When Camila Bortolleto was 9, her parents brought her from Brazil to the U.S.
Bortolleto’s parents are undocumented, but in 2013 she was approved for the Deferred Action for Childhood Arrivals program, which allowed her to get a job and, with it, employment-based health insurance.
-fuBortolleto, now 36 and living in Connecticut, quit her job at a nonprofit in June, which meant she lost her health insurance and had no other options:ACA D recipients are excluded from governmentnded health insurance.
That changed Friday, when tens of thousands of DACA recipients were able to sign up for health insurance under the Affordable Care Act for the first time.
The change — which coincided with the first day of the ACA’s open enrollment period — marks a pivotal moment for the more than 535,000 active DACA recipients in the U.S. That lack of access, experts say, has led to high rates of uninsurance among DACA recipients, sometimes referred to as “Dreamers.”
In May, the Biden administration finalized a rule that allows DACA recipients to apply for coverage through HealthCare.gov, as well as state-based marketplaces, starting Nov. 1. It also gives them access to subsidies that reduce the cost of monthly premiums.
Bortolleto said she plans to apply as early as Friday.
A few weeks ago, she said she was bitten by a dog.
Although she was in severe pain, she said she initially avoided the emergency room because of the cost.
“I wasn’t going to go,” Bortolleto said. “But later that morning, it just hurt, not just the dog bite, but everything hurt.”
The visit ended up costing her a few hundred dollars.
“It gives me a sense of security that I can get health insurance while I’m still looking for my next job,” Bortolleto said.c
High uninsured rates
DACA was an executive order signed by then-President Barack Obama in June 2012 that protected undocumented immigrants who came to the U.S. as children from deportation and gave them work authorization.
For many, the ability to work also meant access to health insurance.
Without access to government-funded programs, insurance options are extremely limited for Dreamers who haven’t gotten coverage through their jobs, said Drishti Pillai, director of immigrant health policy at KFF, a nonprofit that researches health policy issues.
Some turn to state programs for undocumented immigrants, she said. Others may be uninsured and rely on community clinics that provide free or low-cost care.
While people can buy coverage directly through an insurer, the cost is often exorbitant and usually not an option for undocumented immigrants, Pillai said.
The limited options, she said, mean that many DACA recipients can’t get quality health insurance, resulting in high rates of uninsurance.
A study released last year by the immigrant rights nonprofit National Immigration Law Center found that about 1 in 4 DACA recipients reported being uninsured.
“Now they have access to the same health insurance as other people in the ACA,” Pillai said.
The change is expected to help more than 100,000 people get health insurance, according to a White House fact sheet.
However, DACA recipients still can’t get coverage through Medicaid or the Children’s Health Insurance Program, which offers free or low-cost insurance to children and teens, Pillai said.
Legal challenges
In August, Kansas and 18 other states filed a lawsuit to block the ACA rule. The lawsuit was filed in a federal district court in North Dakota and was assigned to a judge appointed by former President Donald Trump.
The lawsuit argues that expanding coverage to DACA recipients will create additional “resources” and harm for taxpayers. It also says it will encourage undocumented immigrants to stay in the U.S. in hopes of obtaining health insurance through the ACA.
Arthur Caplan, chief of the medical ethics department at NYU Langone Medical Center in New York City, described the lawsuit as “just more anti-immigration politics.”
“The lawsuit is annoying and in many ways counterproductive to the public interest,” he said. “It makes sense to give people health insurance because they’re here and they’re going to go to the ER when they get sick and you’re going to charge them higher prices.”
“It’s not like they’re not getting health care anywhere,” Caplan added. “They’re likely to get it in the emergency room, which is the most expensive place.”
In a statement, Kansas Attorney General Kris Kobach, who is leading the legal fight, said: “The Biden administration’s attempt to give Obamacare benefits to illegal aliens at taxpayer expense clearly violates two different laws. That’s why Kansas went to court, and that’s why we expect to win.”
Juliana Macedo do Nascimento, deputy director of federal advocacy at United We Dream, an immigrant advocacy group, said the outcome of the presidential election could also threaten whether coverage continues, noting that Trump has sought to eliminate the DACA program entirely.
Macedo do Nascimento, 38, of Maryland, is a DACA recipient herself and currently receives health insurance through her job. But when she was 22 and uninsured, she suffered a ruptured ovarian cyst that required emergency surgery.
The hospital bill for the procedure was about $30,000, she said. The bill was eventually sent to a collection agency, where it was reduced to $13,000, an amount that took Macedo do Nascimento five years to pay off.
“We know that many people who have DACA may not have the same access,” she said. “People who own their own businesses or work for small businesses that are exempt would not have had access to health care.”
‘This is my home’
Dania Sarahi Quezada, 27, a third-year law student at the University of Washington, plans to sign up for health insurance on Friday.
Quezada moved to the U.S. from Mexico when she was 5 and became a DACA recipient in 2012. She and other DACA recipients have asked the court to allow them to join the Kansas case, siding with the defense.
Quezada has been diagnosed with obsessive-compulsive disorder. She is a full-time law student and has no health insurance.
She gets by because her university offers one subsidized visit to the on-campus student clinic each quarter. She uses that one-time visit solely to get her OCD medication refilled, and pays for the prescription out of her own pocket.
“But if there is an urgent health care issue, I handle it myself as best I can,” Quezada said.
She said she is concerned about the lawsuit, but she will continue to seek health care even if Republican-led states are successful.
“This is my home, and I’m going to fight to live here,” she said.