The Affordable Care Act (ACA), also known as Obamacare, has provided millions of Americans with access to healthcare, including coverage through Medicaid and the Health Insurance Marketplace. However, one significant area of controversy has been the question of whether DACA recipients, or Dreamers, are eligible for health coverage under the ACA. DACA recipients, who were brought to the U.S. as children, are protected from deportation and have the ability to work legally, but their access to federal benefits, including healthcare, has been limited.

This article explores the ACA health coverage for DACA recipients, the policy changes under the Biden administration, and the legal challenges faced by Dreamers in securing health insurance. Understanding these aspects is critical for both DACA recipients and the broader healthcare system.

Who Are DACA Recipients and Why Health Coverage Matters

DACA recipients are individuals who have received Deferred Action for Childhood Arrivals (DACA) status. They are undocumented immigrants who came to the U.S. as children and meet specific eligibility criteria. DACA recipients were granted protection from deportation and temporary work authorization, but they are not eligible for many federal benefits, including Medicaid and other forms of public assistance, due to their immigration status.

Despite their exclusion from certain benefits, health coverage is critical for DACA recipients, especially given the challenges they face in terms of physical and mental health. Many Dreamers suffer from the psychological toll of living in legal uncertainty, and some face significant barriers to healthcare access, such as limited income and fear of deportation.

Health Coverage for DACA Recipients Under the ACA

Under the Affordable Care Act (ACA), most Americans are required to have health insurance, but DACA recipients were largely excluded from the law’s provisions. Specifically, DACA recipients:

• Cannot enroll in Medicaid (unless they qualify through other means such as a state-specific program).

• Are not eligible to purchase health insurance through the Health Insurance Marketplace using federal subsidies.

• Are generally not eligible for coverage under ACA’s employer-based plans, unless their employer provides health coverage regardless of immigration status.

This exclusion from the ACA’s health insurance provisions has left many DACA recipients without affordable health coverage options. For some, this means delaying necessary medical treatments, facing huge medical bills, or simply going without healthcare altogether.

Policy Changes Under the Biden Administration

The Biden administration has made significant efforts to improve the access to health coverage for vulnerable populations, including DACA recipients. One of the key changes has been the expansion of ACA subsidies under the American Rescue Plan (ARP), which made health insurance more affordable for people who earn up to 150% of the federal poverty level. However, while DACA recipients were not initially eligible to purchase coverage through the Health Insurance Marketplace, certain policy changes have impacted their access to health insurance.

1. Health Insurance Marketplace and DACA Recipients

Under the Biden administration, DACA recipients are still not eligible for federal subsidies to purchase health insurance through the ACA marketplace, but they may be able to purchase health insurance at full price if they can afford it. The Biden administration has also worked to improve the ACA by:

• Expanding subsidies for ACA marketplace plans.

• Allowing a broader range of people, including those who are currently in legal limbo, to apply for insurance coverage with fewer barriers.

While DACA recipients still face challenges in accessing ACA coverage, the extension of ACA subsidies has allowed some individuals in other categories (e.g., those with temporary protected status) to gain coverage. Advocates for Dreamers continue to push for permanent solutions that would allow DACA recipients to fully benefit from ACA provisions.

2. Medicaid Access and State-Level Programs

Another change under the Biden administration has been the increased push for states to expand Medicaid. Although DACA recipients are generally excluded from Medicaid, some states have created state-funded healthcare programs that provide coverage for individuals who are excluded from federal programs. These programs are particularly important for Dreamers, especially in states with large immigrant populations, such as California, New York, and Illinois.

Some states, like California, have taken steps to include undocumented immigrants, including DACA recipients, in state-level healthcare programs, expanding Medicaid access. However, this remains inconsistent across the country.

Legal Challenges and Barriers to ACA Coverage for DACA Recipients

Despite the policy changes made by the Biden administration, DACA recipients still face significant legal challenges and barriers when it comes to accessing ACA health coverage.

1. Legal Exclusion from ACA Benefits

Even under the Biden administration, DACA recipients are not included in the ACA’s essential health benefits. This exclusion has led to lawsuits from advocacy organizations arguing that the Affordable Care Act should include DACA recipients, especially given their contributions to the workforce and the economy.

The U.S. Supreme Court has not yet issued a final ruling on whether the ACA should be extended to cover DACA recipients, meaning that legal uncertainty continues. Until this issue is resolved, Dreamers remain excluded from vital healthcare coverage.

2. Federal Funding Restrictions

In addition to legal challenges, federal funding restrictions have made it difficult for Dreamers to access certain healthcare benefits. Federal funding rules prevent DACA recipients from being included in federally funded healthcare programs like Medicaid, leaving states to decide whether to cover immigrants under their own programs. This creates disparities in coverage, with some states offering more comprehensive healthcare support than others.

3. Advocacy for Health Equity

Healthcare advocacy groups and immigration reform organizations continue to fight for the inclusion of DACA recipients in the ACA. The National Immigration Law Center (NILC), United We Dream, and other groups have pushed for legislation that would allow Dreamers to access healthcare through the Health Insurance Marketplace and Medicaid. The goal is to end the exclusion of DACA recipients and other immigrants from healthcare benefits, arguing that access to healthcare is a basic human right.

What Does the Future Hold for DACA and Health Coverage?

The future of ACA health coverage for DACA recipients remains uncertain as legal battles continue and policymakers work to reform immigration and healthcare laws. However, there are key areas where change may be possible:

• Legislative action could result in a new law that extends ACA benefits to DACA recipients, providing them with access to health insurance coverage and a path to permanent residency.

• State-level initiatives might continue to fill the gap, with more states potentially expanding access to healthcare for undocumented immigrants and DACA recipients.