II 

116TH CONGRESS 

2D SESSION S. 3799 

To expand access to health care services, including sexual, reproductive, 

and maternal health services, for immigrants by removing legal and 

policy barriers to health insurance coverage, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 21, 2020 

Mr. BOOKER introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To expand access to health care services, including sexual, 

reproductive, and maternal health services, for immigrants by removing legal and policy barriers to health 

insurance coverage, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Equity and 

5 Access under the Law for Immigrant Women and Families 

6 Act of 2020’’ or as the ‘‘HEAL for Immigrant Women 

7 and Families Act of 2020’’. 


kjohnson on DSK79L0C42PROD with BILLS
2 

•S 3799 IS

1 SEC. 2. FINDINGS; PURPOSE. 

2 (a) FINDINGS.—Congress finds as follows: 

3 (1) Health insurance coverage reduces harmful 

4 disparities by alleviating cost barriers to and in5 creasing utilization of necessary health care services, 

6 especially among low-income and underserved popu7 lations, including women. 

8 (2) Based solely on their immigration status, 

9 many immigrants and their families face legal and 

10 policy restrictions on their ability to obtain afford11 able health insurance coverage through Medicaid, 

12 the Children’s Health Insurance Program (CHIP), 

13 and the health insurance exchanges. 

14 (3) Lack of health insurance coverage contrib15 utes to persistent disparities in the prevention, diag16 nosis, and treatment of negative health outcomes ex17 perienced by immigrants and their families. 

18 (4) Nearly half of immigrant women are of re19 productive age. Immigrant women are also dis20 proportionately living in low-income households and 

21 lacking health insurance coverage. Legal and policy 

22 barriers to affordable health insurance coverage 

23 therefore particularly exacerbate their risk of nega24 tive sexual, reproductive, and maternal health out25 comes, with lasting health and economic conVerDate Sep 11 2014 04:35 Jun 13, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3799.IS S3799

kjohnson on DSK79L0C42PROD with BILLS
3 

•S 3799 IS

1 sequences for immigrant women, their families, and 

2 society as a whole. 

3 (5) Denying health insurance coverage or im4 posing waiting periods for health insurance coverage 

5 unfairly hinders the ability of immigrants to attain 

6 good health and undermines the economic well-being 

7 of their families. 

8 (6) The population of immigrant families in the 

9 United States is expected to continue to grow. One 

10 in seven United States residents is foreign-born, and 

11 approximately one in four children in the United 

12 States has at least one immigrant parent. It is 

13 therefore in the Nation’s shared public health and 

14 economic interest to remove legal and policy barriers 

15 to affordable health insurance coverage based on im16 migration status. 

17 (7) Although Deferred Action for Childhood Ar18 rivals (DACA) recipients are authorized to live and 

19 work in the United States, they have been unfairly 

20 excluded from the definition of lawfully present and 

21 lawfully residing for purposes of health insurance 

22 coverage through the Department of Health and 

23 Human Services, including Medicaid and CHIP, and 

24 the health insurance exchanges. 


kjohnson on DSK79L0C42PROD with BILLS
4 

•S 3799 IS

1 (8) Immigration law is constantly evolving and 

2 new immigration categories for individuals with fed3 erally authorized presence in the United States may 

4 be created. 

5 (b) PURPOSE.—It is the purpose of this Act to— 

6 (1) ensure that all individuals who are lawfully 

7 present in the United States are eligible for all fed8 erally funded health care programs; and 

9 (2) advance the ability of undocumented indi10 viduals to obtain health insurance coverage through 

11 the health insurance exchanges. 

