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Trump rule on health insurance leaves immigrants, companies scrambling for answers


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Trump rule on health insurance leaves immigrants, companies scrambling for answers

By Kristina Cooke, Mica Rosenberg

 

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FILE PHOTO: Hospital beds in the emergency room of a Louisiana hospital. REUTERS/Lee Celano/Files

 

LOS ANGELES/NEW YORK (Reuters) - Nearly a decade after receiving U.S. citizenship, Guatemalan-born Mayra Lopez thought she had cleared all the hurdles for her parents to join her in the United States.

 

Then on Oct. 4 U.S. President Donald Trump changed the rules she and others had been complying with: Trump signed a proclamation requiring all prospective immigrants to prove they will have U.S. health insurance within 30 days of their arrival or enough money to pay for “reasonably foreseeable medical costs.”

 

The new requirement, part of Republican Trump’s hard-line policies on immigration, goes into effect on Nov. 3 and prospective immigrants are scrambling to figure out how to get the necessary coverage, navigating a complex healthcare bureaucracy that has, for the most part, not previously catered to those who are not yet in the country.

 

The administration gave scant detail about how the new requirements would be implemented beyond a bullet-point list of the types of insurance plans that would be accepted.

 

A State Department notice on Oct. 29 said consular officers will verbally ask immigrant visa applicants to identify a specific health insurance plan, the date coverage will begin, and “other information related to the insurance plan as the consular officer deems necessary,” but gave the public only two days to comment on that plan instead of the usual several months.

 

Lopez, 40, who works as a family assistant in California, and many others are finding few options exist for them.

 

Lopez received a letter for her parents’ appointment to be interviewed on Nov. 25 at the U.S. embassy in Guatemala. Near the top it read: “inability to meet this requirement will result in the denial of the visa application,” according to the letter seen by Reuters.

 

She immediately called her own insurer, Kaiser Permanente, but she said she was told her parents, both in their 60s with no serious health problems, would not be eligible because they did not have U.S. social security numbers and even if they did, it would cost more than $1,600 a month to cover both of them, according to interviews with Lopez and her attorney.

 

Lopez then called five other insurers and began to panic when they all told her variations on the same thing, she said.

 

Tony Barrueta, a Senior Vice President at Kaiser Permanente, said in a statement that a social security number is not required to apply for Kaiser Permanente coverage, but the company may request that information.

 

Barrueta said the company acknowledges the complexity of the proclamation and other recent actions “and the confusion they may have created for many immigrants and their families.” He said they were continuing to educate their front-line staff on how to address questions.

 

California’s health insurance marketplace, Covered California, said “consumers must be lawfully present in order to apply for coverage.”

 

Many prospective immigrants seeking to enter the country legally, including those who do not have lawyers, may not be aware of the new requirements and could end up being denied, immigration advocates said.

 

When asked about the concerns, a State Department official repeated the guidelines in the proclamation, which are posted on the department’s website.

 

The White House did not respond to a request for comment.

 

COVERAGE GAPS

 

Long term-plans on the state insurance marketplaces are not available to immigrants before they are in the country lawfully, according to the eligibility requirements outlined in the Affordable Care Act (ACA), Democratic President Barack Obama’s signature health care legislation.

 

The proclamation does not accept subsidized health plans, meaning immigrant applicants would be barred from using income-based subsidies for the purchase of individual coverage, a main tenet of the ACA.

 

Short-term insurance plans are banned in four states and 20 others limit their duration to less than 364 days, the amount of time required by the proclamation, according to the Commonwealth Fund, a nonprofit research group.

 

Even where they are available, short-term plans often have large gaps in coverage and can have exclusions for pre-existing conditions, said Pennsylvania Insurance Commissioner Jessica Altman.

 

Trump has tested the boundaries of established policy, aiming to fulfill his 2016 campaign pledge to curb both legal and illegal immigration, including a yet to be constructed wall along the U.S.-Mexico border. Immigration rights lawyers and civil liberties groups have challenged his policies in court, sometimes with success.

 

“This order overrides about 100 years of law that has always promoted the ability to live with your immediate family members and targets people in a way that Congress didn’t intend,” said Jesse Bless from the American Immigration Lawyers Association.

 

“Congress has made rules that has allowed people to come in based on self sufficiency not wealth or health.”

 

On Wednesday, seven U.S. citizens petitioning for their family members and immigrant advocacy groups filed a lawsuit in Oregon seeking to halt the proclamation.

 

 

The proclamation appears squarely focused at limiting family-based migration, which the President has repeatedly derided as “chain migration,” said Xiao Wang, co-founder of the immigration firm Boundless.

 

The administration issued a rule earlier this year that would limit legal immigration by expanding who could be found to be a “public charge” and barred from residency. The measure has been temporarily halted by federal courts.

 

FAMILY REUNIFICATION DELAYS

 

Some immigration lawyers are telling their clients to consider rescheduling their visa interviews until there is more clarity about how the new health insurance rules would be implemented – potentially delaying family reunification.

