Fox News contributor Laura Ingraham continues to make outlandish allegations about how the Affordable Care Act (ACA) applies to immigrants, including falsely claiming that the law allows undocumented immigrants to purchase subsidized health insurance and that their enrollment in the individual Marketplace will be used to inflate the overall numbers of those who sign up.
MYTH: Undocumented Immigrants Are Eligible For Subsidized Health Insurance Under ACA
Contrary to what Ingraham has been saying on her radio show, undocumented immigrants are not eligible to apply for subsidized health insurance under the ACA. On the October 3 broadcast of her show, Ingraham advanced that falsehood, asking, “First of all, how many of you think that illegal immigrants aren't signing up on these Obamacare exchanges?” She added: “I mean, they're probably the only ones getting through to sign up on the exchanges.”
Ingraham was referring to the difficulty those seeking insurance have had in accessing the federal health care website.
In reality, as the National Immigration Law Center has noted, undocumented immigrants cannot get subsidized health care coverage under the ACA and are not even allowed to purchase private insurance through the individual health insurance Marketplace at full cost. They are also not eligible for subsidized health care or Medicare, nonemergency Medicaid, or the Children's Health Insurance Program (CHIP).
As the federal health care website explains:
Undocumented immigrants aren't eligible for federal public benefits through the Affordable Care Act. For example, undocumented immigrants can't buy coverage through the Marketplace. Premium tax credits aren't available for undocumented immigrants.
Undocumented immigrants may continue to buy coverage on their own outside the Marketplace and can get limited services for an emergency medical condition through Medicaid, if they are otherwise eligible for Medicaid in the state. Undocumented immigrants aren't subject to the individual shared responsibility requirement.
Immigrants who have been granted deferred action through the Obama administration's Deferred Action for Childhood Arrivals (DACA) program are also ineligible for Medicaid, CHIP or ACA benefits.
While undocumented immigrants are barred from applying for subsidized health care, their American children do qualify.
Naturalized citizens, permanent residents, and legal immigrants who have lived in the country for more than five years and don't have health care coverage through their jobs are also able to apply for subsidized health care and other benefit programs under the ACA.
Legal immigrants who have been in the country less than five years whose incomes fall below 400 percent of the federal poverty level -- about $46,000 for an individual and $94,000 for a family of four -- will be eligible for subsidized coverage in the health insurance exchange. Those with incomes below 138 percent of the federal poverty level -- about $15,800 for an individual and $33,000 for a family of four -- will not be eligible for Medicaid coverage (except for pregnant women depending on the state) but can qualify for exchange subsidies if they pay 2 percent of income.
Other immigrants, including refugees, asylum seekers, and those lawfully present under humanitarian measures, also qualify for coverage regardless of how long they have been in the country.
MYTH: “There's A Special Portal Just For” Undocumented Immigrants To Sign Up For Insurance
Discussing her assertion that undocumented immigrants are “probably the only ones getting through to sign up on the exchanges,” Ingraham suggested that there is a “special widget” for a cell phone and a “special portal just for them” to sign up for insurance. She went on to dismiss the fact that undocumented immigrants are ineligible for health care coverage through the ACA:
INGRAHAM: Maybe there's a special widget you have to have on your phone. If you're an illegal immigrant, you can actually go through that portal. Maybe there's a special portal just for them to sign up for Obamacare. I wouldn't be surprised. I mean, the idea that they're going to be denied coverage under Obama - oh, come on. We weren't born yesterday.
According to the federal health care website Healthcare.gov, there are several ways to apply for health insurance on the exchanges and none involve a mobile app:
- by filling out and mailing a paper application
- online through the federal or state websites or through an online commercial broker
- by phone with a customer service representative
- in person with a trained and certified assister or navigator, or at community health centers and hospitals
To date, the only way to apply for insurance by phone is by calling the 1-800 number provided at healthcare.gov. While there are a number of medical mobile apps on the market, none are yet designed to sell insurance.
U.S. News & World Report reported in September that insurance start-up company Oscar “has hired tech professionals from Microsoft, Tumblr, and the gaming company Vostu Ltd. to deliver a user-friendly experience when buying insurance. The company will sell plans on the New York exchange in 2014.”
According to Government Technology, “most users won't be able to shop or apply for plans entirely from their smartphones until late 2014 or 2015.”
MYTH: Administration Wants " As Many Of The Illegal Immigrants As Possible To Sign Up For Obamacare" To Boost Enrollment Numbers
Discussing the congressional testimony of Health and Human Services Secretary Kathleen Sebelius, who faced questions on October 30 from lawmakers about the problems associated with the health care rollout, Ingraham said on her radio show:
INGRAHAM: They don't have any luxury of saying we'll tell you [how many people have signed up for insurance] at the end of November. You know what, I was thinking about that. She wants to put it off until the end of November because they're gonna try to get as many of the illegal immigrants as possible to sign up for Obamacare, because you can't really check all that well on the Obamacare exchange website about immigration status. They'll do anything they can to put off actually having to reveal the pathetic number of people who've signed up.
The bizarre claim that the administration will encourage undocumented immigrants to sign up for the health exchanges to inflate enrollment numbers is not new. A similar falsehood emerged in right-wing media circles in August when Sebelius explained at an event that under the Senate-passed immigration bill, newly legalized immigrants would not be able to apply for subsidies to purchase health insurance or have access to the health care exchanges and the expanded Medicaid program. Sebelius went on to say that this “is, frankly, why -- another very keen reason why we need comprehensive immigration reform.”
