let me compliment
you for that because my colleagues on the other side of the
aisle continue to ask you about the border. What in this rule
change has anything to do with the border? Just give me one
thing that it has to do with the border, one.
[No response.]
Ms. Crockett. OK. Exactly. It does not, right? It does not,
but for some reason they believe if they say it, that is true.
I would love to live in a world where whatever I say somehow is
true, but the reality is that if they want immigration reform,
they are in control of the House, and they can put a bill on
the Floor, but they do not want to do that because they want to
continue to say that immigrants are the big bad boogeyman.
Thank you for your service. This has nothing to do with
immigration. It has everything to do with being good citizens,
and good lawmakers, and good public servants who actually just
give a darn about people. Thank you.
Mrs. McClain. Thank you. I now recognize myself. I think
what it has to do, to answer your question, is incentives. I
think people are logical and people do things that they believe
is in their best interest, and we incentivize people and we
incentivize their behaviors, so that is what it has to do with
immigration. When we incentivize certain behavior, people
respond in a logical fashion.
But with that said, Dr. Montz, in 2012 the Obama
Administration created the Deferred Action for Childhood
Arrival Program via agency memorandum without any authorization
from Congress. But notably, the Obama Administration was
careful to clarify that DACA recipients would not be eligible
for participation in Federal healthcare benefits, such as
Medicaid, CHIP, and Obamacare. And again, what I want to point
out is we have three co-equal branches of government, and we
have to stop changing the definitions, and we have to follow
the rules of law. And if we do not like the laws, then we have
the ability and the authority to change those laws.
Now, CMS has suddenly reversed course and has concluded
that DACA recipients should receive Medicaid, CHIP, and
Obamacare eligibility, OK? Dr. Montz, did CMS base its decision
to reinterpret the Agency's definition of ``lawful presence''
on a 2021 survey which found that 34 percent of DACA recipients
reported not to be covered by health insurance?
Ms. Montz. As I have mentioned to a few of your colleagues,
as we stated in the proposed rule, we have had several reasons
for making this proposed change to treat DACA recipients the
same as other recipients of deferred action.
Mrs. McClain. So, is that a ``yes'' or ``no?''
Ms. Montz. Yes, one of the reasons----
Mrs. McClain. OK. Under the law, are DACA recipients U.S.
citizens or lawful permanent residents?
Ms. Montz. Under longstanding DHS policy, DACA recipients,
just like other recipients of deferred action, are considered
lawfully present.
Mrs. McClain. They are lawful. So, are they U.S. citizens?
Ms. Montz. They are not U.S. citizens.
Mrs. McClain. OK.
Ms. Montz. They are lawfully present.
Mrs. McClain. Yet under the law, do we owe a legal duty to
provide healthcare to DACA recipients over American citizens?
Ms. Montz. Under the Affordable Care Act, eligibility for
the exchanges, as well as premium tax credits and cost sharing
reductions, is extended to U.S. citizens, U.S. nationals, and
those that are lawfully present.
Mrs. McClain. So, the answer is yes?
Ms. Montz. Yes. The Affordable Care Act covers those that
are lawfully present.
Mrs. McClain. OK. But do we have a legal duty to provide
their healthcare over the American citizens?
Ms. Montz. What this rule does is extend eligibility. It
does not restrict eligibility for any other categories.
Mrs. McClain. OK. So, I am a firm believer in following the
law. Some laws I do not like. Some laws I do not agree with.
Unfortunately, we all took an oath to uphold the law. Dr.
Montz, are you aware that in 2022 the Fifth U.S. Circuit Court
of Appeals affirmed that DACA was unlawful?
Ms. Montz. I am aware that there is an injunction for any
new DACA recipients.
Mrs. McClain. OK. Let me try this a different way. Can you
tell me how many illegal border crossings the U.S. Border
Patrol recorded in Fiscal Year 2021?
Ms. Montz. I would defer that answer to----
Mrs. McClain. Let me help you. It is 6.5 million illegal
border crossings. So, what does that have to do, it has to do
with incentives, right, and with all of those incentives comes
money, and that money comes at the cost. I have two issues. Who
is going to pay, and if we do not like the law, it is up to
this body in Congress to change the law. We have got to stop
allowing these agencies to redefine and reinterpret the
definition. Can you tell me did CMS at all consider how
external Federal benefits to DACA recipients would spur future
waves of illegal immigration? Did that come into your status at
all or your decision at all?
Ms. Montz. We endeavor to do our proposed rulemaking under
current law, and, as you know, DACA recipients----
Mrs. McClain. I am sorry. I am running out of time. Yes or
no, did that play into your decision at all?
Ms. Montz. DACA recipients have been here since 2007, and
so we did not believe that there is any impact.
Mrs. McClain. OK. So, no. So, can you please identify the
section of U.S. Code that provides CMS with the authority to
set U.S. immigration policy?
Ms. Montz. HHS does not set immigration policy. However, we
have the authority to set the definition of ``lawful presence''
as it relates to HHS' programs under the Affordable Care Act.
Mrs. McClain. OK. So, there is no code that provides CMS
with the authority to set the immigration policy? Just, I want
to hear that.
Ms. Montz. HHS does not set immigration policy.
Mrs. McClain. All right. So in my opinion, you altered the
law in direct contradiction to the decision of the Federal
court judge which stated that DACA was unlawful, and you did
not consult with the agencies who oversee our immigration
system or whether this would exacerbate President Biden's
border crisis. Instead, you chose to rewrite the law based on a
single study that said 34 percent of DACA recipients who are
here in violation of law had difficulty getting healthcare. And
I am out of time, so I want to be respectful to my other
colleagues.
