The ACA has helped New York close the coverage gap by enrolling over 2.7 million New Yorkers into coverage. But some New Yorkers remain ineligible for these new options for affordable coverage because of immigration status limitations on affordability programs.
The Community Service Society, a HCFANY Steering Committee member, released a new report today that offers an in-depth analysis of costs, eligibility and coverage options related to providing affordable and high-quality health insurance to nearly a half million unauthorized immigrants living in New York who are uninsurable due to their immigration status.
The paper, “How New York Can Provide Health Coverage to its Uninsured Immigrant Residents,” describes three coverage options that would improve health coverage for a vulnerable segment of the state’s population while also closing the coverage gap left by the Affordable Care Act (ACA).
Despite the state’s expansive public insurance programs, there are as many as 457,000 unauthorized immigrants ineligible for coverage. Uninsured people are more likely to get sick and even die younger, and the cost of care can mean financial ruin for uninsured families. Treating uninsured patients also strains the budgets of community health care providers that treat them.
The policy paper investigates three coverage options that would extend health insurance to between 90,100 and 241,600 immigrants New Yorkers who are ineligible for Medicaid and Marketplace coverage due to their immigration status. Funding even the most ambitious of these proposals would result in a less than one percent increase in the state’s health budget of roughly $65 billion.
The report also points out a more modest policy fix that New York could enact this year, while the State considers the more comprehensive options outlined in the report. This option, the Essential Plan “Clean Up,” would extend Essential Plan coverage to about 5,500 lawful immigrants in New York with immigration statuses that would make them eligible for Medicaid in New York, but not for the federally-funded Essential Plan. These New Yorkers include young adults who qualify for Deferred Action for Childhood Arrivals status, also known as the Dreamers.
A report released this week by Kaiser Family Foundation shows that 58% of uninsured New Yorkers are eligible for free or subsidized health coverage. The majority of them – 548,000 people – are eligible but not enrolled in Medicaid. There are several reasons why people who are eligible for Medicaid have not enrolled: some do not know they’re now eligible under the Affordable Care Act’s Medicaid expansion, some avoid Medicaid because of the stigma of poverty attached to the program, and some have had their income drop since they last applied for coverage.
The 317,000 New Yorkers who are uninsured but would qualify for financial assistance (such as Cost Sharing Reductions and Advance Premium Tax Credits) on the Marketplace includes consumers who are newly-eligible for the Essential Plan, New York’s forthcoming Basic Health Program. Consumers enrolled in the Essential Plan will have monthly premiums of $0 or $20 a month, no deductible, and very low copays; this combination should assuage the fears of people who believe health coverage is too expensive. The New York State of Health hopes to draw consumers back during the third Open Enrollment period, which begins on November 1, by highlighting these new levels of affordability. They’ll be targeting these 317,000 New Yorkers with videos, social media campaigns, and catchy new graphics (stay tuned for more!).
Nearly a third of uninsured New Yorkers – 457,000 people – are unauthorized immigrants. New York City Mayor Bill de Blasio’s recent announcement on connecting immigrants to care through a “Direct Access” program was a crucial first step for those immigrants living in the City, and Health Care for All New York will continue to advocate for comprehensive health insurance coverage for our undocumented neighbors. New York State has done a fabulous job in the first two Open Enrollment periods in connecting people to coverage, and the rollout of the Essential Plan will be another step in the right direction. A critical next step for closing the coverage gap in New York will be expanding affordable coverage to New Yorkers who are excluded from coverage options because of immigration status.
New York City Mayor Bill de Blasio announced a new plan yesterday to connect the City’s undocumented immigrants with a soon-to-be launched “Direct Access” health care program. The Direct Access program is not insurance coverage, but a network of health care providers with the cultural competency and linguistic diversity to serve New York’s many immigrant communities.
The Direct Access program is outlined in a newly released report from the Mayor’s Task Force on Immigrant Health Care Access, available here. HCFANY Steering Committee members Becca Telzak (Make the Road New York), Claudia Calhoon (New York Immigration Coalition), Sheelah Feinberg (Coalition for Asian American Children and Families), and Elisabeth Benjamin (Community Service Society of New York) served on the Task Force that wrote the report. The report underscores that coverage is the gold standard for care and recommends that ultimately a coverage-based solution be developed for immigrants:
The Task Force believes that all individuals, regardless of immigration status, should have access to affordable health insurance coverage. Accordingly, it urges the State of New York to expand public health insurance options to the undocumented population and urges Congress and the federal government to remove harmful restrictions on immigrant health insurance access.
Consistent with the report’s findings, HCFANY will continue advocated for health coverage for all New Yorkers, regardless of documentation status and lauds New York City for taking this important interim step while the goal is secured.
By Claudia Calhoon, MPH, Director of Health Advocacy, New York Immigration Coalition; Laura F. Redman, Director, Health Justice Program, New York Lawyers for the Public Interest; and Sarika Saxena, Staff Attorney, Health Justice Program, New York Lawyers for the Public Interest
The release of the 2015 Open Enrollment report from the New York State of Health (NYSOH) demonstrates that NYSOH made important progress in reaching New York’s culturally diverse immigrant communities this year. The New York Immigration Coalition (NYIC) and New York Lawyers for the Public Interest (NYLPI) supported a number of strategies for effective outreach, such as a Spanish-language version of the web portal and outreach materials in 17 different additional languages. HCFANY is excited to see that New York has made concrete progress toward making the Marketplace friendly and accessible for all immigrant communities.
Other important accomplishments in the report include:
- 13% of enrollees selected Spanish as their primary language (as opposed to 10% in 2014)
- 25% of Marketplace enrollees describe themselves as Hispanic, a population that is disproportionately likely to be uninsured (an increase from 21% in 2014)
- Help from the NYSOH call center was given in 92 different languages, suggesting that information on coverage is reaching a wide array of diverse communities.
- Availability of an interactive calendar of events, navigation tools, and new “How to” videos in English and Spanish.
These successes point to the Affordable Care Act’s approach of working with in-person assistors, NYSOH Navigators and certified application counselors. Many Navigators and CACs work at strong culturally competent and language proficient immigrant-serving organizations, offering enrollment assistance in a total of 48 different languages.
The report also highlights important areas for improvement for open enrollment 2016 and beyond. Enrollment for French, French Creole, Italian, Korean, and Russian speakers does not appear to have increased. Consumers who speak languages other than English and Spanish would benefit from a calendar, navigation tools, and videos in other languages. And improved data on racial and ethnic minority and language groups will be essential to help inform targeted and innovative outreach and engagement strategies to make sure all immigrant communities can benefit fully from the ACA. While it is evident that information may be getting to diverse communities, information on enrollment outcomes is not available. Unfortunately, 31% of enrollees chose not to report their race, and 12% chose not to report their ethnicity, which represents a large gap in our knowledge. HCFANY members like the NYIC and NYLPI will continue to work with NYSOH to identify strategies to improve data collection and to educate health consumers about why sharing racial and ethnic identity information is safe and important.
This is the fourth in a series of blog posts about the NYSOH 2015 Open Enrollment Report.