The Enabling Factors & Barriers to the Passage of the Immigrant Children’s Health Improvement Act: A Florida Case Study

More than 50% of first-generation immigrant children do not have health insurance. Lack of insurance directly contributes to worsened access to health care and worsened health outcomes. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) prevented legal permanent residents (LPRs) from accessing federal benefits until they had lived in the United States for at least five years. In 2009, PRWORA’s impact was lessened by the Legal Immigrant Children’s Health Improvement Act (ICHIA), part of the Children’s Health Insurance Program Reauthorization Act (CHIPRA), allowing states to eliminate the five-year wait period for LPR pregnant women and children to be eligible for Medicaid/CHIP. 35 states passed the ICHIA for LPR children and/or pregnant women, while 15 states maintain the wait period for all. Existing literature shows which states implemented the ICHIA but says little about why some states have passed it and others have not. This paper aims to fill that gap by using Florida as a case study, a state in which the ICHIA was proposed unsuccessfully for six years before being passed in 2016. Based on legislative proceedings and interviews with key informants, I identified three key barriers (fiscal impact to the state, the perceived value of self- sufficiency, and anti-immigrant sentiment), and three enabling factors to the ICHIA’s passage (strong Latino Republican caucus, a low fiscal impact, and a unified lobbying coalition). By understanding the enabling factors and barriers in Florida, other states may learn how they can overcome obstacles to expanding immigrants’ access to health insurance.