California is Covering the Undocumented – What About New York?
Across the United States, communities are struggling to overcome a global pandemic. And at the same time, Black, Indigenous, and peoples of color are once again disproportionately impacted due to systemic racism. In addition to overcoming the numerous inequities that have long been ignored, in the time of COVID-19, Asian Americans — particularly those who are East Asian-presenting — have seen an explosion of xenophobia and racial violence. Health Care For All New York (HCFANY) condemns this racial violence and urges our elected officials to enact policies that advance health equity. HCFANY is a statewide coalition of 170 consumer-focused organizations dedicated to achieving quality, affordable health coverage for all New Yorkers, and ensuring that the concerns of real New Yorkers are heard and reflected in policy conversations.
According to Stop AAPI Hate, a joint initiative that has been tracking Coronavirus-related incidents of harassment, hate speech, and/or violence against Asian Americans and Pacific Islanders, there were 3,795 reported incidents in the US from March 19, 2020 to February 28, 2021. Over 500 of these incidents (14%) took place in New York. NYPD data shows there were at least six attacks on Asian Americans in January and February 2021, compared to none during those months in 2020. Additionally, many bias-based incidents continue to go unreported.
Hate crimes themselves perpetuate health equity issues. Discrimination-related stress has been shown to result in health disparities, and victims of hate crimes suffer long-term effects like depression, anxiety and post-traumatic stress disorder (PTSD).
There is a long history of racism and xenophobia against Asian Americans in the U.S., particularly during times of economic hardship, alleged threats to national security, and/or disease. And there is a long history of anti-Asian racism being enacted into law, such as the Chinese Exclusion Act and the incarceration of Japanese Americans during World War II. Underlying these policies are racist and harmful stereotypes of Asians as a “model minority,” pitting communities of color against each other and rendering those who struggle invisible; or Asian Americans as perpetual foreigners and un-American in their own communities. The COVID-related hate incidents of today, fueled by racist statements and misplaced anger towards those perceived as Chinese, perpetuate this history.
Inequities faced by Asian Americans and other communities of color have also been demonstrated through the inadequacy of COVID-19 data reporting and subsequent public health response efforts. Data collection and reporting on race and ethnicity can be vastly different across state, county, and local health systems. For example, Asians are sometimes classified as “Other” and/or aggregated with other racial groups due to their smaller population size. And even when Asian American population data is collected and reported, failure to disaggregate the data by Asian ethnicity erases the variations in economic, social, and cultural diversity among Asian subgroups.
These differences have an effect on whether certain Asian populations, especially immigrants, are likely to have health insurance coverage, whether they may be at increased risk of certain chronic conditions or diseases, and what interventions may be more successful. It is impossible to address these issues without access to data that accurately defines the problem.
Immigrant communities also face barriers to COVID-19 testing, care, and vaccination because of the lack of language access and cultural relevance of accurate information on prevention, testing, and vaccines. Additionally, anti-immigrant attacks, from hate crimes to Trump-era attempts to curtail immigrant access to care, intensify fears and create barriers to care for members of multi-generational households, especially those with mixed immigration status.
To advance health equity, we must come together to fight for racial justice. We need to hold policy makers at all levels of government to be accountable to the needs of communities that are most impacted by systemic racism, and also be committed to creating systemic changes to ensure equitable access to healthcare. HCFANY applauds the State’s commitment to providing $13 Million to support Asian American community-based organizations and to support implementation of data disaggregation of diverse Asian ethnic groups. HCFANY urges state and local leaders to: (1) work in partnership with the Coalition for Asian American Children and Families (CACF) and partnering Asian American community organizations in implementing the robust collection, monitoring, and reporting of disaggregated health data; (2) expand affordable Essential Plan coverage to all New Yorkers, regardless of immigration status; (3) support safety net hospitals that treat diverse New Yorkers of all race, ethnic, national origin, and language backgrounds; and (4) ensure equity and access (especially language access) to COVID-19 information, testing, treatment, and vaccines through community-based measures like pop-up vaccine sites with appropriate in-person interpretation and translation in hard-to-reach AAPI and other underserved communities.
