Biden Administration Finalizes Rule to Allow ‘Dreamers’ to Enroll in ’Obamacare’

U.S. President Joe Biden talks about protecting the Affordable Care Act (ACA) as he speaks to reporters with Vice President Kamala Harris at this side about their "plan to expand affordable health care" during an appearance in Wilmington, Del., Nov. 10, 2020. Jonathan Ernst/Reuters/File Photo

The Biden administration announced on May 3 that it had finalized a directive to expand the Affordable Care Act (ACA), also known as “Obamacare,” to thousands of illegal immigrants who were brought to the United States as children.

The Centers for Medicare and Medicaid Services estimates that “this rule could lead to 100,000 previously uninsured DACA [Deferred Action for Childhood Arrivals] recipients enrolling in health care through Marketplaces or a BHP [Basic Health Program],” the Department of Health and Human Services (HHS) said in a statement.

The move took longer than promised and fell short of President Joe Biden’s initial proposal to allow those illegal immigrants access to Medicaid, which provides free or low-cost health care coverage to the nation’s lowest-income people.

But it will allow thousands of illegal immigrants, known as “Dreamers,” to access tax breaks when they sign up for coverage after the Affordable Care Act’s marketplace enrollment opens on Nov. 1, just days before the presidential election.

“Today, my Administration is expanding affordable, quality health care coverage to Deferred Action for Childhood Arrivals (DACA) recipients,” President Biden said in a statement on May 3. “Dreamers are our loved ones, our nurses, teachers, and small business owners. And they deserve the promise of health care just like all of us.”

The measure could boost President Biden’s appeal among Hispanic voters, a crucial voting bloc that he needs to turn out at the polls.

“I’m proud of the contributions of Dreamers to our country and committed to providing Dreamers the support they need to succeed,” President Biden said. “That’s why I’ve previously directed the Department of Homeland Security to take all appropriate actions to ‘preserve and fortify’ DACA. And that’s why today we are taking this historic step to ensure that DACA recipients have the same access to health care through the Affordable Care Act as their neighbors.”

The move drew criticism from former President Donald Trump’s presidential campaign spokeswoman Karoline Leavitt on May 3.

“Joe Biden continues to force hardworking, taxpaying, struggling Americans to pay for the housing, welfare, and now the healthcare of illegal immigrants,” Ms. Leavitt said in a statement on X. “This is unfair and unsustainable, and Joe Biden’s handouts for illegal immigrants are especially devastating to Black Americans, Hispanic Americans, and union workers who are forced to watch their jobs and public resources stolen by people who illegally entered our country.

“President Trump will put America and the American worker first. He will seal the border, stop the invasion, and expand economic opportunity for American citizens, not illegal aliens.”

Any participant in the Obama-era DACA program will be eligible to access health care through the government marketplace.

HHS Secretary Xavier Becerra said that many of those illegal immigrants have delayed getting care because they lack coverage.

“They incur higher costs and debts when they do finally receive care,” Mr. Becerra told reporters on a call. “Making Dreamers eligible to enroll in coverage will improve their health and well-being and strengthen the health and well-being of our nation and our economy.”

New Definition for ‘Lawfully Present’

The Biden administration modified the definition of “lawfully present,” which is used to determine eligibility for coverage so that DACA participants can legally enroll on the marketplace exchange.

“These changes aim to ensure complete, accurate, and consistent eligibility determinations and verification processes for health coverage for these populations,” HHS wrote.

The DACA initiative was launched by then-President Barack Obama to protect from deportation those who were brought to the United States illegally by their parents as children. The program allowed them to work legally in the country.

However, the “Dreamers” were still ineligible for government-subsidized health insurance programs because they did not meet the definition of having a “lawful presence” in the United States.

Senior officials told reporters that the administration chose not to expand Medicaid eligibility for Dreamers after receiving 20,000 comments on the proposal during the public comment period. They declined to explain why it took so long to finalize the rule, which was proposed in April 2023. The delay kept the illegal immigrants from enrolling for coverage this year.

At one point, as many as 800,000 illegal immigrants were enrolled in DACA, though now that figure is roughly 580,000. Officials predict that only about 100,000 will actually sign up because some may get coverage through their workplaces or other ways, and others may not be able to afford coverage through the marketplace.

Other classes of immigrants, including asylum seekers and people with temporary protected status, are already eligible to purchase insurance through the ACA marketplaces.

Last year, President Biden also unveiled a regulation aimed at fending off legal challenges to DACA; President Trump moved to end the policy, and it has bounced back and forth in federal court. Last fall, a federal judge said the current version can continue at least temporarily.

“President Biden and I will continue to do everything in our power to protect DACA, but it is only a temporary solution,” Vice President Kamala Harris said in a statement. “Congress must act to ensure Dreamers have the permanent protections they deserve.”