Coverage for All hangs in the balance as Assembly returns to Albany

The Assembly is back in session this week to consider a slew of legislative priorities, but the popular Coverage for All bill – which would extend health insurance coverage to undocumented immigrants – does not appear to be among them. Gov. Kathy Hochul has repeatedly brought up concerns about the cost of the proposed bill – even though the bill’s Assembly sponsor said she’d been working with the governor’s office to address those concerns, which are reflected in the amended bill. 

The bill, sponsored by state Sen. Gustavo Rivera and Assembly Member Jessica González-Rojas, would make healthcare coverage accessible to all New Yorkers, regardless of their immigration status. Although the bill passed the state Senate in the waning days of the legislative session, it never made it to the Assembly floor. On Tuesday, the Assembly returned for an extra few days of session, but the Coverage for All bill is not on the chamber’s list of bills to be considered. The office of Assembly Speaker Carl Heastie did not immediately respond to a request for comment.

While immigrant advocates continue to push for the bill’s passage – rallying outside of the Assembly chamber as lawmakers returned for session on Tuesday morning – Gov. Kathy Hochul has expressed concerns over the measure’s supposed financial impact on the state. 

Last year, the Legislature proposed including coverage for undocumented immigrants in the state budget, but Hochul objected. The governor claimed that the price tag for providing health care to undocumented New Yorkers would be $1.9 billion per year, which advocates argued was heavily inflated. Eventually, the governor and Legislature agreed on a state budget that provided health care coverage for undocumented New Yorkers over 65, and Hochul also made a pledge to seek federal funds to offset the cost of extending health coverage to undocumented residents.

Since then, lawmakers introduced an amended version of the Coverage for All bill that requires the state’s health commissioner to submit a 1332 state innovation waiver to the federal government, which would allow New York to use surplus funds in the state’s Essential health care plan to cover the cost of providing health care to undocumented New Yorkers. The bill would also give the commissioner the authority to implement guardrails on the program, including implementing limitations on enrollment in the program and prioritizing certain communities.

González-Rojas told City & State that those amendments were made in collaboration with the administration. “That was based on discussions with the administration early on so make this more palatable to the administration. We've already accommodated all the governor's concerns through the amended bill,” she said.

In May, the governor sent a letter to the federal government on guidance for using federal funds for undocumented immigrants. Several lawmakers then followed up with their own letter to the federal government asking for clarity on whether the state could use untapped federal waiver money as part of the Basic Health Trust Fund to expand subsidized healthcare for undocumented New Yorkers. The federal government responded by explaining the trust fund could not be used for providing healthcare for undocumented individuals but there was no prohibition on using a waiver for state subsidies to provide coverage for those individuals. 

This might have settled the matter, but then the governor found a new objection to the plan. Responding to questions from reporters last week, Hochul said that money in the fund would not last forever.

"I also want to let people know that there's about $2.2 billion in that fund, which will be gone in a very short time, and the costs accrue to the state for the implementation of that would be in the first few years, $6 billion, upwards of $13 billion,” Hochul said. “If the federal government wishes to give us more to complement that, supplement that, give us $13 billion, that makes it a lot easier on the state."

Gonzalez-Rojas said she’s worried that the governor is  “moving the goalpost” for getting the legislation passed and said there is no basis for Hochul’s claim that $13 billion in federal money would be required to expand health care coverage to undocumented immigrants. “(Hochul) came out of the blue with $13 billion. She hasn't given any justification of where that dollar figure came from,” González-Rojas said.

A spokesperson for the administration said the state estimates the total cost of covering undocumented persons who do not currently qualify for subsidized insurance will be $2-3 billion annually – in part due to the cost of conducting outreach to the undocumented population – and that figure will increase in the coming years. Meanwhile, the bill’s sponsors maintain there will be no financial impact on the state. In fact, they believe the bill will save the state over $500 million – which is what the state currently spends in Medicaid funds to provide emergency care to undocumented New Yorkers who do not qualify for the state’s health care plan.

When asked about the bill by reporters on Tuesday, Hochul touted her and the Legislature’s work expanding Medicaid to undocumented seniors last year – but reiterated her concerns about its potential impact on the state’s finances. “We've been having conversations, but I know that the Assembly is looking at it,” she said. “I also have to be cognizant of the extraordinary cost that would be imposed on New York State taxpayers at a time when the warnings about our finances are troubling.”

González-Rojas said that she is open to having conversations with the administration to get the bill over the finish line, and she also pointed to Hochul’s ability to approve the bill with chapter amendments – which would allow the bill to be signed into law under certain conditions set by the governor.  

Hochul has until the end of the year to act on bills passed by the Legislature. If the Assembly fails to pass the bill by the end of session, or the Assembly passes the bill but Hochul fails to sign it into law by the end of the year, then advocates and lawmakers will need to start the process over again.