Medicaid Matters New York and Health Care for All New York – the two major statewide health care consumer advocacy coalitions – applaud the State Legislature for several historic additions to the adopted state budget for 2021-22 related to funding for public schools and universities, rental and mortgage assistance, assistance to undocumented essential workers and small businesses, and taking some first steps toward restoring progressivity to the state’s tax system. Millions of low-income New Yorkers who rely on our state’s public health insurance programs will benefit from these improvements to the Governor’s initial set of budget proposals.
However, our State leaders failed to break ground in health care, which is disappointing in light of a decade of austerity budgets and the ongoing nature of the COVID-19 public health crisis. Medicaid Matters and HCFANY are specifically concerned about the following issues:
- The arbitrary Medicaid global spending cap was extended for another year. As a consequence, Medicaid continues to be approached with an austerity mindset. For ten years, Medicaid has suffered from unnecessary cuts, impacting access to services for low-income people, families, people with disabilities and communities.
- Public health insurance coverage was not expanded to low-income immigrants who have had COVID-19. Instead, those who are undocumented remain reliant solely on Emergency Medicaid for acute care and charity care programs for ongoing treatment. As a consequence, many will likely forego seeking necessary care, thereby prolonging illness and suffering, risking death, and incurring medical bills they cannot pay.
- The home care crisis and institutional bias remain unaddressed. Home care workers play a vital role in serving and protecting disabled New Yorkers and seniors living independently, a role that became even more critical and evident during the pandemic. However, New York’s failure to invest in home care has created a “worst in the nation” workforce crisis that prevents meaningful access to home care services for thousands of people and results in greater institutionalization.
- This is the first time in decades that New York State has adopted a discriminatory maternity coverage policy. Instead, only citizen and lawfully residing immigrant women will enroll in free (state-funded) Marketplace coverage after their Medicaid ends—continuing a system that allows for disruptions in care.
- No new initiatives were created to address inequities that are wide-spread throughout our state’s public health, health care, and health coverage systems, despite significant federal pandemic-related funds the state has received over the past year to address these disparities. The pandemic has revealed them clearly, and they can no longer be ignored.
On the positive side, we thank both the Governor and Legislature for these new initiatives:
- Eliminating all premiums in the state’s Essential Plan that provides insurance coverage to low-income people and families who are not eligible for Medicaid. This move will enable them to keep medical, dental, and vision coverage in place without financial barriers, an important step during the ongoing pandemic.
- Protecting the financial stability of community health centers and other safety net providers by delaying the implementation of the planned pharmacy carve-out from the state’s Medicaid Managed Care program.
We also acknowledge and appreciate restorations in funding cuts initially proposed by Governor Cuomo that made no sense given our ongoing pandemic:
- An across-the-board Medicaid rate cut that particularly threatened safety net hospitals that serve large numbers of Medicaid and uninsured patients.
- Elimination of Indigent Care Pool funding to public hospitals.
- Cuts to the state’s Vital Access Provider Assistance Program that keeps certain safety net and rural hospitals financially afloat.
- Additional cuts to Article VI public health funding to New York City.
- Allowing insurers to impose restrictions on the ability of doctors to prescribe certain drugs to Medicaid patients (elimination of the provision known as “prescriber prevails”).
- Another 25% cut to home care workforce recruitment and retention money that would have further harmed community-based long-term care.
- Cuts to programs serving adult home residents.
While as a whole and on the surface it may appear that New York continues to meet the needs of those enrolled in our state’s public health insurance programs and the providers they rely on, the 2021-22 adopted budget fails to make needed investments to turn away from austerity politics, protect all immigrants, expand community-based long-term care, and promote health equity. A lack of harm must not be confused with a budget that provides for what New Yorkers need. We can do better, and we must.