So with that, I yield to Ms. Lee for her closing statement.
Thank you so much.
Ms. Lee. Thank you, Madam Chair. All Americans deserve
healthcare, and DACA recipients deserve to have a secure and
healthy future in our country. Today we are here because too
many Republican lawmakers on this Committee reject this vision
and continue to fear monger, lying to the American people to
buy into their twisted thinking. Again, Republicans are holding
a hearing to deny 129,000 people healthcare. Sad.
Republicans like to paint a picture of America in crisis,
millions of people lined up at the border all coming to destroy
your way of life. They tell you that if you do not support
their policies, the crisis will only get worse. But today, we
have not heard any compelling argument that there is any kind
of connection between DACA recipients being provided with
healthcare and our failing immigration system. DACA recipients
cannot just become DACA recipients to get healthcare.
So, let me explain the law. DACA recipients would have had
to, one, have come to the United States back in 2007; and two,
have been younger than 16 in order to qualify today for
healthcare under the Biden Administration's proposed rule.
Unless migrants who come or who want to come to the United
States for healthcare are going to go back in time to meet
those qualifications, this rule is not going to incentivize any
new ones to come to our country for healthcare. The coverage
under this rule does not apply to them.
Today, I am disappointed to say that not only has this
hearing been disingenuous with the American people, it has
wasted an opportunity to go after real waste, fraud, and abuse.
It has wasted an opportunity to make our government, our
economy, and our country work better. Next time the
Subcommittee meets, let us do better.
In closing, Madam Chairwoman, I have statements with me
today from pediatricians, budget and policy experts, and
immigration rights advocates all stating that President Biden's
proposed rulemakes our healthcare statements stronger and
affirms that allowing more people to have health insurance is
beneficial to our collective well-being.
I ask unanimous consent to enter these enter three
statements into the record: one from the National Immigration
Law Center; another from the Center on Budget and Policy
Priorities; and another jointly from the American Academy of
Pediatrics, Center for Law and Social Policy, First Focus on
Children, Georgetown Center for Children and Families, Kids in
Need of Defense, the Children's Partnership and the Young
Center for Immigrant Children's Rights.
Mrs. McClain. Without objection.
Ms. Lee. Thank you. I yield back.
Mrs. McClain. Thank you, Ms. Lee. The reason why we are
having this hearing is because it is law, right? We are a land
and a Nation of laws. Today's hearing demonstrated that the
Biden Administration is prioritizing illegal immigrants over
the American people. This Administration has chosen to reward
those who enter the country illegally, with release from
custody in many cases, and now with access to public benefits
at the cost of taxpayers and Americans who need it.
We learned that CMS' proposed rule to expand access to
Medicaid, CHIP, and Obamacare to DACA recipients will cost
American taxpayers millions per year. Last I checked, this body
is supposed to be the steward of American taxpayer dollars.
That is our job, and that is what we are doing. CMS' own
estimates show that Medicaid and CHIP state expenditures would
increase by $40 million, and Federal expenditures would
increase by $40 million in just the first year. Total
expenditures would then balloon up to $130 million per year,
and that does not even include the proposed Obamacare expansion
which will cost another $15 million to $20 million annually.
Now, I just say that because people have a tendency when
they spend other people's money, the taxpayers' money, not to
respect it as much as it is their money. That is our job. As
messy as it may be, that is our job to be stewards of the
American taxpayers' money. I am curious on how we are going to
pay for this. Last I checked, we have a major deficit in this
country, and I have yet to hear any explanation of how we are
paying with this.
So, forget about the changing of the rules. Forget about
the reinterpretation. Now we have the cost. It is our
responsibility to ask those tough questions, and I will remind
everybody that DACA stands for ``Deferred Action for Childhood
Arrivals.'' That means that DACA recipients are still and
always have been unlawfully present in the United States. We
may not like that, people may not agree with that, but that is
the law. And it is up to this chamber to change it, not
reinterpret the definition with the stroke of a pen. They would
not have even been eligible for Deferred Action otherwise.
Lawless Democrats have deferred the prosecution of these
immigration cases, despite Federal judges holding DACA is
unlawful and DHS being prohibited from accepting further
applicants, and, again, we may not like that, but it is the
law. Only in Biden's America can bureaucrats defy Congress and
the courts to change the laws and extend benefits to
individuals who are unlawfully present in the United States.
There is already a crisis at the Southwest border caused by the
Biden Administration's failed policy. This proposed rule would
only further signal to the world that illegal immigration is
rewarded by the current Administration. We put a welcome mat at
the door. That is why you see the immigration numbers
skyrocketing.
The Biden Administration sees no difference between an
American citizen and a non-citizen unlawfully present in this
country. That, for me, is simply unacceptable. We should not
reward individuals unlawfully present in the United States with
benefits reserved for American citizens and those who lawfully
present in this country. Even President Obama's HHS knew that
expanding public health benefits to DACA recipients was
unlawful and a bad idea, but in Biden's America, it seems that
wrong is right and up is down, and 2 plus 2 equals 5, and all
we have to do is change the definition and say it is so.
Illegal aliens are entitled to the same taxpayer-funded
health benefits as American citizens? That does not comprehend
with me. I will continue to fight to fix Biden's border crisis
and to fight against the Administration's policies that reward
those who violate the law because I believe in the rule of law.
And make law-abiding citizens pay for it, it does not make
sense.
In closing, I want to thank our witness once again for your
important testimony.
And without objection, the Members will have 5 legislative
days to submit materials and to submit additional written
questions for the witnesses, which will be forwarded to the
witnesses for their response.
Mrs. McClain. If there is no further business, without
objection, the Subcommittee stands adjourned.
[all]