The Biden administration on Friday finalized a rule that would expand healthcare coverage for immigrants who came to the US as children and are shielded from deportation under the Deferred Action for Childhood Arrivals program, known as Daca.
Under the new rule, recipients of the Obama-era Daca program would be newly eligible to access healthcare coverage through the Affordable Care Act marketplaces for the first time.
In a statement, Biden hailed the rule as a “historic step” but acknowledged that only Congress could provide Dreamers and their families the security of permanent status and a pathway to citizenship.
“Today, my administration is expanding affordable, quality healthcare coverage to Deferred Action for Childhood Arrivals (Daca) recipients,” the president said. “Dreamers are our loved ones, our nurses, teachers and small business owners. And they deserve the promise of healthcare just like all of us.”
The White House move comes amid a searing election-year debate over immigration, as Republicans, led by their presumptive presidential nominee, Donald Trump, attempt to blame a rise in border crossings on Biden and his administration’s polices.
Enrollees of the Daca program are authorized to study and work in the US, where they collectively pay an estimated $6.2bn in federal taxes every year. However, Daca enrollees were not eligible for government-subsidized health insurance programs because they were not by definition “lawfully present” in the US.
The rule modifies that definition to ensure Daca recipients are not excluded from individual healthcare marketplaces due to their immigration status.
Like the majority of Americans, most Daca recipients get health insurance through an employer. But about one-third of the 580,000 Daca recipients do not have access to insurance, and until now were ineligible for federal health programs. Recipients of Daca are about three times more likely than the general public to be uninsured.
The administration estimates that the new policy could cover as many as 100,000 previously uninsured Daca recipients. At a federal cost of about $5,000 a person, the program is expected to cost less than $1bn.
The rule change does not make Daca recipients eligible for Medicaid, a health insurance program for poor and disabled Americans that is jointly run by the states and federal government. Proposals to make Daca recipients eligible for Medicaid infuriated Republicans, even as many a left-leaning states have extended Medicaid to to immigrants or their children, including those living in the US without authorization. Medicaid is often states’ largest budget line item.
“Making Dreamers eligible to enroll in coverage will improve their health and wellbeing and strengthen the health and wellbeing of our nation and our economy,” the health and human services secretary, Xavier Becerra, told reporters, applauding so-called Dreamers as immigrants “who have worked hard to live the American dream”.
Uninsured people are more likely to skip preventive services, delay treatment when they are ill and to be saddled with medical debt. An estimated 22 million people in the US lacked health insurance in 2022 – an all-time low expected to climb as states boot people off Medicaid following the pandemic.
Daca recipients can apply for coverage through HealthCare.gov and state-based marketplaces in November, and some may be eligible for financial assistance. However, like many Americans, even Daca recipients with insurance will not be entirely shielded from healthcare’s exorbitant cost.
Federally regulated insurance marketplaces have among the highest cost-sharing in the industry. For people who are not low-income, insurers can force people on a family plan to kick in up to $18,900 a year. The exchanges were established through the ACA, a law better known as “Obamacare” that Biden helped push through Congress in 2010 as vice-president. During Trump’s presidency, Republicans tried and failed repeatedly to repeal the law, which has grown in popularity.
Daca was created in 2012 by then president Barack Obama, after more than a decade of failed attempts by Congress to pass an overhaul of the nation’s beleaguered immigration system. The White House action comes as the program, which has served roughly 800,000 immigrants since its creation, is in legal peril with its fate ultimately expected to be decided by the supreme court.
A bipartisan border bill, backed by Biden and other top Democrats, did not include a pathway to citizenship for the hundreds of millions of Daca recipients, known as Dreamers. The legislation was derailed by Trump shortly after it was unveiled in the Senate earlier this year.
But the lack of a provision providing a pathway to citizenship for Dreamers, a broadly popular policy proposal that was once a top priority for Democratic lawmakers, was a major setback for immigrant rights advocates.
“Congress must act to ensure that Dreamers can remain here permanently, so that they can fully contribute to our communities and our country,” Neera Tanden, the White House domestic policy adviser, told reporters. “Dreamers are part of the American fabric. They’re our friends, neighbors and coworkers and we must do right by that, not just for them but for the country.”