 

Some other wealthy countries, such as Germany, require people applying for visas and residency to provide proof of health insurance. But those countries do not have the same healthcare costs and insurance system as the United States.

 

The Trump proclamation said it aims to stop healthcare providers and taxpayers from bearing “substantial costs in paying for medical expenses incurred by people who lack health insurance or the ability to pay for their healthcare.” It cited data that “lawful immigrants are about three times more likely than United States citizens to lack health insurance.”

 

Healthcare policy experts say immigrants use the U.S. system less often than Americans. According to an analysis by Leighton Ku, Director of the Center for Health Policy Research at George Washington University, recent immigrants without insurance accounted for less than one-tenth of 1% of U.S. medical expenditures in 2017.

 

Sometimes having short-term plans that provide only limited coverage can be as costly to the healthcare system as not having insurance at all, Pennsylvania’s Altman said.

 

The Trump administration has expanded short-term health plans and made them renewable, which experts say undermines the ACA.

 

Rajeev Shrivastava, the chief executive of VisitorsCoverage, which sells travel insurance policies to U.S. visitors and immigrants, said online search traffic for immigrant plans on his website increased by 150% after the proclamation.

 

He said the new policy “creates an opportunity” for insurance companies to develop plans for incoming immigrants, though some are waiting for more clarity from the government.

 

For U.S. citizens married to immigrants who have been living in the country without legal status there are additional considerations. Jorge, 45, has been in the United States for almost 20 years and is married to a U.S. citizen. He has been granted a so-called unlawful presence waiver that would allow him to leave and apply to become a legal resident without facing a multi-year bar.

 

His visa interview in Colombia is scheduled for later this year. At least 10 insurers have told him he cannot apply unless he can prove he is in the country legally, Jorge said. He also does not qualify for travel insurance, he said, because he is currently in the United States.

 

 

“This has been very stressful,” said Jorge, who spoke to Reuters on the condition that his last name not be used.

 

One option available to him, a short-term health insurance plan that offers limited coverage, is only available for six months in Illinois and the proclamation requires coverage for 364 days. He bought it anyway.

 

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-- © Copyright Reuters 2019-11-01
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I do not like Donald Trump.  But, I understand why this law is being implemented.  Health care in the United States is a disaster. It is expensive.  And, many US citizens cannot afford to purchase it.  Until we can find a way to pay for our own citizens to receive affordable medical care and insurance, we can't be expected to pay for immigrants and non citizens health care.   When persons become citizens and turn 65, they can apply for medicare.   Legal residents can apply for lower cost subsidized health care when they live in the US.  It is expensive to use medical services in the US.  Even US citizens who are expats need to have some sort of health insurance when they visit the US in case they have an accident or emergency need.  The US is not alone.  Other countries including Thailand require health insurance for long term visa holders...ie: Thailand.  And, I have heard this program will expand to include shorter term visa holders and tourists.  Other countries require health insurance to visit.  I understand the burden placed on any government and community by high health care costs.  The US should have rules in place and guidelines before implementing this policy but, they of course did not. Thailand discussed it and postponed it until they had a plan. The only suggestion I have it to get short term travel insurance (180 days,) until they can qualify for some other insurance help.  Just my thoughts. 

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The US needs a better healthcare system that's for sure. It's amazing that parents in their 60s are being brought the US legally. I can see letting them visit for a couple months a year but moving and staying is a bit ridiculous if they aren't extremely wealthy. Those who have immigrated to the US are the ones who need to think about their own choices and why they or their families have problems.  This immigration issue is one of the few which will swing votes to Trump.

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9 minutes ago, TooBigToFit said:

The US needs a better healthcare system that's for sure. It's amazing that parents in their 60s are being brought the US legally. I can see letting them visit for a couple months a year but moving and staying is a bit ridiculous if they aren't extremely wealthy. Those who have immigrated to the US are the ones who need to think about their own choices and why they or their families have problems.  This immigration issue is one of the few which will swing votes to Trump.

Erm.... Ivanka brought her parents in.

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Sadly, the administrations expectation is for immigrants to get something that many US citizens can't get.   

 

I have no problem with requiring people entering the US to have some type of medical coverage, but it's almost impossible to get.   

 

 

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55 minutes ago, steve187 said:

are you referring to Thailand with this statement, if so where have you heard it

 

It was well publicised earlier that Thailand was going to require all visitors to Thailand to have health insurance. The plan was put on hold this year because of a drop in tourist numbers and they said they didn't want to scare people away. Exactly how they intend to implement that remains unclear, perhaps a tourist levy at the point of entry, dunno.

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As a uninsured amarican for 40 years i can say the system is flawed.

In california there are more immigrants non english speaking than natives. Its bad it needs to stop. 

Trumps on to it. But its too late.

The entire usa medical world is beyond hope.

