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Oregon Bill Would Protect Legal Immigrants Seeking Health Care

Lawmakers want to let immigrants apply for financial help from a hospital rather than have to apply for the Oregon Health Plan, the state’s Medicaid program.
February 2, 2021

Oregon lawmakers are pursuing legislation that would help legal immigrants get health care without worrying about Trump-era federal rules that critics say discourage them from going to hospitals or clinics.

House Bill 2360 would prevent nonprofit hospitals and clinics from requiring patients to apply for Medicaid before they could seek care under a hospital’s charity aid program. The bill, heard Tuesday in the House Health Care Committee, is the state’s response to a controversial and complex federal rule from the Trump administration that has the effect of discouraging legal immigrants who are seeking citizenship from accessing medical care if a hospital first requires them to apply for Medicaid.

Trump’s rule expanded the list of benefits that authorities can use to determine if a person is a “public charge,” or financial burden to the government. The expanded list includes Medicaid. Non-U.S.-citizens who are in the country legally but are not approved as permanent residents can have their applications for permanent residency or citizenship denied or delayed if they are deemed public charges.

Hospitals, however, want patients to have insurance -- including Medicaid -- so that the hospital will be reimbursed for services. As standard practice, many hospitals ask uninsured patients to apply for Medicaid, which is available to lower-income families.

But that application can kill or delay a legal immigrant’s citizenship application, under the rule the Trump administration implemented in 2019.

Advocates of the new federal rule said it keeps out low-income immigrants who are a financial drain. Critics said the rule deters legal residents from accessing a basic service: health care. President Joe Biden on Tuesday started the process of unwinding much of that restriction and outlined other steps for immigration reform. Biden rescinded a Trump memorandum that requires family sponsors of immigrants seeking naturalization to repay the federal government if their relative receives public benefits. Biden also ordered agencies to review the public charge rule, a move that advocates view as a first step toward eliminating it. 

The Trump-era rule said that a person likely to use non-emergency Medicaid, federal housing vouchers, federal food stamps and other federal benefits can for some periods of time be denied permanent residency, also known as a green card.

Protecting Immigrants in Oregon

Regardless of what happens federally, Oregon lawmakers want protections in place.

The Oregon bill would allow a person to apply for financial help at a hospital without being forced to seek Medicaid and putting their immigration status in jeopardy. The legislation allows a person to opt out of Medicaid applications.

Rep. Andrea Salinas, D-Lake Oswego, sponsored a similar bill in the 2020 session. That bill passed the House, but died with most other legislation during the GOP-led walkout to kill a carbon tax bill. 

“I have talked with immigrants here in Oregon who have shared with me their fear and confusion” about the federal rule, Salinas, a chief sponsor of the bill, told the committee. 

Lawmakers also recognized that hospitals can encourage people to enroll in Medicaid, which currently has 1.26 million low-income Oregonians. Medicaid reimbursements are crucial for hospitals and other health care providers. To that end, the bill would not prevent providers from working with patients to help them sign up for Medicaid.

“It’s a bill dealing with fairness,” said Sen. Lew Frederick, D-Portland, a chief sponsor of the bill with Salinas.

The bill is critical because charity care -- in essence free care provided by the hospital -- is the payer of last resort. As a result, hospitals may have policies that ban people from being accepted for charity care unless they first apply for Medicaid, said  Rep. Ricki Ruiz, D-Gresham and another chief sponsor of the bill. 

Hospitals and health care advocates support the legislation. The Oregon Association of Hospitals and Health Systems said in submitted testimony it supports the bill, provided nothing stops hospitals from educating patients about Medicaid benefits and helping them apply if they want to.

“While enrolling people in coverage is our collective goal, hospitals recognize and understand the risk for individuals and families seeking permanent residence status,” Sean Kolmer, the group’s senior vice president of policy and strategy, wrote. “With that, OAHHS supports HB 2360’s intent to ensure patients and families are provided essential services.”

If the legislation leads to unintended consequences like a drop in Medicaid enrollment among people not impacted by the federal public charge rule, the hospital association said it would want to work on a solution. 

Public charge rule "confusing"

Providence Health & Services, a non-profit Catholic health care provider, also backs the legislation, calling the public charge rule “complicated and confusing.” 

“Its mere existence has created fear among immigrant families,” William Olson, Providence chief operating officer, wrote about the federal rule. “We need to do everything we can to support these families and ensure they have access to the care they need.”

Providence does not require patients to apply for Medicaid before seeking charity care, Olson said in submitted testimony.

The Oregon Nurses Association, which represents about 15,000 registered nurses, also supports the bill. In its testimony, the group said that requiring patients to apply for Medicaid would discourage vulnerable residents from seeking timely care. 

“At a time when global viruses threaten public health and strain health systems, it would be shortsighted and potentially catastrophic to create additional barriers to care,” Deborah Riddick, the association’s director of government relations, wrote lawmakers.

You can reach Ben Botkin at [email protected] or on Twitter @BenBotkin1.