12 SEC. 3. REMOVING BARRIERS TO HEALTH COVERAGE FOR 

13 LAWFULLY PRESENT INDIVIDUALS. 

14 (a) MEDICAID.—Section 1903(v)(4) of the Social Se15 curity Act (42 U.S.C. 1396b(v)(4)) is amended— 

16 (1) by amending subparagraph (A) to read as 

17 follows: 

18 ‘‘(A) Notwithstanding sections 401(a), 402(b), 403, 

19 and 421 of the Personal Responsibility and Work Oppor20 tunity Reconciliation Act of 1996, payment shall be made 

21 under this section for care and services that are furnished 

22 to individuals who are not citizens of the United States, 

23 including aliens described in paragraph (1), if they other24 wise meet the eligibility requirements for medical assist25 ance under the State plan approved under this title (other 


kjohnson on DSK79L0C42PROD with BILLS
5 

•S 3799 IS

1 than the requirement of the receipt of aid or assistance 

2 under title IV, supplemental security income benefits 

3 under title XVI, or a State supplementary payment) and 

4 are lawfully present in the United States (including such 

5 an individual who is granted deferred action or other fed6 erally authorized presence).’’; 

7 (2) in subparagraph (B)— 

8 (A) by striking ‘‘a State that has elected to 

9 provide medical assistance to a category of 

10 aliens under subparagraph (A)’’ and inserting 

11 ‘‘individuals provided medical assistance pursu12 ant to subparagraph (A)’’; and 

13 (B) by striking ‘‘such an alien on the basis 

14 of provision of assistance to such category’’ and 

15 inserting ‘‘such an individual on the basis of 

16 provision of assistance to such individual’’; and 

17 (3) in subparagraph (C)— 

18 (A) by striking ‘‘an election by the State 

19 under subparagraph (A)’’ and inserting ‘‘the 

20 application of subparagraph (A)’’; 

21 (B) by inserting ‘‘or be lawfully present’’ 

22 after ‘‘lawfully reside’’; and 

23 (C) by inserting ‘‘or present’’ after ‘‘law24 fully residing’’ each place it appears. 


kjohnson on DSK79L0C42PROD with BILLS
6 

•S 3799 IS

1 (b) CHIP.—Subparagraph (N) of section 2107(e)(1) 

2 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

3 amended to read as follows: 

4 ‘‘(N) Paragraph (4) of section 1903(v) (re5 lating to lawfully present individuals).’’. 

6 (c) EFFECTIVE DATE.— 

7 (1) IN GENERAL.—Except as provided in para8 graph (2), the amendments made by this section 

9 shall take effect on the date of enactment of this Act 

10 and shall apply to services furnished on or after the 

11 date that is 90 days after such date of enactment. 

12 (2) EXCEPTION IF STATE LEGISLATION RE13 QUIRED.—In the case of a State plan for medical as14 sistance under title XIX, or a State child health plan 

15 under title XXI, of the Social Security Act which the 

16 Secretary of Health and Human Services determines 

17 requires State legislation (other than legislation ap18 propriating funds) in order for the plan to meet the 

19 additional requirements imposed by the amendments 

20 made by this section, the respective State plan shall 

21 not be regarded as failing to comply with the re22 quirements of such title solely on the basis of its 

23 failure to meet these additional requirements before 

24 the first day of the first calendar quarter beginning 

25 after the close of the first regular session of the 


kjohnson on DSK79L0C42PROD with BILLS
7 

•S 3799 IS

1 State legislature that begins after the date of enact2 ment of this Act. For purposes of the previous sen3 tence, in the case of a State that has a 2-year legis4 lative session, each year of such session shall be 

5 deemed to be a separate regular session of the State 

6 legislature. 

7 SEC. 4. CONSISTENCY IN HEALTH INSURANCE COVERAGE 

8 FOR INDIVIDUALS WITH FEDERALLY AU9 THORIZED PRESENCE, INCLUDING DE10 FERRED ACTION. 

11 (a) IN GENERAL.—For purposes of eligibility under 

12 any of the provisions described in subsection (b), all indi13 viduals granted federally authorized presence in the 

14 United States shall be considered to be lawfully present 

15 in the United States. 

