The Senate proposal requires Registered Provisional Immigrants (RPI’s) to wait 15 years before they can apply for federal health and anti-poverty programs such as Medicaid and SNAP (food stamps).  During these 15 years, these lawfully present immigrants will continue to contribute to our economy and help maintain the very programs that they are denied access to through their taxes.  The Senate proposal also excludes of RPI’s from affordable health care under Obamacare (Affordable Care Act).  After universal acknowledgement that the status quo in our health care system and expenditures is unworkable, we had a lengthy and contentious national debate on how to fix our broken health care system.  We are told that Obamacare works only if everyone – healthy or sick, young and old – pays their fair share for health care, which will reduce costs for all of us, but the Senate proposal carves out young and healthy immigrants from Obamacare, contrary to its stated goals.  How excluding certain individuals – who will be living and working in our communities for the long-term – from access to affordable care will help achieve a healthier, integrated workforce, a strong economy, and reduce the nation’s health care costs is a question we all should be asking.  Instead of talking about how we can’t afford to include immigrants in the ACA, Medicaid and SNAP, let’s talk about how we can’t afford not to.

In addition to public health, what are some of the key consequences from excluding aspiring citizens from affordable health care and social safety-net programs for 10-15 years that may impact the rest of the population?

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  • Patricia Middleton

    Sickness and disease (some resulting in deaths) will increase at an innumerable rate. All U.S. citizens and immigrants should have access to an affordable health plan including dental and medical preventive care.

    • Sonal Ambegaokar, J.D.

      Thank you Patricia. Like education, health care is an investment that has long lasting effect and can affect lots of different avenues of our lives. Healthy individuals can more easily learn and work and provide for themselves and their family. Healthy communities are safer and environmentally friendly with more green spaces and healthier food options for everyone. Healthier nations have stronger, more effective economies and can spend less on health care costs by keeping people healthy. In addition to preventing bad outcomes like disease and death, if everyone living in the U.S. could have access to quality, affordable care now, we can increase the likelihood of achieving more positive outcomes for everyone.

  • Stan Braverman

    Healthcare and Immigration is like mixing oil and water in that it is difficult to deal with. I had a conversation a few years back with the Deputy Minister for Health in Canada and all he deals with is healthcare for immigrants. Canada has strict health exam for immigrants and if it appears the immigrant will be a drain on the system they will deny permanent resident status. In the US healthcare costs are twice what they are in Canada and if we provide healthcare for massive number of immigrants who have significant healthcare costs it will only significantly add to the already excessive healthcare costs which we cannot afford. At the same time we need immigrants and if we do not provide adequate healthcare for them the country will end up paying the cost in the future. The answer is really very simple and that is we need to significantly bring down the cost of US healthcare. At the current time the country is spending close to 20% of the GDP on healthcare while every other developed country spends about 10% of their GDP on healthcare. The US is spending twice as much and not covering everyone. In money terms it turns out that excessive cost is 10% of the US GDP or about 1.4 trillion dollars. If we brought it to the level that other developed countries spend and at the same time effectively provide healthcare for everyone the US could afford to provide healthcare for all immigrants. But the US cannot afford to provide healthcare to immigrants given the excessive current costs of the US system. So once again the major problem in the US is not immigration but the poorly run healthcare system.

    • Guillermo Cantor

      You raise some very interesting points. While health care is costly, other countries have come up with more inclusive and efficient policy solutions to make health care more accessible to more people. And while there are fiscal considerations involved, those solutions are also based on broader conceptions regarding the value of health. In the current discussion regarding immigrants’ access to health care in the United States, however, fiscal worries tend to dominate the debate. This makes me wonder how much the American society actually values health. Are we missing the main point in this discussion? Isn’t it to everyone’s advantage to live in a healthier society? The benefits of prevention and the positive effects of health in a number of social outcomes–including national economic growth–have been very well documented for years. Shouldn’t we as a society try to come up with more creative solutions to provide the basis for a healthier community?

