Covering All, Regardless of Immigration Status

Aissatou secured work as a domestic cleaner after immigrating to the United States. Chemicals in the cleaning products irritated the skin on her hands, and, after contracting Covid-19, she frequently experienced shortness of breath. Aissatou does not go to the doctor because she does not have insurance to cover the cost of the health care she so desperately needs.

Aissatou’s story is not unique in the State of New York. Over 150,000 uninsured, low-income New Yorkers are ineligible for coverage because of their immigration status.  Many do not qualify for employer-sponsored programs, leaving them to rely on government programs, which may prohibit enrollment for people who are undocumented. As a result, immigrants have some of the highest uninsured rates in the state.

Uninsured New Yorkers often avoid care for fear of costs. When they can no longer avoid care and seek treatment in emergency rooms, they often incur unaffordable bills. These barriers result in a population of immigrants disproportionately affected by injury, chronic conditions, and communicable diseases, all of which have been well-reported in Public Health Post.

We can do better by enacting Coverage For All (A880/S1572), which would allocate $345 million to a state-funded Essential Plan. Our legislative representatives in Albany can make all New Yorkers eligible for quality, affordable health care coverage. This would include all New Yorkers who are currently excluded from purchasing health insurance due to their immigration status. It would also include all New Yorkers living up to 200% of the federal poverty level.

A state-funded Essential Plan would leverage $482 million in federal emergency Medicaid funds to lower the cost of the overall program. The state’s portion would total $345 million and cover over 110,000 immigrant New Yorkers. The Urban Institute calculates that insuring 110,000 uninsured people could save over $318 million in uncompensated health care costs.

The Coverage For All campaign within the Health Care For All New York initiative is led by the New York Immigration Coalition and Make the Road New York. It comprises a coalition of community members, community organizations, health care providers, legal service providers, and labor, immigrant, and health care consumer advocates. African Services Committee sits on the campaign’s steering committee and regularly emcees marches and rallies to further empower our constituencies.

Over 54% of New York’s essential workers are immigrants. They have been on the frontlines of New York’s fight against Covid-19. Taking care of our sick and elderly. Cleaning our public spaces. And delivering our meals. Throughout the pandemic, the African Diaspora immigrant community has been at greater risk of exposure to Covid-19, largely because of their status as essential workers. This exposure has led to a greater number of infections and deaths related to Covid-19 compared to the general population in the State of New York. According to a 2021 report by Families USA, more than 8,200 New Yorkers died from Covid-19 due to lack of health insurance coverage. At least 2,700 were undocumented.

Of course, the implementation of Coverage For All comes with challenges. We would need to educate potential benefactors to compel them to enroll. This would mean helping them to overcome their fear of government and misinformation about changes to the public charge rule, which I have vocally opposed. We would also need to educate stakeholders in health systems to ensure that they do not turn people away from enrolling.

Including Coverage For All in the state budget will be a very real and concrete action the state can take to address the glaring racial disparities in health that the pandemic has exposed.

Including Coverage For All in the state budget will be a very real and concrete action the state can take to address the glaring racial disparities in health that the pandemic has exposed.

The State of New York has a well-documented history of providing coverage to immigrant communities excluded from federal programs. But we are falling behind in comparison to other states. California and Illinois are providing health insurance coverage to people who are undocumented by using state funds, and New York can do the same.

Last month, in the State of the State address, Governor Hochul announced her intention to establish an Equity Agenda committed to improving “health equity” and “expanding coverage.” The Governor can begin by adding Coverage For All to this year’s state budget. Increasing the number of insured New Yorkers will improve community health outcomes and economic security, which means we all win. Immigrant New Yorkers win. New York wins. While living through a global pandemic, we must demand nothing less.

Editor’s Note: Details of the client are changed in order to protect their identity.

Photo via Iwaria