There are lots of opportunities coming up over the next couple of weeks to learn more about health policy priorities and how to take action. Here’s a few of them!
TODAY: Statewide Day of Action for Guaranteed Healthcare (link)
The Campaign for New York Health is holding a day of action for the New York Health Act, which would provide comprehensive health coverage for everyone who lives or works full-time in New York. Look for #PassNYHealth to see what people are saying and join in!
- Learn more about why we need the New York Health Act here.
- If you missed the day of action you can always show your support for the New York Health Act by clicking this link and telling your State Assemblymember and Senator to support the bill. If they already do, the link will give you an opportunity to thank them!
Tomorrow: #Coverage4All Virtual Day of Action
There are 400,000 New Yorkers without insurance because of their immigration status. A1585/S2549 would guarantee that all New Yorkers can access life-saving health coverage if they have had COVID-19. Look for #Coverage4All and #PassA1585 all day tomorrow to help get the word out!
What else can you do?
- Sign up for campaign updates here.
- Become listed as a supporting organization here.
- Contact your legislator any time using the instructions here.
Friday, 11:00-12:00: Budget Briefing for Health Justice Advocates
Join the Campaign for NY Health, the Consumer Directed Personal Assistance Association of New York State, Coverage4All, Health Care for All NY, and Medicaid Matters NY for an overview of the FY22 Executive Budget Proposal and its implications for healthcare in New York. Register here.
Friday, February 5 1:00-3:00: HCFANY Annual Meeting
What can we expect from legislative session this year? How do we push forward and ensure quality, affordable health care for everyone in New York State during a pandemic and a budget crisis? Join us to learn more about our legislative and budget priorities for 2021 and how you can take action yourself! Click here to register!
During this virtual meeting we will:
- Award Senator Gustavo Rivera as this year’s Consumer Champion and present a posthumous Lifetime Achievement award to Kristin Sinclair, Director of the Senate Health Committee.
- Share information about the state budget and our legislative priorities, including expanding health coverage to all New Yorkers, ending medical debt, and addressing systemic inequity in our health care system.
- Talk about future workshops that will offer deep dives on different health policy issues and opportunities to take action.
In a climate of relentless attacks on immigrants, including as to their right to quality health care, it’s easy to get discouraged. But California has recently provided us with a ray of hope.
In July, California’s Democratic governor, Gavin Newsom, signed legislation to cover (with state funding) an estimated 90,000 low-income undocumented young adults aged 19 to 25 through that state’s Medicaid program. California is the first state to cover some young adults through Medicaid. Coverage will begin in 2020. California immigration advocates had originally hoped to cover far more of the undocumented, including older adults.
The Affordable Care Act — while in many ways a big step forward — failed undocumented immigrants by excluding them from the major benefits of the law, including the right to enroll in Medicaid, to receive subsidies, to purchase qualified health plans (QHPs), or even to enroll in QHPs without receiving a subsidy.
Denying health coverage to the undocumented is punitive, bad health policy and bad health policy. People without health coverage often delay care or go without necessary care, often leading to more severe problems that are ultimately more expensive to treat. And hospitals are required to provide emergency care to everyone, including the undocumented, which means those who disproportionately treat immigrants get an unfair share of the costs.
HCFANY and Coverage4All, a HCFANY project, are campaigning for comprehensive coverage for undocumented New Yorkers through our state’s Essential Plan, which covers people up to 200 percent of the federal poverty line for no or a minimal premium and minimal cost-sharing. We estimate that over 100,000 additional New Yorkers would get coverage. The passage of “Green Light” legislation in 2019 (driver’s licenses for undocumented New Yorkers) and New York City’s creation of NYC Care to provide care to the undocumented gives us reason to hope that we can see action on health coverage. In the 2020 session, we’ll be campaigning for New York to follow California and provide comprehensive coverage for those now denied coverage due to their immigration status.