Undocumented immigrants given temporary legal status under a new immigration bill would be denied access to Medicaid and other subsidized insurance offered under the federal health-reform law.

That would mean thousands of immigrants, while  waiting for up to 10 years to be fully legalized, would likely continue turning to Oklahoma hospitals, clinics and other providers for free or reduced-cost care, health and advocacy-group officials said. Immigrants also would tend to delay or forego treatment because they can’t afford it, officials said.

Immigrants given legal status under the bill would gain one new health option: They could legally get a job that offers health insurance. But according to studies, many immigrants work for small employers who don’t offer affordable coverage and won’t be required to do so under the Patient Protection and Affordable Care Act.

In Oklahoma, those immigrants would face the same situation as many other low-income people. An estimated 130,000 to 170,000 Oklahomans will remain ineligible for Medicaid next year because of Gov. Mary Fallin’s decision to reject federal money to expand the program. They and any immigrants given temporary legal status also could not use tax credits to buy subsidized coverage on a new federal health exchange, where people can shop for plans online.

There are about 75,000 illegal immigrants in Oklahoma and 11 million nationwide, according to the Pew Hispanic Center.

Patti Davis, executive vice president of the Oklahoma Hospital Association, said the group was studying the possible impact of the immigration bill. She did not have a specific figure for the cost of uncompensated care for illegal immigrants, but said hospitals provide a total of more than $500 million a year in uncompensated care. Those costs lead to higher costs for other patients.

“Federal law requires hospitals to provide emergency treatment and stabilization,” Davis said. “The bottom line is we all as citizens pay for uncompensated care.”

The immigration bill, unveiled this week by a bipartisan group of senators, would grant “resident provisional immigrant status” to those who entered the country illegally before Dec. 31, 2011. Most would be granted the status for six years if they pay a $500 penalty, have no felonies or more than three misdemeanors, and meet other criteria. They would be eligible to work legally and travel in and out of the country. Immigrants would need to fulfill other requirements to gain full legal status after 10 years. An exception is so-called “dreamer” applicants, who were brought to the U.S. illegally as children. They could become permanent residents after five years.

The legislation, which also sets strict criteria for securing the border, is expected to generate intense debate in Congress and undergo changes if it passes.

The denial of health coverage to immigrants affected by the bill was not unexpected, as  giving them benefits would intensify opposition. The immigrants also won’t be eligible for federal welfare programs for families and children.

The denial, however, underscores further how tens of thousands of Oklahomans may have little or no access to health coverage after the Affordable Care Act more fully takes effect on Jan. 1.

National Immigration Law Center health-policy analyst Jenny Rejeske said the immigration-bill exclusion defeats the purpose of health-care reform because the goal was to get as many people as possible paying into the insurance system. This allows everyone to purchase insurance at lower rates and keeps everyone covered and healthier, she said.

“(The exclusion) absolutely makes no sense from a health care and economic perspective,” said Rejeske. “This piece is definitely a disappointment.”

When illegal immigrants need health care, they often turn to community clinics and emergency rooms. Many seek care at the last minute due to inability to pay or fear of deportation, said Monica Palmer, director of clinical services at Catholic Charities in Oklahoma City.

The only state-sponsored treatment option for the undocumented is a program for expectant mothers, offered through SoonerCare, Oklahoma’s Medicaid program.

Claudia Barajas, of the Latino Community Development Agency in Oklahoma City, said the lack of options, as well as limited services at clinics and long wait times at hospitals, leaves undocumented families struggling with chronic illnesses such as heart disease and diabetes.

She views the immigration bill as good news. With provisional status, immigrants can work for almost any employer and buy into a health plan if it’s offered and the worker can afford the cost. In 2014, health care reform will require employers with more than 50 full-time workers — those averaging 30 or more hours per week — to offer health insurance.

“It will be easier for (immigrants) to get a job and apply for health insurance,” Barajas said. “It’s still good. We are increasing job opportunities for people. We are also giving them an opportunity to get an education.”

Historically, however, non-citizens, including legalized and illegal immigrants, are more likely to work at small businesses that don’t offer health insurance, according to a 2013 report by The Henry J. Kaiser Family Foundation, a research group.

“You want everyone to have health insurance and be healthy,” Rejeske said. Referring to the immigration bill, she added, “It isn’t enough for everybody.”

Note: Chase Cook is reporting on illegal immigrants and health care as part of an “Immigration in the Heartland” fellowship sponsored by the Institute for Justice and Journalism.

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