16 (b) PROVISIONS DESCRIBED.—The provisions de17 scribed in this subsection are the following: 

18 (1) EXCHANGE ELIGIBILITY.—Section 1311 of 

19 the Patient Protection and Affordable Care Act (42 

20 U.S.C. 18031). 

21 (2) REDUCED COST-SHARING ELIGIBILITY.— 

22 Section 1402 of the Patient Protection and Afford23 able Care Act (42 U.S.C. 18071). 


kjohnson on DSK79L0C42PROD with BILLS
8 

•S 3799 IS

1 (3) PREMIUM SUBSIDY ELIGIBILITY.—Section 

2 36B of the Internal Revenue Code of 1986 (26 

3 U.S.C. 36B). 

4 (4) MEDICAID AND CHIP ELIGIBILITY.—Titles 

5 XIX and XXI of the Social Security Act, including 

6 under section 1903(v) of such Act (42 U.S.C. 

7 1396b(v)). 

8 (c) EFFECTIVE DATE.— 

9 (1) IN GENERAL.—Subsection (a) shall take ef10 fect on the date of enactment of this Act. 

11 (2) TRANSITION THROUGH SPECIAL ENROLL12 MENT PERIOD.—In the case of an individual de13 scribed in subsection (a) who, before the first day of 

14 the first annual open enrollment period under sub15 paragraph (B) of section 1311(c)(6) of the Patient 

16 Protection and Affordable Care Act (42 U.S.C. 

17 18031(c)(6)) beginning after the date of enactment 

18 of this Act, is granted federally authorized presence 

19 in the United States and who, as a result of such 

20 subsection, qualifies for a subsidy under a provision 

21 described in paragraph (2) or (3) of subsection (b), 

22 the Secretary of Health and Human Services shall 

23 establish a special enrollment period under subpara24 graph (C) of such section 1311(c)(6) during which 

25 such individual may enroll in qualified health plans 


kjohnson on DSK79L0C42PROD with BILLS
9 

•S 3799 IS

1 through Exchanges under title I of the Patient Pro2 tection and Affordable Care Act and qualify for such 

3 a subsidy. For such an individual who has been 

4 granted federally authorized presence in the United 

5 States as of the date of enactment of this Act, such 

6 special enrollment period shall begin not later than 

7 90 days after such date of enactment. Nothing in 

8 this paragraph shall be construed as affecting the 

9 authority of the Secretary to establish additional 

10 special enrollment periods under such subparagraph 

11 (C). 

12 SEC. 5. REMOVING CITIZENSHIP AND IMMIGRATION BAR13 RIERS TO ACCESS TO AFFORDABLE HEALTH 

14 CARE UNDER THE ACA. 

15 (a) IN GENERAL.— 

16 (1) PREMIUM TAX CREDITS.—Section 36B of 

17 the Internal Revenue Code of 1986 is amended— 

18 (A) in subsection (c)(1)(B)— 

19 (i) by amending the heading to read 

20 as follows: ‘‘SPECIAL RULE FOR CERTAIN

21 INDIVIDUALS INELIGIBLE FOR MEDICAID

22 DUE TO STATUS’’; and 

23 (ii) in clause (ii), by striking ‘‘lawfully 

24 present in the United States, but’’ and in25 serting ‘‘who’’; and 


kjohnson on DSK79L0C42PROD with BILLS
10 

•S 3799 IS

1 (B) by striking subsection (e). 

2 (2) COST-SHARING REDUCTIONS.—Section 1402 

3 of the Patient Protection and Affordable Care Act 

4 (42 U.S.C. 18071) is amended by striking sub5 section (e) and redesignating subsection (f) as sub6 section (e). 

7 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 

8 Section 1331(e)(1)(B) of the Patient Protection and 

9 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 

10 amended by striking ‘‘lawfully present in the United 

11 States,’’. 

12 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 

13 Section 1412 of the Patient Protection and Afford14 able Care Act (42 U.S.C. 18082) is amended by 

15 striking subsection (d) and redesignating subsection 

16 (e) as subsection (d). 

17 (5) REQUIREMENT TO MAINTAIN MINIMUM ES18 SENTIAL COVERAGE.—Subsection (d) of section 

19 5000A of the Internal Revenue Code of 1986 is 

20 amended by striking paragraph (3) and by redesig21 nating paragraph (4) as paragraph (3). 

