Immigrants to Be Denied U.S. Entry Without Proof of Health Insurance Arrangement

Immigrants who will "financially burden" the U.S. healthcare system are ineligible for U.S. residence.


IMPORTANT NOTE: The subject of the below update is in the midst of litigation, and the new rule described will thus not take effect upon the date planned, if ever. A U.S. federal judge issued a preliminary injunction blocking its implementation (in late November 2019), which hold will last until the lawsuit is finished and the ultimate result decided upon.

U.S. law has long prevented applicants from approval for immigrant visas (permanent residence or a green card) if they are likely to become a "public charge" (rely on need-based government assistance). With a recent Executive Order, however, President Trump has made the effect of that law much more severe, basically barring U.S. entry and residence to anyone without an immediate source of health insurance coverage.

Announced on Presidential Proclamation on the Suspension of Entry of Immigrants Who Will Financially Burden the United States Healthcare System states that certain immigrants who will "financially burden" the U.S. healthcare system are ineligible for immigrant visas and U.S. residence, unless they can show they will have a U.S.-government approved form of health insurance within 30 days of U.S. entry.

Before getting into the details, let's look at who is excluded from this proclamation. It is not meant to affect applicants for asylum, refugee status, withholding of removal, or protection under the Convention Against Torture.

It also appears to apply only to immigrants coming from abroad, as opposed to adjusting status within the U.S., through an office of U.S. Citizenship and Immigration Services (USCIS).

And the order specifically says that the following categories of applicants need not worry about proving they have health insurance:

  • temporary visa holders, or "nonimmigrants" in legal jargon
  • Special immigrant visa applicants in either the SI or SQ classification, who are also nationals of Afghanistan or Iraq, as well as their spouse and children
  • immigrating children of U.S. citizens, including adopted children (visa categories IR-2, IR-3, IR-4, IH-3, and IH-4)
  • immigrating parents of U.S. citizens (visa category IR-5), so long as the U.S. sponsor can prove that their health care won't impose a substantial burden on the U.S.
  • returning U.S. residents who've been away from the U.S. for an extended time but approved for reentry (category SB-1)
  • children under 18, unless they are accompanying a parent immigrating to the United States and that parent is subject to the new order
  • anyone whose entry would act in furtherance of important U.S. law enforcement objectives, as determined by the Department of State or Attorney General
  • anyone whose U.S. entry would be in the U.S. national interest, as determined by the Department of State on a case-by-case basis.

For immigrants who must prove they will have health insurance, the approved sorts include:

  • employer-sponsored plans, including retiree plans, association health plans, and Consolidated Omnibus Budget Reconciliation Act of 1985 plans
  • unsubsidized health plans offered within a state's individual market
  • short-term, limited-duration policies effective for at least 364 days or until the beginning of the person's planned, extended travel outside the United States
  • catastrophic plans
  • family members' plans
  • medical plans provided to the U.S. Armed Forces under Title 10, U.S. Code Chapter 55, such as TRICARE coverage
  • visitor health plans that provide adequate coverage for medical care for a minimum of 364 days or until the beginning of planned, extended travel outside the United States
  • Medicare plans, or
  • any other health plans providing adequate coverage for medical care as determined by the Department of Health and Human Services.

Notice that Medicaid program is not on this list. It will be allowed only for minor immigrants, 18 years or younger. Also not on the list is subsidized coverage under the ACA, otherwise known as Obamacare.

For affected immigrants who cannot show sufficient coverage under an approved plan, the only alternative to visa denial is to show possession of sufficient financial resources to pay for reasonably foreseeable medical costs in the future.

If you are well into the process of applying for an immigrant visa, and think this could be an issue for you, your best hope is to do everything possible to keep the process moving along, such as gathering your documents and getting your consular interview scheduled. The order doesn't apply to anyone who has obtained a visa before its November effective date.

Also, this order came down with little warning, so expect bumps in the road before it becomes official procedure. At the moment, no forms have been created for its implementation, and no trainings have been held for consular officers.

On top of that, lawsuits seeking to block the order are all but inevitable.

Effective Date: November 3, 2019