President Obama has championed two sweeping policy changes that could transform how people live in the United States: affordable health care for all and a path to citizenship for the 11 million immigrants in the country illegally.
But many immigrants will have to wait more than a decade to qualify for health-care benefits under the proposed immigration overhaul being debated in Congress.
Lawmakers pushing the immigration bill said that adding more recipients to an already costly benefit would make it unaffordable.
Health-care analysts and immigration proponents argue that denying coverage will saddle local governments with the burden of uninsured immigrants. They also fear a crisis down the road as immigrants become eligible for coverage, but are older, sicker and require more expensive care.
Those placed on provisional status would become the nation's second-largest population of uninsured, or about 25 percent, according to a 2012 study by the Urban Institute.
The Affordable Care Act will make health insurance accessible for millions of uninsured people starting in January.
The proposed immigration overhaul explicitly states that immigrants cannot receive Medicaid or receive the health subsidies for more than a decade after they qualify for legal status, and only after certain financial and security requirements have been met.
"That's one of the privileges of citizenship," said Republican Sen. John McCain, one of the so-called Gang of Eight pushing the immigration bill, during a conference call with reporters. "That's just what it is. I don't know why we would want to provide Obamacare to someone who is not a citizen of this country."
Immigrants with provisional status may obtain insurance through employers, but many are unskilled and undereducated, and tend to work low-wage jobs at small businesses that don't have to provide the benefit under the health-care law.
Immigrants in the country illegally also can access community health centers, but the officials who run those clinics said they are overwhelmed by the demand.
The issue has received more attention in recent weeks. Some House Republicans have threatened to kill the immigration bill unless immigrants are required to pay for all their health-care costs even after they gain legal status.
Democratic Sen. Barbara Boxer of California, meanwhile, said she wants the government to distribute at least $250 million to state and local governments because they are the ones who will feel the financial pain of immigrants being left out of the health-care law.
Pregnant women, children, seniors and the disabled are eligible for emergency Medicaid services regardless of their immigration status.
Immigrants who are U.S. citizens are also affected by the limits on health-care access if they provide for family members here illegally.
Opponents said they understand the concerns of immigrants not getting health care.
"We aren't saying people shouldn't get health care. The question is who is going to pay for it?" said Ira Mehlman, spokes-man for the Federation for American Immigration Reform, a national group that opposes the immigration overhaul. "They would all be on Medicaid or heavily subsidized in some other way."
Critics of the decision said immigrants are eager to pay for affordable health care insurance and already support federal benefits by paying sales and income taxes.
They note that adults who are unable to overcome health emergencies are less likely to contribute to the workforce and society.
"The risk of them being uninsured if they are in the country illegally is the same risk of anyone else in the country not being insured," said Stephen Zuckerman, a health economist for the Urban Institute. "It's always more expensive to treat people at a more advanced stage of disease."
In North Carolina, Jessica Sanchez-Rodriguez said she has undergone a series of surgeries and medicines to treat her spina bifida, a developmental congenital disorder, and an ailment that leads to brain swelling.
Her parents brought her illegally from Mexico when she was 11 months old. As a minor, she received subsidized medical care, but she was cut off when she turned 18 in February.
Her family is trying to raise money for a $55,000 surgery to connect a catheter to her bladder.
"It's terrible," Sanchez-Rodriguez said. "I have to go to school with these pains."