Undocumented Immigrants

Washington State

One of the most inane restrictions of the ACA in my view, as I noted in my "If I Ran the Zoo" wish list back in 2017, is that it doesn't allow undocumented immigrants to enroll in ACA marketplace health plans ("Qualified Health Plans" or QHPs).

I don't just mean that they aren't eligible for federal financial subsidies--that's a prohibition which I can at least understand, even if I don't agree with it. I mean that they aren't allowed to enroll in ACA exchange-based QHPs even at full price, as noted in Section 1312(f)(3):

(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.

Last week I noted that of the 33 million people still uninsured in the United States, around 6.5 million of them can't be covered via Affordable Care Act provisions because they're undocumented immigrants, who aren't legally allowed to #GetCovered via either the ACA exchanges (private coverage) or Medicaid expansion (public coverage). Another 3.7 million legal residents/citizens, of course, are caught in the Medicaid Gap. I also brought up the undocumented immigrant factor in a piece yesterday trying to break out the other portions of that 33 million total.

Anyway, in the comments, "dawgitall" asked a reasonable question: If there's around 11 million undocumented immigrants in the U.S. total (everyone seems to agree on that estimate), and 6.5 million of them aren't insured at all, what's the deal with the remaining 4.5 million?