UPDATED: Important information for DOCUMENTED Immigrants re. the ACA

MAJOR UPDATE / MEA CULPA: 

Hey there, I called again and I was able to talk to a more knowledgeable agent who found out what the issue was and was able to enroll me in a plan!

Apparently, the Marketplace renewed automatically my application based on my 2016 income, which was enough to receive a tax credit in 2017, but is no longer enough to receive one in 2018.

Luckily, my income has increased since then, so I reported the change and was able to get a credit applied to the premiums

Still need to send copy of my green card for verification, but I can use the tax credit immediately

So I'm not sure why the person I talked to earlier today told me the rules had changed

Sorry for the confusion

OOF. OK, this pretty much torpedoes the entire basis of this blog entry. I'm going to leave it up in the interest of letting documented immigrants know that they ARE eligible to enroll AND for tax credits, but it sounds like the original concern may be unwarranted after all.

ORIGINAL POST FOLLOWS:

There's a lot of heated rhetoric about the 11 million or so undocumented immigrants in the United States, especially since Donald Trump hit the political scene...but there's less discussion of documented citizens, who fall into a whole bunch of different categories.

Under the Affordable Care Act, "lawfully present immigrants" are eligible to enroll in plans via HC.gov or one of the state exchanges as long as they fit one of the following categories:

The term “lawfully present” includes immigrants who have:

• “Qualified non-citizen” immigration status without a waiting period (see details below)
• Humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking)
• Valid non-immigrant visas
• Legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals) See a full list of immigration statuses eligible for Marketplace coverage.

Here's the full list of eligible immigration statuses:

• Lawful Permanent Resident (LPR/Green Card holder)
• Asylee
• Refugee
• Cuban/Haitian Entrant
• Paroled into the U.S.
• Conditional Entrant Granted before 1980
• Battered Spouse, Child and Parent
• Victim of Trafficking and his/her Spouse, Child, Sibling or Parent
• Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)
• Individual with Non-immigrant Status, includes worker visas (such as H1, H-2A, H-2B), student visas, U-visa, T-visa, and other visas, and citizens of Micronesia, the Marshall Islands, and Palau
• Temporary Protected Status (TPS)
• Deferred Enforced Departure (DED)
• Deferred Action Status (Exception: Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for health insurance)
• Lawful Temporary Resident
• Administrative order staying removal issued by the Department of Homeland Security
• Member of a federally-recognized Indian tribe or American Indian Born in Canada
• Resident of American Samoa

In addition, the following Applicants are eligible as well:

• Temporary Protected Status with Employment Authorization
• Special Immigrant Juvenile Status
• Victim of Trafficking Visa
• Adjustment to LPR Status
• Asylum (see note below)
• Withholding of Deportation, or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT) (see note below)
• Applicants for asylum are eligible for Marketplace coverage only if they’ve been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days.

Finally, folks with these statuses are also eligible:

• Registry Applicants
• Order of Supervision
• Applicant for Cancellation of Removal or Suspension of Deportation
• Applicant for Legalization under Immigration Reform and Control Act (IRCA)
• Legalization under the LIFE Act

And yes, as long as they're "legally present", they're also eligible for APTC and/or CSR subsidies:

Lawfully present immigrants and Marketplace savings

If you’re a lawfully present immigrant, you can buy private health insurance on the Marketplace. You may be eligible for lower costs on monthly premiums and lower out-of-pocket costs based on your income.

• If your annual income is 400% of the federal poverty level or below: You may be eligible for premium tax credits and other savings on Marketplace insurance.
• If your annual household income is below 100% federal poverty level: If you’re not otherwise eligible for Medicaid you’ll be eligible for premium tax credits and other savings on Marketplace insurance, if you meet all other eligibility requirements.

I have no idea how many documented immigrants are enrolled in ACA exchange policies this year, although I was surprised to discover that there's around 43-44 million immigrants total in the United States; if you subtract the 11 million or so who are undocumented, that's still around 32 - 33 million documented immigrants, or roughly 10% of the entire population. Assuming their income demographics follow a similar breakdown to U.S. citizens, that suggests that perhaps 1 million or so of exchange enrollees nationally are "lawfully present" immigrants.