Conservative media used her remarks to claim that the reason Sebelius called for passing comprehensive immigration reform was “to boost Obamacare enrollment.”
While administration officials have said that an official enrollment number will not be available until mid-November, “nearly 700,000 applications have been submitted to the federal and state marketplaces” as of the end of October, according to Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services.
The Advisory Board Company, which tallies early enrollment data from the 15 state-based exchanges, has reported that through data compiled October 30, at least 150,000 people have successfully picked or have enrolled in a plan. More than 389,000 people have applied for coverage.
The Wall Street Journal further reported on October 27 that states have signed up tens of thousands of new Medicaid enrollees. In California, 600,000 people were reportedly enrolled in Medi-Cal, the state's Medicaid program, as of the program's first day.
As Jonathan Cohn wrote in the New Republic, low initial enrollment for health insurance doesn't necessarily spell doom for the ACA:
The main reason for low enrollment will be that people don't sign up for health insurance programs right away. They wait until the last minute. This is true of public insurance and this is true of private insurance. And while you've heard people (including me) say this for months, this is one of those cases when numbers tell the story better than words. And there are some numbers very few people have seen.
The numbers are from Massachusetts, the state whose health reforms became the template for the Affordable Care Act's coverage expansion. The place to look is within what's known as the “Commonwealth Care” program, which is where people getting private insurance subsidies shopped for plans--in other words, an analogous structure to the new federally run exchanges.
Cohn included this graph from MIT professor Jonathan Gruber, which showed that only 0.3 percent of people had signed up for health insurance in Massachusetts after one month and just 6.3 percent after two.
The Boston Globe added: “Pushed by the threat of a penalty if they were uninsured, many more people -- healthy people, in particular -- shopped for insurance as the [January 2008] deadline approached. By December 2007, 171,847 were covered through the Connector.”
MYTH: HealthCare.Gov Can't Really Verify Immigration Status Of Applicants
Ingraham rationalized her claim that the administration will “try to get as many of the illegal immigrants as possible to sign up for Obamacare” by saying that it's “because you can't really check all that well on the Obamacare exchange website about immigration status.”
The healthcare.gov website is very clear that in “order to buy private health insurance through the Marketplace, you must be a U.S. citizen or be lawfully present in the United States.”
In fact, one of the first things you need in order to prove you are eligible for health insurance through the exchanges is a valid social security number:
The information provided is then checked through a “data services hub” to determine eligibility:
Federal and state Marketplaces and state Medicaid and CHIP agencies verify application information through a “data services hub.” The hub allows the Marketplace and Medicaid and CHIP to securely submit application information. The federal government sends information back to verify the data.
As Reuters explained, the hub “links the online health insurance marketplaces with numerous federal agencies and can verify people's identity, citizenship, and other facts.” Reuters further noted: “Without the hub, consumers are unable to apply online for coverage or determine their eligibility for federal subsidies to help pay for insurance premiums.”
MYTH: Undocumented Immigrants Will Be Able To “Game” Health Care Marketplace With No Consequences
On October 28, The Weekly Standard highlighted a healthcare.gov information sheet about what immigrant families need to know about the health care marketplace, noting that “the site goes to great lengths to explain that Marketplaces, whether federal or state, are not permitted to ask for the immigration status of family members who are not applying for coverage or benefits.”
The Standard further noted that the site makes clear that "[s]tates can't deny benefits because the applicant doesn't provide the SSNs of people who aren't applicants for benefits or recipients of Medicaid or CHIP benefits, or those not required to provide SSNs."
On her radio show, Ingraham used that article to claim that this is proof undocumented household members of lawful immigrants will be able to gain coverage under their lawful relative's policy. She stated:
INGRAHAM: “The site goes to great lengths to explain that the Marketplaces, whether federal or state, are not permitted to ask for the immigration status of the family members who are not applying for coverage or benefits” -- meaning the family members are gonna be part of the umbrella policy.
You get a policy -- you got a legal brother who's here or an illegal wife, they're part of it. They get access under the federal exchange, which is what we told all of these Republicans, who said don't worry about it, it's gonna be great. It's gonna be great.
She played a clip of Sen. Marco Rubio (R-FL) stressing that under the Senate immigration bill, newly legalized immigrants would not have access to federal benefits or health care benefits, then stated: “Oh my god, poor Marco.”
Ingraham went on to argue that undocumented immigrants would be able to “game” the system and try to get coverage because even if the application process reveals an immigration violation, “no action will be taken relative to immigration laws.” She added that this “is creating perverse incentives for wrongdoing and it doesn't surprise me one bit.”
What Ingraham failed to grasp however is that anyone who applies for coverage, whether through an individual or family plan, will be subject to verification. So in the scenario she outlined above, the undocumented wife would have to provide information about her immigration status for verification, which would automatically bar her from coverage.
Indeed, as the Marketplace makes clear, there's no reason for those who aren't applying for coverage or who won't be included under a family plan to provide their immigration information.
The more important takeaway from this, however, is that this practice, which Homeland Security noted is long-standing and “in line with ICE's [U.S. Immigration and Customs Enforcement] operational focus,” is a way to reach and allay the fears of the estimated 16 million people who live in mixed-status families. This demographic is historically under-insured and studies have shown that these immigrants are hesitant to apply for health benefits they qualify for out of fear of adverse immigration consequences.