Gabriel Henao fled Colombia to escape a guerrilla group that twice threatened to kill him. After staying in Mexico for a while, he arrived in Colorado in July 2022 and settled in Fort Collins.
He said the severe abdominal pains started when he was in Mexico. It left him debilitated and bedridden for days at a time. In the U.S., Henao continued to suffer from pain, but he said cleaning houses didn't earn him enough to pay for his health insurance.
Colorado did not offer Medicaid coverage to residents like Henao who live in the country without legal status or to immigrants who are required to wait five years after receiving a green card. Without coverage, Henao would not have been able to get proper tests, let alone diagnose and treat her abdominal pain, he said.
That changed earlier this month when Henao received care through Colorado's Omnisarud program. The program provides undocumented health insurance to low-income immigrants in the country. When the program begins accepting enrollments in 2022, 10,000 people will be eligible without mandatory premium payments, and this year Colorado expanded the zero-premium pool to 11,000 people.
Alianza NORCO, a nonprofit organization that assists immigrants in northern Colorado with legal and other resources, is helping Henao adjust to the United States and assisting him in applying to the Omnisarude program.
“I started getting really scared and nervous and anxious because I didn't have the money to take care of my health,” said Henao, a 44-year-old father of three who runs a clothing warehouse in Colombia. He applied for asylum, saying his life was in danger in his home country.
Now that he had an appendectomy three weeks ago, he said in Spanish through an interpreter from the Colorado Immigrant Rights Coalition, “I'm feeling great.”
Colorado is among a growing number of Democratic-controlled states that are expanding health care to a limited number of immigrants who cannot buy public insurance because of their legal status.
Supporters argue that insured people are more likely to receive treatment and preventive care for chronic conditions, avoiding costly medical crises that end up costing taxpayers and raising premiums for the insured. They argue that such a system will save money in the long run. But critics object to spending millions of dollars to insure people living here without permission at a time when more states are facing budget shortfalls.
Meanwhile, the surge of migrants at the U.S.-Mexico border is expected to be a key issue in the presidential election campaign. And earlier this week, nine Democratic governors sent a letter to the Biden administration and Congressional leaders urging them to resolve the “humanitarian crisis” of “the sustained arrival of people seeking asylum and in need of shelter and assistance.” requested.
Colorado's program is open to immigrants, regardless of legal status, with annual incomes of less than $22,000 as an individual or $45,000 for a family of four. The state filled 11,000 vacancies in two days. The program costs the state an estimated $73 million annually, according to the Colorado Department of Insurance.
“For some people, it's the first time everyone in their family has access to health care, and this is a life-changing breakthrough,” said Raquel Lane Arellano, communications manager for the Colorado Immigrant Rights Coalition. said. “They're not just looking for emergency treatment. They can get preventive treatment.”
cover more people
Supporters say the pandemic and the health disparities it has exposed have spurred national efforts to provide coverage to more people, regardless of immigration status.
“This is a very exciting trend and one we are monitoring closely. Some of the work on this issue has been going on for decades,” said Tanya, senior staff attorney at the National Immigration Law Center. Broder said. “However, during the height of the pandemic, there was a really heightened awareness of the value of investing in health care for all, when our health is interconnected and we needed to work together in our communities to protect our citizens. Because states recognized that it makes sense to protect everyone's health.''Health. “
California, Oregon, and Washington also offer health insurance to people of all ages with incomes below a certain level, regardless of immigration status. Minnesota plans to do so starting in 2025.
Additionally, at least 24 states and Washington, D.C., currently offer insurance to immigrant pregnant women during the five-year waiting period to qualify for Medicaid, according to an analysis by KFF, a health policy research institute. Meanwhile, seven states — California, Illinois, Maryland, Massachusetts, Minnesota, Rhode Island, and Washington — are using state grants and funding from the federal Children's Health Insurance Program, known as CHIP, to provide support for children regardless of immigration status. We provide insurance for one year after giving birth. , according to KFF.
Starting in March, Michigan will eliminate the five-year waiting period for Medicaid for children and pregnant women. Simon Marshall-Shahr, senior policy analyst at the Michigan Public Policy Federation, said the change would cover up to 4,000 children and about 5,500 women, most of them Hispanic. Michigan will spend about $6.4 million on the program, with federal matching funds bringing the total to $26.4 million.
