Published in the POLITICO New York on March 1, 2016
Ana Rodriguez was thrilled when she first received health insurance through New York state’s Medicaid program.
It made her feel just like everyone else, said Rodriguez, who was brought to Miami from the Dominican Republic when she was 6 years old.
Her immigration status kept her from obtaining a Florida driver’s license, which made commuting a hassle, so at age 24 she moved to New York, which had a more accessible public transportation system, and where, thanks to a New York court ruling, she was able to enroll in Medicaid, the health insurance program for low-income residents.
Rodriguez applied for the Deferred Action for Childhood Arrivals, or DACA, program, which was created by President Barack Obama in 2012 to provide relief for undocumented immigrants brought to this country when they were children.
Rodriguez, now 30, lives in Bushwick and finds sporadic work through a temp agency, often in the catering business. She earns less than $10,000 in a year, she said.
An aspiring jeweler, Rodriguez hopes to save enough to one day open her own business. But she has been warned — should her income increase above $16,243, she will no longer qualify for Medicaid.
The Affordable Care Act is supposed to cushion that blow by offering subsidies to purchase private health insurance to those who earn too much to qualify for Medicaid. But Rodriguez, because of her DACA status, isn’t entitled to federal subsidies. Nor is she allowed to purchase a plan through the Obamacare exchange even if she was willing to pay the entire cost.
“If I start to do better, I’ll have no health care,” Rodriguez said. “It’s frustrating because we all want to progress and take care of ourselves and have a better income every year, but … I will have to choose between health care and income.”
Rodriguez is one of approximately 5,500 immigrants in New York state facing this fiscal cliff, according to a report from the Community Service Society, which advocates on behalf of immigrants and low-income New Yorkers.
Representatives from Health Care For All New York will be in Albany on Wednesday calling on the governor and Legislature to expand the state’s Basic Health Program, also known as the Essential Plan, so that it covers people like Rodriguez until they earn $23,760, or twice the federal poverty level.
That would cost the state $10.3 million per year, according to the report.
“It would make a huge difference, just knowing that if you get sick you can go to a doctor,” said Denisse Rojas, a first-year medical student at the Icahn School of Medicine at Mount Sinai.
Rojas, 26, was brought to California when she was a few months old, and, like Rodriguez, must reckon with what an increasing income would mean for her health insurance status.
“Thankfully, I haven’t been really ill but you’re always really worried something is going to happen to you,” she said.
New York is a rarity in that the state offers people residing under the color of law — a legal term for those who are not citizens but not under threat of deportation — Medicaid benefits.
When Obama created the DACA program, thousands of New Yorkers who were brought to the United States at a young age were suddenly eligible for Medicaid. It also allowed them to pay taxes.
This past January, the state launched the Essential Plan, which provides federal subsidies to citizens who earn too much to qualify for Medicaid but still cannot afford a private health insurance plan.
Because the Essential Plan was created under the auspices of the Affordable Care Act, DACA immigrants are not eligible, even though some other immigrants can receive those benefits.
“This measure is a matter of fairness and equality for people who are legally here in New York,” said Elisabeth Benjamin, vice president of health initiatives for the Community Service Society and a co-founder of Health Care For All New York. “It’s remarkably unfair to leave this tiny subset behind.”
Advocates want the state to pick up the tab for the approximately 5,500 immigrants whose income qualifies them for the Essential Plan but who are ineligible because of their immigration status.
“New York already offers Medicaid at full State expense to very low income people with DACA status,” David Sandman, president and CEO of the New York Health Foundation, said in an email. “This provision would rationalize the coverage system for a small number of young immigrants who would otherwise be cut off and punished for earning even a dollar more than the Medicaid threshold.”
The movement to expand the Essential Plan has gained some support.
Assemblyman Richard Gottfried, chair of the health committee, and Assemblyman Marcos Crespo, chair of the Puerto Rican/Hispanic caucus, have asked Speaker Carl Heastie to include the money into their one-house budget.
“Access to coverage ensures people are physically and mentally healthier and are less likely than their uninsured counterparts to die prematurely,” they wrote. “Coverage helps reduce the costs of publicly-funded uncompensated care.”
Nearly two dozen other Assembly members have signed onto the plan.
Gottfried, in an email, said expanding the Essential Plan for the DACA cohort makes fiscal sense and would likely save money over the long term.
“People not eligible for the Essential Plan would likely go without care or delay care for serious health conditions, which in turn drives them to hospital emergency rooms where the costs are highest and the providers uncompensated,” Gottfried said. “Someone making 138 percent of poverty [level] — under $1,400 a month — certainly can’t afford to buy a decent health plan on the market. Even if they can find a cheap premium, they are likely to face several thousand dollar deductibles on an income far too low to save for emergencies. So they will more likely go without insurance altogether.”
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