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Biden’s long-awaited plan to give health care to Dreamers, explained

Almost half of the immigrants eligible for DACA are uninsured. Biden is trying to fix that.

A person at an outdoor rally wearing a shirt that says “Dreamer” across the back.
People gather for a rally to celebrate the 10th anniversary of the Deferred Action for Childhood Arrivals (DACA) in Battery Park on June 15, 2022 in New York City. 
Michael M. Santiago/Getty Images
Nicole Narea covers politics and society for Vox. She first joined Vox in 2019, and her work has also appeared in Politico, Washington Monthly, and the New Republic.

The Biden administration is expanding health coverage under Medicaid and the Affordable Care Act to beneficiaries of the Deferred Action for Childhood Arrivals program (DACA), delivering a long-sought victory for immigrant advocates.

The new rule means the 600,000 immigrants with active DACA status will be able to apply for coverage through their state Medicaid agencies and through the federal health insurance marketplace, where they may qualify for financial assistance based on income. But that victory might be short-lived if the DACA program itself is overturned in court, where it is currently under threat. If DACA is overturned, that could leave hundreds of thousands of DACA beneficiaries, or so-called “DREAMers,” at sudden risk of deportation.

Since 2012, DACA has shielded 800,000 immigrants who came to the US as children without authorization from deportation and offered them work permits, but not access to government health benefits. That has made DACA recipients the exception among immigrant populations protected from deportation under other programs, including parole and temporary protected status. And it’s in spite of the fact that DACA recipient households pay $6.2 billion in federal taxes and $3.3 billion in state and local taxes every year, offsetting the costs of programs like Medicaid for Americans.

The Department of Health and Human Services proposed a rule Thursday that would finally rectify that inequity, allowing the roughly 47 percent of DREAMers who are uninsured access to coverage. It would do so by explicitly including DACA recipients in the category of “lawfully present” immigrants. The White House set a goal of finalizing the measure by the end of the month.

“This will be a welcome end to the longtime bar on eligibility that has kept many people from being able to access affordable health coverage,” said Shelby Gonzales, vice president for immigration policy at the Center on Budget and Policy Priorities. “Part of honoring their contributions and belonging is ensuring that they have access to affordable health coverage.”

The White House acknowledged in its announcement that “every day counts” in implementing the rule — and that might be because DACA itself is at risk. The program is not currently open to new applicants or those whose status has lapsed for more than a year as legal challenges to the program continue. Though President Joe Biden reiterated his call Thursday for Congress to pass permanent protections for DREAMers, it’s unlikely the Republican-controlled House will take up his request after more than a decade of failed negotiations.

What the proposal means for DACA recipients and the future of the program

The proposed rule would give DACA recipients access to affordable health care that may have previously been out of reach. Almost half of undocumented immigrants overall were uninsured in 2021, compared to less than one in 10 US citizens, according to a report by the Kaiser Family Foundation.

Even lawfully present immigrants who are eligible for coverage face barriers to accessing that coverage, including “fear, confusion about eligibility policies, difficulty navigating the enrollment process, and language and literacy challenges,” the report says. There is a lingering chilling effect from the Trump administration’s efforts to penalize immigrants considered to be “public charges” — dependent on public benefits — even though Biden reversed that policy.

Still, the proposed rule may offer only a temporary reprieve for DACA recipients. A Texas federal court is currently weighing the legality of the DACA program, after the Biden administration issued a rule last year codifying DACA that replaced the 2012 memo that created the program. An appeals court found that DACA was illegally established under the Obama administration through the 2012 memo, but it’s not clear whether the new rule and the DACA program as it exists today will survive legal scrutiny. For now, DACA recipients’ protections remain in place, but the Texas court could strike down the program any day now.

That has left immigrant advocates yet again pushing Congress to pass permanent protections for DREAMers. The many bipartisan efforts to reach a deal over the years have always fallen short as Republicans have tried to trade those protections for harsher border security measures, a deal Democrats have refused to accept. That dynamic continues to stymie immigration reform efforts, even though a majority of Americans would support creating a pathway to citizenship for DREAMers, according to a June 2021 poll by the American Civil Liberties Union.

The most recent failed attempt came in December when Sen. Kyrsten Sinema (I-AZ) and Sen. Thom Tillis (R-NC) created a legislative framework that would have traded an extension of controversial pandemic-era border restrictions for protections for DREAMers. But the proposal was met with a tepid reception from both parties.

Thursday’s proposed rule doesn’t break that gridlock.

“While we applaud this step, we can’t lose sight of the fact that we still need to address the urgent need for comprehensive immigration reform,” the advocacy group Voto Latino said in a statement. “Dreamers are our friends, neighbors, coworkers, and family members. ... it’s time they receive the protections they deserve.”

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