The Washington PostDemocracy Dies in Darkness

The Health 202: 'Dreamers' have yet another worry: Losing their health coverage

with Paulina Firozi

THE PROGNOSIS

Young immigrants known as "dreamers" may have gotten a respite from the Supreme Court yesterday as it refused to take up their case, pushed by President Trump after a lower court ruled the administration couldn't terminate their legal status in the United States.

But those protected by the Deferred Action for Childhood Arrivals, implemented by then-President Obama, still have plenty to worry about, including a lack of congressional will on the issue. And there's one more thing: dreamers risk losing health coverage if they're protected status isn't renewed along with their work permits.

DACA didn’t significantly expand access to the federal health-care programs that's enjoyed by American citizens -- such as subsidized health coverage in the Obamacare marketplaces. But it did open the door for more young immigrants to obtain coverage through employer plans and a few state Medicaid programs.

Let’s be clear about one thing: dreamers who have managed to get health coverage aren’t going to suddenly lose it on March 5. That deadline is now relatively meaningless, even though that’s the date set by the Trump administration for the end of DACA unless Congress intervenes.

Federal district judges in California and New York have issued nationwide injunctions against ending the program. And yesterday, the Supreme Court essentially bought DACA recipients even more time by declining to hear arguments, meaning young undocumented immigrants can continue applying for permit renewals while the case works its way through the legal system, The Washington Post’s Robert Barnes reports.

“The litigation now will take its usual course, and the issue probably won’t return to the Supreme Court before the next term,” Bob writes. “In the meantime, the White House and Congress can continue to seek a political resolution.”

Trump, who was meeting yesterday with governors at the White House, had this to say: “We’ll see what happens. That’s my attitude.”

But as the shadow of a potential end to DACA encroaches, some dreamers — who were brought illegally to the United States as children by their undocumented parents — have practical concerns like health coverage.

Wild disparities remain between the uninsured rate of undocumented immigrants — 39 percent among the non-elderly, according to the Kaiser Family Foundation — and American citizens, 9 percent of whom lack coverage. Those immigrants who secured DACA status didn’t gain eligibility under federal rules to enroll in Medicaid or buy private plans on the Affordable Care Act’s marketplaces, even if they cover the full cost themselves.

Here's a picture of the problem from the Guttmacher Institute, a pro-abortion rights research group:

And from the Southern Poverty Law Center:

However, the program did allow more of these young people to access employer-sponsored coverage if they were able to find a job with such perks. More than 50 percent of DACA recipients got a job that offered health coverage or other benefits, according to Georgetown University’s Health Policy Institute.

Coverage from these employer-sponsored plans wouldn’t end right away if and when DACA protections are eliminated. But they would wind down if a dreamer had to quick work because of an expiring work permit. DACA work permits are due to expire in a staggered fashion only if Congress and the courts allow the protections to fade away. It appears unlikely Congress will act anytime soon and certainly not this week, as lawmakers return to Washington for just two days.

Another option for dreamers is Medicaid programs in 10 states that have chosen to put their own dollars toward coverage for undocumented immigrants, as state officials are not allowed to use federal Medicaid funds to cover dreamers.

Last month, New York Gov. Andrew M. Cuomo (D) doubled down, announcing that 42,000 dreamers in his state will remain eligible for state-funded Medicaid regardless of whether DACA expires.

“The federal government’s failure to take action to protect DACA recipients is appalling, un-American, unjust and puts hundreds of thousands of children at risk,” Cuomo said at the time. “Here in New York we will do everything in our power to protect DACA recipients and ensure they receive health care.”

California, which also gives DACA recipients access to its Medi-Cal program if the immigrants earn less than 138 percent of the federal poverty level, made a similar move. After Trump’s announcement last fall to end DACA, the state posted this on its website: “There will be no change to the Medi-Cal coverage for DACA recipients (adults or children) in California.”

