Opinion: NY can provide health care to undocumented immigrants and still save the state $500 million

More than 8,200 New Yorkers are estimated to have tragically died from COVID-19 because they didn’t have health insurance coverage, according to a Families USA report. At least 2,050 of them were undocumented immigrants. The pandemic’s impacts cast a horrific spotlight on health care inequality and the financial and human costs of a broken health care system.

Immigrant workers were on the front lines during the most deadly and difficult periods of the pandemic. They carry out essential work that helped New York weather the storms of the last three years and the resulting economic downturn. In fact, immigrants make up 54% of essential workers in New York and 70% of undocumented workers are employed in essential businesses. These New Yorkers contribute billions in taxes and economic productivity, yet do not reap benefits like accessing state health coverage options.  

It is entirely indefensible that many of these New Yorkers continue to suffer prolonged illness and even premature death because they’re denied access to health care. Right now, an estimated 245,000 uninsured New Yorkers are excluded from federally funded health insurance such as Medicaid and the Essential Plan because of their immigration status.

We must pass our Coverage for All bill in this year's state budget to expand health insurance access to income-eligible New Yorkers regardless of immigration status. Last year, the state passed an expansion of Medicaid eligibility for undocumented immigrants aged 65 and over, and ensured that everyone, regardless of immigration status, has access to 12 months of post-pregnancy coverage. This was a significant, yet partial, victory. Unfortunately, Gov. Kathy Hochul is now proposing an implementation delay, but we know this coverage expansion must be available immediately. And, as the state proceeds with implementing last year’s gains, we must address delayed care and unmet health needs of the rest of our undocumented neighbors by passing Coverage for All. The bill would bring us closer to universal coverage in New York and ease pressures on our emergency care providers.  

Passing Coverage for All is the right thing to do. In addition to expanding coverage to the largest population of New Yorkers currently facing exclusion, it can also be done at zero cost to the state and will almost certainly generate savings and other economic benefits. Currently, the state’s Essential Plan Trust Fund account has an existing $9 billion surplus and is estimated to generate an additional $2 billion annual surplus. The state’s 1332 waiver application should propose using this $2 billion in federal funding to expand coverage to undocumented New Yorkers. 

Colorado and Washington already have permission to use their federal 1332 waivers to include all immigrants in health care coverage, while California and Illinois pay for immigrant coverage through their states’ Medicaid programs. New York can and should catch up and step forward as a leader, living up to our proud history as a national vanguard in public health advancements and as a state where immigrants receive just treatment.

By including immigrants in the waiver request, the state could save over $500 million in what it now spends on uncompensated care. New York City Comptroller Brad Lander found that passing Coverage for All would lead to annual benefits of $649 million from preventing premature deaths, $22 million in increased labor productivity and $20 million in lower out-of-pocket costs in the city. 

Last year, Hochul pledged to seek such a waiver to ensure health coverage access for all immigrants in New York. To the shock of immigrant communities and advocacy groups, the governor’s waiver request excluded this vital measure. Hochul’s U-turn could leave New York’s 245,000 undocumented immigrants without a path to access health care, decimating their hopes and leaving them to languish with poor physical and mental health. It is in the financial interest of our state that she updates the waiver request to include health coverage for immigrants.

Coverage for All is as popular as it is sensible. The nonpartisan research firm PerryUndem found that 8 in 10 New Yorkers agree that immigration status should not make it harder for an individual to receive quality health care. New Yorkers get it: Health care is a human right, and by ensuring the health of our immigrant communities, we will give our communities the best chance of recovering – and thriving.