And this month, a new law went into effect in California that provides Medicaid coverage to adults ages 26 to 49, regardless of immigration status.
California gradually rolled out health insurance to immigrants. In 2020, the state expanded its Medicaid program, called Medi-Cal, to young adult immigrants ages 19 to 25, modeling the Young Adult Expansion Program on its previous program for children under 19.
“This expansion comes from the state's general fund, which means there are no new taxes or new sources of funding that must be raised for this expansion,” said Sara Darr, policy director at the California Immigration Policy Center. That's true.'' Because emergency department visits are costly for both individuals and hospital systems, creating a program to expand access to primary health insurance “makes fiscal sense,” she said.
Backlash against efforts
But critics say California can't afford the expansion given the state's growing budget deficit. Republican state Sen. Brian Jones, the minority leader, issued a statement earlier this month urging Democratic Gov. Gavin Newsom to enact an 18-month freeze on the program.
“Amid massive budget deficits, hospital closures, and a massive influx of immigrants illegally crossing our open borders, now is not the time to expand this costly government program,” Jones wrote. Ta. “Our priority is to protect our critical services and core capabilities.”
In Nevada, Republicans last year blocked an effort to expand Medicaid to undocumented immigrants, saying the proposal would be too expensive. During a floor debate in March, Republican state Sen. Robin Titus, who is also a physician, advocated adding thousands more people to the Medicaid rolls at a time when the state already suffers from a lack of enough health care workers. He said he was concerned.
“You're diluting a system that's already diluted even more. So in the long run, it could hurt everyone,” she said. “How do we solve access to health care when we already don’t have enough health care?”
But Republican-majority Utah this month began enrolling children in a new state-funded children's health insurance program that covers undocumented immigrant children. A bipartisan bill signed by Utah Republican Gov. Spencer Cox last March allocated $4.5 million for the program.
Critics argue that immigrants living in the United States illegally burden the system without contributing to it. However, even unauthorized workers have payroll taxes deducted from their paychecks, and they also pay sales tax when making purchases. Immigrants without legal status pay property taxes on their homes, pay property taxes indirectly as renters, and at least half file income tax returns.
Research shows that these taxes help support public insurance programs such as Medicaid and Medicare. Immigrants who immigrated without legal authorization cost an estimated $51.9 billion more in medical costs, according to an analysis published in the American Medical Association's JAMA Network Open in 2022 by researchers from Boston University, Harvard Medical School and other institutions. It turned out that they were paying into the health care system.
Ultimately, “it's a question of values,” said Dahl of the California Immigration Policy Center. “We want our communities to be healthy. … It's much less expensive to just get preventative care, get tested regularly, and take insulin. Take a statin if you need it. If you have blood pressure problems, take a statin. These are actually much cheaper than expensive life-saving treatments and tests.”
Starting this month, Washington state will allow undocumented immigrants and those eligible for the Deferred Action for Childhood Arrivals program, which delays deportation for immigrants who came to the U.S. as children, to purchase health insurance through the state's exchange market. is recognized. People with incomes of $36,450 or less may qualify for state assistance to cover premiums.
The state also plans to launch a new Medicaid program in July for poor residents ages 19 and older, with spending caps.
Dr. Leo Sergio Morales, co-director of the Center for Latino Health at the University of Washington, noted that certain treatments and procedures, such as transplants, are particularly expensive and increasingly inaccessible to the uninsured.
“Transplants can potentially save lives,” Morales said.[and] People must be able to afford post-transplant medications and treatments. This means that they will be immunosuppressed for the rest of their lives. ”
States are also struggling with budget constraints. Last November, for example, Illinois suspended new enrollment in its health insurance program for non-citizens over the age of 42.
Colorado's Omnisarud currently provides zero-premium coverage to 11,000 people, but there are about 200,000 immigrants in Colorado without authorization, according to Colorado Immigrant Rights Coalition's Lane.・Mr. Arellano pointed out. “Our biggest hope is that the program continues to grow,” she said. “This is truly an ‘all ships rising’ situation.”
“There is economic reason and sound data to prove that preventive care saves the economy and the health of families in the long run,” she added. “When people get sick or go into medical debt, it hurts families, it hurts entire communities, it hurts the economy.”
Henao hopes more states create programs like Omnisarud.
“All communities will benefit if arriving migrants receive the support they need, the ability to work, and access to health insurance,” he said. “Medical costs are high in this country.”
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