AHH, OOF and OUCH

AHH: Twenty states are seeking a repeal of the entire Affordable Care Act with a new lawsuit against the Trump administration. The lawsuit, led by Texas and Wisconsin and filed in the U.S. District Court in the Northern District of Texas, says Congress's action to repeal the law's centerpiece -- its individual mandate to buy insurance -- necessarily invalidates the rest of the law. The mandate is still technically in effect, but its accompanying fine will be reducted to zero beginning in 2019.

Texas Attorney General Ken Paxton argued the individual mandate is now unconstitutional because without its penalty it cannot be called a tax, which is the reasoning the Supreme Court used to uphold the mandate back in 2012. "With no remaining legitimate basis for the law, it is time that Americans are finally free from the stranglehold of Obamacare, once and for all," Paxton said in a statement.

OOF: Republican moves to loosen Obamacare rules around health coverage could cause premiums to rise by double digits next year, the Urban Institute estimates in an analysis released yesterday.

After taking a look at the combined effects of Congress repealing the law's individual mandate and the Trump administration expanding short-term health plans that are exempt from coverage requirements, researchers concluded monthly premiums would rise 18 percent on average in 43 states without limits on less-comprehensive coverage. The higher prices would cause 7.6 million fewer people to buy coverage in 2019, they concluded.

“Those affected by these large premium increases would be disproportionately middle-income people with health problems because they prefer health insurance that covers essential health benefits, are unlikely to have access to medically underwritten short-term limited-duration policies, and are not financially protected by the ACA’s premium tax credits,” researchers Linda Blumberg, Matthew Buettgens and Robin Wang write.

OUCH: New federal data dashes recent hopes of improvements in childhood obesity, instead showing a spike in obesity among the youngest American children. The percentage of kids age 2 to 19 who are obese jumped from 14 percent in 1999 to 18.5 percent in 2015 and 2016, NPR reports, according to CDC survey data. The data also show there was no statistical difference between the obesity rate in 2013-2014 compared with 2014-2015 surveys, contrary to hopes that obesity had begun to decline in recent years.

"We have known about this epidemic of childhood obesity — and have been pouring research dollars and public health dollars into this problem — for at least 20 years," Sarah Armstrong, a Duke professor who helped conduct the analysis told NPR. "And despite that, we don't seem to be making a big dent in the situation…We need to double down our efforts and find out what's going to work, or the health of our future generation is really in jeopardy."

AGENCY ALERT

--As part of an expanded effort to combat opioid addiction, the Food and Drug Administration will begin allowing pharmaceutical companies to sell medications that diminish cravings for opioids, the New York Times reports. 

The FDA has already approved three drugs for opioid treatment -- buprenorphine, methadone and naltrexone -- but will also release guidance in the next few weeks for developing new, longer-acting formulas for treatment and for developing drugs that don’t end addiction but help with aspects of it. The latter includes things such as cravings, or overdoses, reporter Sheila Kaplan writes. Officials such medications will help people suffering from opioid abuse function better and can be used along with other therapies.

HHS secretary Alex Azar referenced such medication-assisted treatment during his address to the National Governors Association over the weekend.

"While the Trump administration has generally supported medication-assisted treatment, Mr. Azar’s predecessor, Tom Price, was not completely on board with it. Mr. Price caused an uproar among treatment experts when he dismissed some medications that reduce cravings through synthetic opioids last spring as substituting one opioid for another," Sheila writes. "Azar, who took office late last month, said he would work to reduce the stigma associated with addiction and addiction therapy, and would not treat it as a moral failing."

HEALTH ON THE HILL

--Today the leaders of the powerful House Ways and Means Committee will send a "request for information" -- known as an RFI -- to insurers, benefit managers, health-care providers and prescribers to learn more about how to protect Americans from opioid addiction and overdose, according to committee staff who pointed to a July 2017 HHS inspector general report showing one-third of Medicare Part D enrollees received an opioid prescription in 2016.

“To combat this crisis and protect more Americans from the perils of opioid abuse, we need to have all hands on deck," Chairman Kevin Brady (R-Tex.) said in advance remarks shared with The Health 202. "More than 42 million Americans receive prescriptions through the Medicare program – and we [lawmakers on both sides of the aisle and all stakeholders] have a shared responsibility to ensure the Medicare Part D program continues to improve lives."