I received the following note from someone who wishes to remain anonymous:

ACA signup rules have changed if you're a legal immigrant. Now you can't get a tax credit or even SEE what your premium would cost after an estimate of your tax credit until your legal immigrant status is verified. I was asked to pay first month premium in full, but can't afford it. Also, I can't compare plans and choose one if I don't know what my out-of-pocket expenses would be. It's unethical to ask consumers to buy a product without them knowing what it would cost them. Not sure if you can help but wanted to let you know!

Part of this didn't right to me: Anyone can window shop by plugging in their details (including household income) into HealthCare.Gov/see-plans and they'll receive an estimate of what type of tax credits and/or CSR assistance they're eligible for, which plans are available and what the plans will cost after applying the subsidies. There's no way for a web browser to know whether the person running the search is a citizen or not (yet), so this made no sense.

After asking some more questions, the situation came into focus:

I was told I can't get my tax credit until my legal immigrant status is verified and in the meantime I should just go ahead and pick a plan and pay the first premium in full

This was after I called because I couldn't see the premiums reflecting any tax credits online...I just logged into my account and started my application for 2018

All of the premiums are too high for me if I had to pay in full...I've been covered since the ACA started and always received tax credits

When Obama was president, you still had to send in a copy of your green card to verify your legal status but in the meantime you would get an estimate of your tax credit and see what your actual out-of-pocket premiums would be before even choosing a plan and enrolling

Here's what they're referring to: Yes, you can bring up the window shopping tool, plug in your info and get an estimate of your tax credits and final cost, but that's not the same as doing so as part of the application/enrollment process itself, which is where the plan selection and tax credit amount are formally locked into your account. Apparently starting today, if you're not a U.S. citizen, you won't be able to see your actual tax credits or final cost until after you've enrolled, verified, and (apparently) paid your January premium in full.

Then the tax credit would kick in during the first month of enrollment...They never asked you to pay the full premium.

You had to send a copy of your green card every year...If they didn't find you eligible, I think you would lose your coverage, perhaps pay back the tax credit received or a fine, but I'm not sure because it didn't apply to me

All I know is you had time until February to send a copy of your green card and I always got my insurance and first tax credit in January

The person on the phone specifically told me that this year the rules are different

OK. I have mixed feelings about this.

During the first Open Enrollment Period, HC.gov and the CMS back end system did a pretty poor job of verifying people's legal status before letting them enroll in an ACA exchange plan; over the summer of 2014, it was reported that they hadn't yet verified the status of hundreds of thousands of exchange enrollees. By that fall, they had hacked the number of people with issues down to 115,000. Eventually 112,000 of those folks were kicked off their policies (and presumably had to pay back any tax credits they had received), although 4,500 were allowed back onto their policies shortly thereafter. Note, however, that this didn't happen until September 2014...which was anywhere from 5-9 months after their policies had gone into effect.

In 2015, things improved substantially: Only 226,000 unverified enrollees wound up enrolling in the first place, and their policies were cancelled as of March (just 1-2 months into the calendar year).

I haven't really kept up with this issue much the past two years, but they've definitely gotten better about weeding out enrollees who can't prove their legal status. In both 2016 and 2017, HC.gov had streamlined/improved their process to the point that they were "purging" unverified exchange enrollees from the tally in the middle of the enrollment period itself.

So far, I have no problem with this; I'm perfectly fine with the system being streamlined and improved to weed out undocumented immigrants (clarification: personally, I'd be OK allowing undocumented immigrants to enroll as well, as long as they actually pay their premiums and so forth, but I do understand that they aren't allowed to do so under the law today, so I'm OK with taking steps to ensure they don't).

HOWEVER, this takes it too far in the opposite direction. For one thing, this means that legally present immigrant enrollees will be flying blind: They're being required to enroll in a policy without knowing what their true/final price is actually going to be. That's a big leap of faith, especially given the openly-hostile attitude of the administration in the first place.

If they upload all their documentation (green card, etc) in a timely fashion and it's all squared away before January 1st, fair enough...but what if it takes CMS longer to get around to doing so? What if they have to pay not just January, but February or March's premiums at full price before their verification is processed and they receive their tax credits?

Remember, most exchange enrollees earn less than 250% of the poverty line; there's a reason they need the tax credits on a monthly basis as opposed to waiting until tax time the following year. They probably wouldn't need the tax credits in the first place if they could afford to pay full price month to month.

Anyway, assuming this person has presented the situation accurately, it's yet another barrier being thrown in front of people legally attempting to enroll for heatlth insurance this year.