22 (b) CONFORMING AMENDMENTS.— 

23 (1) ESTABLISHMENT OF PROGRAM.—Section 

24 1411 of the Patient Protection and Affordable Care 

25 Act (42 U.S.C. 18081) is amended— 


kjohnson on DSK79L0C42PROD with BILLS
11 

•S 3799 IS

1 (A) in subsection (a)— 

2 (i) by striking paragraph (1); and 

3 (ii) redesignating paragraphs (2), (3), 

4 and (4) as paragraphs (1), (2), and (3), 

5 respectively; 

6 (B) in subsection (b)— 

7 (i) in paragraph (1)(A), by striking 

8 ‘‘and date of birth’’ and inserting ‘‘date of 

9 birth, and social security number (if appli10 cable)’’; 

11 (ii) by striking paragraph (2); and 

12 (iii) by redesignating paragraphs (3) 

13 through (5) as paragraphs (2) through (4), 

14 respectively; 

15 (C) in subsection (c)— 

16 (i) by striking paragraph (2); 

17 (ii) in paragraph (3), by striking 

18 ‘‘subsection (b)(3)(A) provided under para19 graph (3), (4), or (5)’’ and inserting ‘‘sub20 section (b)(2)(A) provided under para21 graph (2), (3), or (4)’’; and 

22 (iii) by redesignating paragraphs (3) 

23 and (4) as paragraphs (2) and (3), respec24 tively; 

25 (D) in subsection (e)— 


kjohnson on DSK79L0C42PROD with BILLS
12 

•S 3799 IS

1 (i) in paragraph (1), by striking ‘‘sub2 section (c)(4)’’ and inserting ‘‘subsection 

3 (c)(3)’’; 

4 (ii) in paragraph (2)— 

5 (I) in subparagraph (A), by strik6 ing ‘‘paragraphs (1), (2), (3), and 

7 (4)’’ and inserting ‘‘paragraphs (1), 

8 (2), and (3)’’; and 

9 (II) in subparagraph (B), by 

10 striking ‘‘subsection (b)(5)’’ and in11 serting ‘‘subsection (b)(4)’’; 

12 (iii) by striking paragraph (3); 

13 (iv) by redesignating paragraph (4) as 

14 paragraph (3); and 

15 (v) in paragraph (3), as so redesig16 nated— 

17 (I) in subparagraph (A), by strik18 ing ‘‘(other than subsection (b)(2))’’; 

19 and 

20 (II) in subparagraph (B)— 

21 (aa) in clause (i)— 

22 (AA) by striking ‘‘Ex23 cept as provided in para24 graph (3), the’’ and insert25 ing ‘‘The’’; and 


kjohnson on DSK79L0C42PROD with BILLS
13 

•S 3799 IS

1 (BB) by striking ‘‘para2 graphs (2), (3), and (4)’’ 

3 and inserting ‘‘paragraphs 

4 (1), (2), and (3)’’; and 

5 (bb) in clause (iv), by strik6 ing ‘‘subsection (b)(5)’’ and in7 serting ‘‘subsection (b)(4)’’; and 

8 (E) in subsection (f)(2)(A), by striking 

9 ‘‘subsection (e)(4)(C)’’ and inserting ‘‘sub10 section (e)(3)(C)’’. 

11 (2) QUALIFIED INDIVIDUALS.—Section 1312(f) 

12 of the Patient Protection and Affordable Care Act 

13 (42 U.S.C. 18032(f)) is amended— 

14 (A) in the heading, by striking ‘‘; ACCESS

15 LIMITED TO CITIZENS AND LAWFUL RESI16 DENTS’’; and 

17 (B) by striking paragraph (3). 

18 (c) EFFECTIVE DATE.—The amendments made by 

19 this section shall apply to years, plan years, and taxable 

20 years, as applicable, beginning after December 31, 2020. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS