Introduction
Mr. Chairman and Members of the Subcommittee, thank you for the opportunity
to appear before you this morning. I am the Director of the Office of Refugee
Resettlement (ORR) and the Office of Family Assistance (OFA). I have worked
with refugees and immigrants both overseas and domestically for over twenty
years and believe that the discussion on the utilization of public assistance by
immigrants is of vital importance because it cuts across two major public issues
being addressed by the Administration and the Congress -- immigration reform and
welfare reform.
Also with me today is Jack Ebeler, the Deputy Assistant Secretary for Health
Policy, at the Department of Health and Human Services. Mr. Ebeler will address
your questions concerning health issues.
The ORR was created by the Refugee Act of 1980, which established the
framework for selecting refugees for admission to the United States and for
providing Federal resettlement assistance. This assistance is provided
principally to help refugees and their families achieve economic
self-sufficiency and social adjustment as soon as possible after their arrival
in the United States.
The OFA is the Federal agency that administers Aid to Families with
Dependent Children (AFDC), the nation's largest cash assistance program and
the Jobs Opportunities and Basic Skills Training (JOBS) programs, which helps
people on welfare become self-sufficient.
Because refugees often rely on AFDC to sustain their families during
resettlement, we have had unique opportunities to share information and develop
new ways of approaching refugee dependency in those areas of the country where
there exists a problem. For example, the State of New York has developed a
comprehensive, privatized, refugee resettlement program in New York City -- one
of the largest resettlement sites in the country -- using both ORR and OFA
resources. Staff from both ORR and OFA have joined staff from the State of
California and its counties and launched the California Initiative (CI). The CI
has been enormously successful in devising new approaches to helping refugees
become self-sufficient. Conversely, since the refugee program has emphasized
early employment throughout its history, the lessons learned about diversion
from accessing benefits, job placement, post-employment services, and
eliminating barriers to self-sufficiency have been brought to bear within the
AFDC and JOBS programs.
Eligibility of Aliens for Public Assistance
Under current law, undocumented aliens and most legal nonimmigrants are
ineligible for the major Federal means-tested public assistance programs,
including food stamps, AFDC, Supplemental Security Income (SSI), and Medicaid,
with an exception for emergency medical assistance under Medicaid.
Most legal immigrants qualify for these programs on the same basis as
citizens with an exception for sponsored immigrants. Under current law,
sponsored immigrants' access to public assistance is limited because a sponsor's
income and resources are usually taken into account when determining
eligibility. We refer to this calculation as "deeming."
Alien Utilization Of Public Assistance
At this time, while we do not have citizenship data in all the programs that
the Administration for Children and Families administers, we do have data on
immigrant utilization of AFDC and refugee public assistance.
I would like briefly to review data derived from the Office of Refugee
Resettlement's 23rd survey, conducted in 1994, of a national sample of refugees
who were selected from the population of all refugees who arrived between May 1,
1989 through April 30, 1994, and then review data derived from the 1993 Quality
Control program about immigrant utilization of AFDC.
The 1994 survey showed that welfare utilization varied considerably among
refugee groups. Non-cash assistance utilization was generally higher than cash
assistance.
The 1994 refugee survey found that about 57 percent of the refugees surveyed
were self-sufficient, 43 percent were receiving some form of cash assistance: 24
percent on AFDC, 5 percent on Refugee Cash Assistance, 7 percent on Supplemental
Security Income (SSI), and 7 percent on state and local General Assistance
programs. A comparison of 1994 data with 1993 data indicates that refugee
welfare dependency rate is going down. In 1993, the dependency rate was 48.7
percent; in 1994 it was 43 percent.
Slightly more than 50 percent of all refugees reported that their medical
coverage was provided through Medicaid or Refugee Medical Assistance and that
the utilization rates varied widely among ethnic groups -- from a low of 23
percent for Eastern European refugees to a high of 71 percent for non-Vietnamese
refugees from Southeast Asia.
About 27 percent of all refugee households samples had received AFDC in the
past 12 months, slightly higher than the proportion reported in the previous
survey. Approximately 20 percent of refugee households had at least one
household member who had received Supplemental Security Income in the past 12
months. This rate is almost unchanged from the previous year's 19 percent.
Refugees from the former Soviet Union, with about 13 percent of their five year
population over 65, utilized SSI most often, with 28 percent of their households
receiving SSI. By contrast, only about one percent of Latin American refugees
were 65 or over and less than three percent of their sampled households received
SSI.
Overall, findings from ORR's 1994 survey indicate that refugees face
significant problems upon arrival in the United States but that over time many
refugees find jobs and move toward economic self- sufficiency in their new
country.
Much depends on their own backgrounds and on where they resettle in the
United States.
Many other studies conclude that refugees, while a relatively small
percentage of all immigrants admitted to the United States, represent a
disproportionate share of immigrant participation in public assistance programs.
There are many explanations for this including the fact that refugees are
admitted to the United States for very different reasons than other immigrants.
Most immigrants who enter the U.S. must show that they are unlikely to
become a public charge. Those who are admitted could be excluded if they do, in
fact, become public charges. The United States admits refugees because they
have a well-founded fear of persecution because of race, religion, nationality,
membership in a particular social group, or political opinion. Refugees do not
have private sponsors who sign affidavits of support, nor are they admitted
because they have a particular employment skill, educational attainment, or a
relative able to support them. Their admission is based on humanitarian grounds
and they often arrive traumatized from war, in ill health, with little or no
resources and lacking in English language skills. For these reasons, the law
exempts refugees from the public charge restrictions. As stated earlier, ORR's
mission is to help refugees become self-supporting as quickly as possible, and I
believe we have made substantial progress in this regard.
Of course, refugees are not the only non-citizen recipients of public
assistance. You will hear later from a panel of experts, some of whom have
written extensively on the broader issue of non-citizen utilization of public
assistance.
While my remarks focus principally on the refugee and AFDC programs, I would
like to note a Congressional Budget Office study entitled, "Immigration and
Welfare Reform" that was published one year ago. Like some of the panelists
slated to testify later, CBO found that with the exception of SSI, immigrants
generally are no more likely to use public assistance that native-born
residents. Working with the AFDC and food stamp programs, the CBO found that in
1992 citizens represented 95 percent of all recipients of AFDC, legal permanent
residents about 4 percent, and newly arrived refugees about one percent. The
food stamp program's percentages were virtually identical. In sum, CBO found
that in 1992, about 4.7 percent of recipients of AFDC were legal immigrants,
about the same as their percentage of the U.S. population.
Estimating Medicaid utilization is more difficult but CBO did note that they
estimated about 6.5 percent of Medicaid recipients were legal immigrants.
Our own review of the AFDC program's Quality Control (QC) System showed that
in 1993 just 4.8 percent of the AFDC caseload were non- citizens, about the same
as the 1992 QC figure of 4.6 percent. The 1992 percentage from our QC data is
virtually identical to the percentage cited in CBO's 1992 study discussed
earlier.
Health Insurance Requirement
In your letter, you asked us to comment on a proposed requirement that all
immigrants that enter under the classification for parents have health insurance
and long-term care insurance before they enter.
This requirement would impose a mandate upon purchasers of health insurance
that, absent a corresponding mandate that insurers offer such coverage on an
equitable basis, would set standards that are virtually impossible to meet.
Imposition of this requirement could come at the expense of family
reunification.
Private health insurance policies, equivalent Medicare Part A and B and
long-term care benefits care benefits provided under Medicaid, are currently
unavailable commercially, in part because premiums for such coverage would
simply be unaffordable. Our preliminary estimates indicate that, for parents
age 65 and over, coverage for Medicare- comparable acute care benefits plus a
Medicaid-comparable long-term care policy would cost $9,000 or more per person
per year.
Insurers often require medical examinations and tests before they will offer
individual acute care or long-term care policies, and are unlikely to accept
tests performed outside the United States. However, this still would require a
demonstration of health insurance coverage prior to entry into the United
States.
To the extent this requirement would necessitate reliance upon state
insurance departments to determine the acceptability of individuals policies, to
monitor, and to enforce continued coverage, and to convey this information to
consular officials worldwide, additional resources would be required to fund
this additional administrative burden on the state.
The long-term care insurance requirement is especially problematic. The
long-term care insurance industry is in its infancy. Availability, type and
quality of benefits, consumer safeguards, and regulation by State insurance
departments all vary widely. It is not known whether current premiums will
provide sufficient revenue to pay promised benefits many years in the future.
Immigration laws should serve to strengthen U.S. citizen families. These
requirements, however unintentionally, erect unnecessary barriers to U.S.
citizens being reunited with their parents.
Conclusion
I know that during the past year you have heard testimony from other
witnesses who have outlined actions the Administration has taken on a wide
variety of immigration-related issues. When the emotional and controversial
issues of immigration and welfare reform connect, real progress is sometimes
overlooked.
We are working with state and local officials and with public and private
organizations to change the culture of the welfare office, making it a place
where families can get help while they look for work. Throughout the country,
the welfare system is being reformed by emphasizing self-sufficiency and
personal responsibility. We have granted 53 welfare reform waivers to 37 States
so they may experiment with policies and tailor their programs to local
circumstances. Partnerships are being forged as they never have been before,
and this welfare reform is affecting immigrants and refugees, as well as
citizens.
As I indicated to you last August during our consultations on refugee
admissions, we believe the domestic refugee resettlement program is in a
position to meet the needs of refugees today while being able to respond
effectively to a changing, and often unpredictable, world refugee situation.
More than ever before, we have focused the refugee program's resources on the
newly-arrived refugee while encouraging refugee specific, culturally and
linguistically appropriate services. We also welcome changes in the welfare
system that will encourage refugees to obtain early employment because our
experience shows that working is the best and fastest way to achieve language
competency, social adjustment, and self- sufficiency.
Thank you for this opportunity and I would be pleased to answer any
questions you may have.
