When Paloma Bouhid began working as a concierge at the Walt Disney World Resort in Florida seven years ago, it was the first time she received health care insurance.
But the lifeline she found through her job unexpectedly slipped away in 2020, when at 26 she lost her job during a round of mass layoffs.
“The first thing I thought of is, ‘Oh my gosh, I don’t have a job’ and then you very quickly realize that also means I’m not insured,” Bouhid, whose family immigrated from Brazil to Tampa in 1999, said.
Bouhid is one of the nearly 580,000 young adults without legal status who have been in the U.S. since they were children and are working or studying under the Deferred Action for Childhood Arrivals program, also known as DACA. An overwhelming majority were born in Mexico and other Latin American countries.
DACA recipients like Bouhid are barred from accessing federally funded health insurance, but that may change soon: The administration of President Joe Biden is finalizing a proposed rule that would allow them access to it.
Biden administration plans to expand health care access for DACA recipientsApril 13, 202302:20
Since bouncing back by starting a small business specializing in organization and decluttering in early 2021, Bouhid struggles with making $500 monthly payments toward her private health insurance, calling it “absolutely unaffordable.”
“Knowing now that I have this opportunity to have affordable health care, it definitely takes a weight off my shoulders," Bouhid said.
The DACA program has helped many eligible young immigrants access better paying jobs and educational opportunities, often enabling them to feel secure in their ability to seek and afford health care services, according to Roberto Gonzales, a professor of sociology and education at the University of Pennsylvania who has been tracking the lives of more than 400 DACA recipients since the program was implemented in 2012.
"But not all DACA beneficiaries have been able to access employment or educational opportunities that allowed them to receive health care benefits," Gonzales said.
About a third of DACA recipients — an estimated 34% — don't have health insurance coverage, according to the Department of Health and Human Services.
"As a result, they were limited to local clinics with long wait times and emergency rooms as the primary sources of health care," Gonzales said. "This meant that, oftentimes, illness and injuries were not treated in a timely manner."
"For some DACA beneficiaries we met, this led to a worsening of conditions," he added.
Setting the path for better health outcomes
The Centers for Medicare and Medicaid Services at the Department of Health and Human Services submitted a proposed rule on Thursday that would amend the definition of “lawful presence” to include DACA recipients, for purposes of Medicaid and Affordable Care Act coverage.
The agency said the proposed rule will be published in the Federal Register by the end of the month to give the public an opportunity to submit comments before the rules are finalized.
"If it gets finalized, I would definitely take advantage," Gretel Rodríguez, a 22-year-old DACA recipient from New Jersey, said. "I have been in this country since I was a 4-year-old, but I haven't had decent access to health care."
Universities often require students like Rodríguez and Katia Rubio Leal to have health insurance at the time of enrollment. The requirement forced both of them to start paying expensive premiums that barely cover any of their needs, both women said.
"Let's say I'm in the gym, and an injury happens, that's when it's accessible," Rodríguez, who was born in Honduras, said about her health insurance, adding it doesn't cover her eye exams, the eye glasses she wears or medical check ups for her asthma. She has to pay for those services out of pocket.
Rubio Leal, a 21-year-old DACA recipient, also recalled spending over $2,000 for limited health insurance coverage during her first year of college at Rockhurst University at Kansas City, Missouri — an amount that by her junior year had become unsustainable, she said.
By the time Rodríguez goes to law school after she graduates from Rutgers University in May, DACA beneficiaries like her "could see their health care access improve markedly" if the rule is finalized, Gonzales said.
"They could access a primary care provider, which would allow them to be more proactive in managing their health and to seek medical interventions for specific ailments," he said. "It would immediately lead to better health outcomes."
For Rubio Leal, who was born in Mexico and raised in Arkansas, being able to access federally funded health insurance as she pursues a degree in biomedical engineering would be a huge improvement. As a child who lacked insurance coverage, Rubio Leal recalled an instance her parents repaid a dentist with food for performing emergency dental work they couldn't afford.
"I would just want to be able to go to sleep at night knowing that my health is in check. And if it's not, that I can easily get help for it," Rubio Leal said.
She aspires to pursue a doctorate's degree, with the ultimate goal of improving how prosthetic limbs are built and expand their accessibility.
Continuing to look for 'a permanent solution'
DACA recipients contribute an estimated $6.2 billion in federal taxes every year, already pouring funds into the federal health insurance programs they may soon have access to.
Teissy Angel Ramirez, 28, was born in Mexico and raised in California. She moved to Nevada three years ago to care for her mother after being diagnosed with abdominal cancer.
She currently works as a phlebotomist while also completing an associate of arts degree at the College of Southern Nevada with hopes of transferring to the University of Nevada, Las Vegas to study public policy.
Angel Ramirez has been working in the medical field since she was 18, starting as a caregiver for autistic patients at a mental and behavioral health center and later one for elder and disabled patients.
The jobs have provided her with health insurance coverage, since she lacks options for affordable insurance due to her immigration status.
Angel Ramirez's goal is to work in public policy and advocacy advancing immigrant and human rights. Having expanded access to affordable health care would mean not having to choose between her dream career and health care access.
"We can't forget there are still individuals that do not have the health insurance," she said.
Gonzales added that while health care expansion to DACA recipients "would be an important step forward, especially for the most vulnerable," he emphasized that DACA "is a temporary and partial program that does not lead to citizenship and could very well be terminated."
While the program has been around for a decade, it has faced legal challenges from the previous administration and Republican-led states. DACA has been closed to new registrants since July 2021 while a lawsuit filed by Texas and other GOP-led states makes its way through the courts.
To improve the chances that DACA will survive legal battles, the Biden administration implemented a rule in October that turned the program into a federal regulation.
A federal judge in Texas is expected to rule on the legality of the new rule this year.
"What DACA beneficiaries need more than anything is a permanent solution," Gonzales said.
For "Dreamers" like Rodríguez, that permanent solution is a pathway to citizenship for them and all undocumented immigrants.
"That's the main goal," she said. "That's how I stay grounded in my activism."