根据ACA（始于2014年），所有人“lawfully present” in the United States must maintain minimum essential health insurance coverage for the whole year or must pay a penalty at the end of the year. This means that every 合法存在 non-citizen in the United States must enroll in qualifying health insurance in the United States or pay the yearly penalty, unless the non-citizen maintains qualifying health insurance through an employer, individual, or government health insurance program. Lawfully present non-citizens include those persons in the United States with lawful permanent resident status (Green Cards); employment visas (E, H, L, R, or TN); and other miscellaneous lawful statuses (TPS, asylum, refugee status, non-immigrant visas, and deferred action/CAT/Withholding of Removal).
合法存在的非公民可以通过注册联邦或州医疗保险交易所，以及在其中一个交易所网站（即www.healthcare.gov）上注册医疗保险，来满足健康保险注册要求。这些网站允许未投保的个人通过私人保险公司找到合格的保险，如果个人’s employer does not provide health insurance coverage and the individual does not otherwise have qualifying health insurance coverage. Also, these websites allow 合法存在 non-citizens to receive tax credits that will help them pay for their health insurance if their income is low.
One exception to the health insurance enrollment requirement for 合法存在 non-citizens is that the law does not treat non-citizens as “lawfully present” under the ACA if the person cannot be reasonably expected to remain 合法存在 in the United States for the entire term of the health insurance plans offered through the exchange websites. For example, H-2B visas allow foreign workers to enter the United States for ten month periods. If the insurance exchanges require enrollment in an insurance plan for longer than the worker can reasonably be expected to remain in the United States, the law does not consider them “lawfully present”根据ACA。这些人不需要参加合格的健康保险。