There needs to be a re set and i believe its not far away. Let the banks keep on doing things there way and we will all be living in reality. The usa is about to collapse. Trump is leading the way.

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21 hours ago, snoop1130 said:

Nearly a decade after receiving U.S. citizenship, Guatemalan-born Mayra Lopez thought she had cleared all the hurdles for her parents to join her in the United States.

 

Then on Oct. 4 U.S. President Donald Trump changed the rules she and others had been complying with: Trump signed a proclamation requiring all prospective immigrants to prove they will have U.S. health insurance within 30 days of their arrival or enough money to pay for “reasonably foreseeable medical costs.”

Seems reasonable that people that never contributed one cent to the US should prove they won't be using taxpayer money for their health care.

 

It's no different to the situation in Thailand where non citizens must pay or have insurance. I had travel insurance when I arrived, and bought local insurance when I was living there.

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usa medical care is a huge problem, extremely expensive to boot. though not perfect, canada seems to have a decent nationalized healthcare but canada does not maintain military bases/presence around the world, a huge expense.

 

dentists in usa have a great racket as they get paid largely in cash. they have little worries about fighting with insurance companies to get reasonably reimbursed. a root canal in usa about 1000usd, in vietnam 50-100 and in my experience equally as competent and professional.

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4 hours ago, wwest5829 said:
21 hours ago, Chomper Higgot said:

Erm.... Ivanka brought her parents in.

But then, she had married into money ...

 

true but non wealthy immigrants have been bringing their family members in for decades.

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1 hour ago, thaibeachlovers said:

Seems reasonable that people that never contributed one cent to the US should prove they won't be using taxpayer money for their health care.

 

It's no different to the situation in Thailand where non citizens must pay or have insurance. I had travel insurance when I arrived, and bought local insurance when I was living there.

It would be reasonable if the insurance companies would insure them.

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The United States is a backward country, why anyone would live there is a complete mystery. They can't even care for the basic stuff like healthcare for all. 

 

I find it ironic that the US claims to be the best country to live in the world, but the reality is far different. 

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14 minutes ago, the guest said:

 

I find it ironic that the US claims to be the best country to live in the world, but the reality is far different. 

How do you know? Do you live there?

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5 minutes ago, Sujo said:

I seem to recall that you dont.

I seem to recall that you, as usual, are wrong, from  March to August/September at least. Plus all the years beforehand. But what, you need to ad hominem for your buddy? Hows your view of the states by the way, do you live there? I dont care enough about you to recall details of anything you may have ever said before.

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1 minute ago, Nyezhov said:

I seem to recall that you, as usual, are wrong, from  March to August/September at least. Plus all the years beforehand. But what, you need to ad hominem for your buddy? Hows your view of the states by the way, do you live there? I dont care enough about you to recall details of anything you may have ever said before.

So you dont live there. Got it.

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7 minutes ago, Sujo said:

So you dont live there. Got it.

well duh dude its November. See the schedule? Do you want me to go back early? The accountant will be <deleted>, he doesnt want me around too much. 

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7 minutes ago, Thainesss said:

Those poor immigrants. How dare the government require that they wont be a burden on society and the taxpayer. How dare the administration require proof that they can sustain themselves. 

 

I dont think its so much that they are expected to get insured. Maybe that its so hard for them to get as they arent in US.

Plus trump did this with only giving insurance companies 2 days to give submissions instead of several months so they could arrange company policies.

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2 minutes ago, Sujo said:

I dont think its so much that they are expected to get insured. Maybe that its so hard for them to get as they arent in US.

Plus trump did this with only giving insurance companies 2 days to give submissions instead of several months so they could arrange company policies.

 

Huh?

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3 hours ago, atyclb said:

usa medical care is a huge problem, extremely expensive to boot. though not perfect, canada seems to have a decent nationalized healthcare but canada does not maintain military bases/presence around the world, a huge expense.

 

dentists in usa have a great racket as they get paid largely in cash. they have little worries about fighting with insurance companies to get reasonably reimbursed. a root canal in usa about 1000usd, in vietnam 50-100 and in my experience equally as competent and professional.

If Canada health care is so great, why do a high percentage of Canadians come to the States for medical care?

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The Stephen Miller / 45 agenda on immigration is rather obvious. They want to limit immigration in general. They want zero refugees. They are OK with a limited number of high skilled / wealthy mostly white people. No more bring me your tired and poor. It's an extremist far right wing white nationalist immigration agenda.

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22 minutes ago, Jingthing said:

The Stephen Miller / 45 agenda on immigration is rather obvious. They want to limit immigration in general. They want zero refugees. They are OK with a limited number of high skilled / wealthy mostly white people. No more bring me your tired and poor. It's an extremist far right wing white nationalist immigration agenda.

That is simply untrue.  In fact Trump has lobbied for increased numbers of immigrants from what have become under repesented countries such as those in eastern Europe.  Why not take in some of the suffering Ukranians and such.  Canada has had good success with this.

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