Brady's Democratic counterpart, ranking member Richard Neal (D-Mass.), is also part of the request.

— As Congress faces mounting pressure to enact stricter gun laws, House Majority Whip Steve Scalise (R-La.) told Fox News yesterday lawmakers should focus on addressing mental-health problems before putting more restrictions on gun ownership.

“Let’s focus more on addressing these problems in mental health that we’ve started to deal with in Congress,” said Scalise, who was seriously injured in a congressional ball practice shooting in Alexandria, Va., last summer. “Let’s close loopholes, let’s figure out what went wrong with government before people start talking about taking away the rights of law-abiding citizens.”

STATE SCAN

--Andrew Wakefield, a disgraced former doctor who famously claimed there was a link between vaccines and autism, hopes to advance his anti-vaccine movement by working to unseat a moderate Republican in Houston with a more conservative candidate. 

Texas, the British ex-researcher’s adopted home, has seen an increase in the rate of children who have opted out of vaccines for philosophical reasons since Wakefield moved to the state more than a decade ago, The Guardian reports. Now Texas for Vaccine Choice, a group that ascribes to Wakefield's views, has thrown support behind conservative Susana Dokupil as she challenges fellow Republican Sarah Davis.

“Anti-vaccine campaigners in the state’s biggest city are door-knocking, fundraising and Facebook-ing in hopes they can replace a moderate Republican with a conservative challenger, to represent a district that houses 2.1-miles of hospitals and research institutions,” Jessica Glenza reports. "Davis angered often women-led anti-vaccine groups, which prefer to be called 'vaccine choice' or 'medical freedom' campaigners, when she urged lawmakers to mandate human papillomavirus vaccines for foster children."

“There are clearly a number of candidates running with this platform front and center – vaccine choice, medical freedom,” Wakefield told The Guardian. “The members of Texans for Vaccine Choice have been very successful in their lobbying.”

--A few more good reads from The Post and beyond:

Judge tosses lawsuit challenging federal marijuana laws (AP)

Report faults District’s treatment of mentally ill people in criminal justice system (Fenit Nirappil)

TRUMP TEMPERATURE

White House meets with veterans groups amid dispute at VA, tension over access to health care (Emily Wax-Thibodeaux)

MEDICAL MISSIVES

Failing to tell patients that nothing will help may only make them suffer more (Samuel Harrington)

A new study eases fears of a link between autism and prenatal ultrasounds (Laura Sanders)

INDUSTRY RX

'Pharma bro' Shkreli to be held responsible for $10.4 million in losses (Reuters)

DAYBOOK

Today

  • The Bipartisan Policy Center holds an event on the “Future Role of Government in Health IT and Digital Health."
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the opioid crisis.
  • The House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law holds a hearing on competition in the pharmaceutical supply chain.

Coming Up

  • The House Energy and Commerce Subcommittee on Health will hold a hearing on combating the opioid crisis on Wednesday.
  • The Senate Health, Education, Labor and Pensions Committee holds an executive session on various bills on Wednesday.
  • The U.S. Chamber of Commerce holds an event on combating the opioid crisis on Thursday.
SUGAR RUSH

Here's a look at Ivanka Trump the daughter vs. Ivanka Trump the adviser: 

Ivanka Trump is in the unique position of being both the president’s daughter and an official White House adviser. Here’s how she’s handled it so far. (Video: Patrick Martin/The Washington Post)

President Trump said he thinks he would have “run” into Marjory Stoneman Douglas High School in during the shooting. Here’s how he has fared in the face of danger in the past:

President Trump said he thinks he would have “run” into the school in Parkland, Fla., during the shooting. Here’s how he’s fared in the face of danger before. (Video: Bastien Inzaurralde, Peter Stevenson/The Washington Post)

Melania Trump says Parkland students "deserve a voice:"

At a luncheon for governors’ spouses Feb. 26, first lady Melania Trump spoke about the shooting that killed 17 people in Parkland, Fla. (Video: The Washington Post)

Jimmy Fallon says he plans to march with the Parkland students in Washington next month: 

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