Fiscal Prudence – Not Reactive Politics – Should Dictate New York Health Policy
David R. Jones, The Urban Agenda
More than one million New Yorkers remain uninsured in our state with immigrants representing the third largest group of uninsured residents. For a state that has historically been a national leader when it comes to pioneering innovative healthcare options for its residents, the fact that so many New Yorkers are without coverage is simply a disgrace.
Maybe in other states like Mississippi or Alabama this is acceptable, but not in New York.
Besides improving health care outcomes and taking the strain off a stressed out health care system, narrowing the state’s coverage gap bolsters the economic security of the newly-insured and reduces the chances of medical debt and bankruptcy. In the face of ongoing global pandemics, increasing access to healthcare not only makes economic sense, but it makes everyone safer.
Last year, in her first budget as New York’s chief executive, Governor Hochul and the State Legislature extended comprehensive health coverage to undocumented immigrants over 65 – an important first step toward closing the New York’s coverage gap for uninsured immigrant residents. The 2022-23 state budget also expanded eligibility for the Essential Plan to higher income levels, eliminated the $9 monthly premium for Child Health Plus (CHP), and extended Medicaid coverage – regardless of immigration status – for people during their first year post-pregnancy. Given New York’s unconscionably high maternal mortality rate, especially for Black and brown families, this extension of post-pregnancy coverage in the first year of the life of a child was particularly significant.
The Community Service Society (CSS) and other advocates applauded the governor for expanding health coverage to undocumented adults and promoting health equity overall. At the time, the governor asked for patience as her administration searched for a solution to tackling the larger issue of extending coverage to all immigrants of all ages, something she indicated she would pursue through applying for a Section 1332 Waiver under the Affordable Care Act.
About 250,000 New Yorkers are prohibited from enrolling in public health programs such as Medicaid and the Essential Plan, or accessing coverage through Qualified Health Plans because of their immigration status.
During a post-budget press conference last year, Gov. Hochul was asked why health coverage for undocumented adults, between the ages of 19 and 64, were not part of the budget. In response, the governor acknowledged that the availability of immigrant coverage is “not ideal,” but that going forward her administration would “reach out to the federal government to ask for a Waiver,” so that New York would be able to fund health insurance for low-income undocumented immigrants through the existing federal-funded Basic Health Plan/Essential Plan Trust Fund.
The Trust Fund is a potent source of funding with an $8 billion surplus which increases by $2 billion each year. States such as Colorado and Washington have already taken advantage of it to obtain Section 1332 waivers to cover immigrants. Federal rules stipulate that the Trust Fund can only be used to pay for health insurance coverage.
In light of the progress in last year’s budget to address healthcare affordability, there were high expectations within New York’s advocate community that the Hochul Administration would use this year’s budget to secure authority to cover immigrants and chip away at the state’s coverage gap—by seeking federal underwriting to do so. Even fiscal hawks at the Citizen’s Budget Commission and the Empire Center have encouraged this approach.
But instead of taking advantage of the opportunity to have the federal government cover the cost of health insurance for immigrants, the governor’s current budget proposal features waiver language that would actually exclude immigrants. In doing so, the state is passing up an opportunity to save more than $500 million annually on Emergency Medicaid funds spent on immigrant emergency care.
And that’s not all. Opting to fund immigrant coverage through a federal waiver would yield further savings for the state by substantially reducing the amount safety-net hospitals’ spend on uncompensated care ($1,174 per person covered each year) since more New Yorkers would have comprehensive coverage. New York City would also save $100 million a year by retiring its NYC Cares program, since the population that benefits from the program would be eligible for health insurance.
In many ways, New York’s omission of immigrant coverage in the governor’s waiver proposal is analogous to “red” states’ refusal to expand Medicaid coverage to their low-income residents, many of whom are Black and low-income.
New York should be a leader on progressive health care initiatives. And fiscal prudence, not reactive politics, should dictate health policy.
Over the 30-day budget amendment period, it is imperative that lawmakers voice their opposition to the 1332 Waiver proposal in the governor’s budget because it backtracks on her commitment last year to include immigrants. Readers can also express their opposition to the Waiver without the inclusion of immigrants directly on the State’s website which has an easy to use poll here: https://deloittesurvey.deloitte.com/Community/se/3FC11B261AF2A434 .
Expanding healthcare coverage to immigrants can be done without costing the state a dollar. What are we waiting for?