The Affordable Care Act was designed to help connect all Americans with health care coverage, yet there is one group of citizens and immigrants, mainly children, who may be left behind if changes are not made to the regulations. Children who are citizens or lawfully present immigrants but who have family members who are not (aka “mixed-status families”) face unnecessary barriers to obtaining coverage through the Exchanges. A parent without legal status, but whose spouse and children have a right to obtain coverage through the Exchanges, may be deterred from applying for coverage if they are not guaranteed that their right to privacy will be adequately protected. Mixed status families are often fearful that personal information submitted to a government entity could result in the family being forcefully separated.
It would be in the best interest of our nation and America’s families if all children were able to access the health care they needed at an affordable price but we have a long road ahead of us in order to achieve that goal. In the meantime, I would like to outline some immediate and important changes to the “Exchange I” rules that would make the future much brighter for many children in America.
In order to make the Exchanges more welcoming to all families, the “Exchange I Rules” should:
- Specifically embrace and emphasize the Affordable Care Act’s confidentiality and nondiscrimination protections;
- Strictly limit the ability of Exchanges to collect, use, disclose, and retain personal information; and
- Emphasize that any Exchange policy or practice that serves to discourage the participation of eligible members of mixed-status families may constitute a violation of civil and privacy rights.
- Ensure that rules governing points of contact with mixed-status families emphasize outreach and communications that are “culturally-competent” and specifically targeted to help them choose the appropriate coverage for children and other eligible family members.
Without this support in the regulations, U.S. citizens and eligible immigrants, many of them children, will be unable to get the health care coverage they were promised through the Affordable Care Act. While these changes are small, they would have a dramatic impact on children.
As a consultant to CCF, I am working on comments on the Exchange I rules that will articulate the need for these changes and others. I would love to hear your thoughts on how you think the regulations can help ensure that the Exchanges are welcoming to all children and families in your state.
My next blog will look at how the ACA-enacted Small Business Health Options Program (SHOP) has great potential for linking uninsured immigrants to coverage but also has potential pitfalls when merged with the Exchanges.
Editor’s Note: Dinah Wiley is an attorney and a consultant in law, policy and program development. She has special expertise in immigration law and policy and the health care and income security safety net. If you are interested in submitting comments to the Exchange I proposed regulations specifically regarding the impact on immigrants, please contact Dinah via childhealth@georgetown.edu.