  • Dave Z

    The United States is currently spending more than we can afford on medicare and medicaid. In the very near future very difficult decisions will need to be made, decisions which will effectively deny healthcare to US Citizens. Sorry, but the money just isn’t there. The last thing we need is to add 10 million new people to the health rolls. The reality of the future is that health care will be available but only to those who can afford it. The time for the nanny state is over. Obamacare is also a mistake and likely one that will never get off the ground. If people want health care, let them pay for it themselves. Americans can barely afford paying for their own care, let along paying for others.

    • Sonal Ambegaokar, J.D.

      Despite the fact the US spends the most per capita on healthcare in the world ($8,233/per person) and that health care costs are 17.6% of our GDP, the US has some of the worst health outcomes in the world. For example, we rank #1 in likelihood a child will die before age 5 and the # of women who die due to complications of pregnancy and childbirth. (See These seem to be basic health outcomes that the richest country in the world should be doing better at it, especially if are throwing all this money into the health care system. Most policymakers, economists, and even patients know health care is expensive and unaffordable and will be unsustainable in the long-term if things remain the status quo. But one of the key reasons the costs of health care are so high in the US is that we have 46-50 million Americans who do not have insurance and have to wait til they get really sick before they seek care, usually in the ER. Obamacare is trying to help reduce the number of uninsured. But this is only step 1 of what needs to be done to fix the health care system, especially for communities of color who continue to face health disparities. Denying health care to immigrants because we currently spend too much on health care doesn’t help us now or in the long run because it doesn’t address the root causes of why our health care system is inefficient – that we wait to treat people only when they are very sick. And denying health care to immigrants doesn’t help control costs, prevent the cost-shifting that already happens from the uninsured to the insured, or forcing people to use the ER for conditions that could have been prevented altogether or treated for less money. Finally, if we know 11 million individuals are going to remain in the U.S., we need to give them an opportunity to pay into the system so that they can pay their fair share. We’re setting ourselves up for even more costs if we don’t allow immigrants to buy affordable health insurance – which helps reduce everyone’s health insurance costs. We know the status quo isn’t working for any of us so let’s try something that makes more common sense.

  • hess

    The most importent issue for imegrant is something to stay in country and support to build country health and benifit then they can get all benifit i understand they are here long time and giving country as much they can but not legal way so first make mother strong then look something from her thts all i said

    • Sonal Ambegaokar, J.D.

      Thank you hess. Immigrants who are here lawfully as well as those who are undocumented currently contribute to the U.S. in many positive ways. For example, the majority of immigrants work – often more than 1 job – and many do labor intensive work in agriculture, construction, or in food processing plants just as a few examples. In addition, immigrants do pay taxes through the payroll system as well as property or sales taxes. Finally, many immigrants are entrepreneurs and small business owners and thus create jobs for both citizens and other immigrants. America is the successful and vibrant nation it is because of immigrants – those in the past, present and in the future.

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  • Don Aldridge

    Do not deny them health care, just charge more for it. Say the immigrant has to pay twice as much until they become citizens.

    • Sonal Ambegaokar, J.D.

      Immigrants do want to pay their share for health care. Even though hospitals must provide ER care, uninsured patients, including immigrants, are sent a bill for those services. Immigrants are often not screened for Emergency Medicaid or financial assistance programs by the hospital and are unaware they can ask for help to reduce their bill based on their income. As a result, many immigrants have medical debt that they are attempting to pay because they want to do the right thing and not jeopardize their ability to stay in the U.S. However, due to the bloated health care costs of hospitals (see Newsweek article, Why Medical Bills Are Killing Us by Steven Brill:,9171,2136864,00.html#ixzz2LfCV2wC0) and charging uninsured patients more than insured patients, medical debt for the uninsured is one of the #1 reasons for personal bankruptcy. All of us should be fairly charged for health care services so that one group is not charged more than others for no reason. Immigrants should pay for their health care, but it should be a fair amount they can actually afford and not go into bankruptcy over, like all of us.

  • Sonal Ambegaokar, J.D.

    What are some examples of how we all would be better off if everyone, including immigrants, had access to affordable health care and/or affordable health insurance?