Of Course Undocumented People Should Have Guaranteed Healthcare. NYC Is Making It a Reality.

New York City’s universal healthcare plan is setting an important new standard for health policy in the United States.

Natalie Shure February 4, 2019

Bill de Blasio's healthcare plan could be a game changer. (Photo by Gary Gershoff/Getty Images for Housing Works, Inc.)

In ear­ly Jan­u­ary, New York City May­or Bill de Bla­sio announced a new city­wide health­care pro­gram he claimed will enshrine uni­ver­sal cov­er­age in the city. From this moment on in New York City every­one is guar­an­teed the right to health­care,” he announced on MSNBC. We are say­ing the word guar­an­tee’ because we can make it happen.”

While the plan won’t equate to a Medicare for All pol­i­cy of the type being pushed on the nation­al lev­el, it nonethe­less rep­re­sents a heart­en­ing step for­ward. It’s the bold­est step that can be tak­en at the city lev­el,” says Kather­ine Rob­bins, Direc­tor of the sin­gle-pay­er advo­ca­cy coali­tion Cam­paign for New York Health. De Bla­sio was very clear at the press con­fer­ence that this pro­pos­al is no replace­ment for sin­gle-pay­er at the state or nation­al lev­el, but it shows there is momen­tum on this issue.”

De Blasio’s plan also includes health­care for undoc­u­ment­ed city res­i­dents — a crit­i­cal step at a moment the far right has scape­goat­ed immi­grants to fire up a racist, xeno­pho­bic base.

The plan is two-pronged and geared toward the city’s esti­mat­ed 600,000 res­i­dents cur­rent­ly with­out health insur­ance. The rough­ly half of these res­i­dents who qual­i­fy for Metro­Plus — a man­aged care plan sold on the state exchanges with a net­work of pub­lic providers — will be tar­get­ed for expand­ed enroll­ment in that pro­gram, which one spokesper­son from the mayor’s office dubbed a city-lev­el pub­lic option.” The remain­ing 300,000 are believed to be undoc­u­ment­ed indi­vid­u­als whose immi­gra­tion sta­tus ren­ders them inel­i­gi­ble for most insur­ance. For them, de Blasio’s plan will strive to con­nect patients direct­ly with local pub­lic providers.

Expand­ing health­care access this way is unique­ly pos­si­ble in New York, which boasts the largest city-lev­el pub­lic hos­pi­tal sys­tem in the coun­try. While unin­sured peo­ple can already get care at these facil­i­ties with­out hand­ing over infor­ma­tion about their immi­gra­tion sta­tus, such ser­vices are nei­ther well coor­di­nat­ed nor pub­li­cized. The esti­mat­ed $100 mil­lion bud­get for NY Care will large­ly be used to stream­line the patient expe­ri­ence, with the mayor’s office promis­ing short­er wait times and an empha­sis on on-board­ing patients into the sys­tem for pre­ven­tive rather than emer­gency ser­vices, cre­at­ing a con­ti­nu­ity of care for a pop­u­la­tion that rarely has it.

Few pop­u­la­tions are as per­sis­tent­ly with­out health insur­ance as the undoc­u­ment­ed. Their legal sta­tus makes it near­ly impos­si­ble to hold jobs that pro­vide employ­er-spon­sored insur­ance, which con­tin­ues to be the pri­ma­ry source of Amer­i­cans’ health cov­er­age, and pro­grams like Med­ic­aid and Medicare seri­ous­ly restrict the par­tic­i­pa­tion of undoc­u­ment­ed adults. Even the Afford­able Care Act bars unau­tho­rized immi­grants from pur­chas­ing poli­cies on the state exchanges, with or with­out fed­er­al sub­si­dies. The result is that cov­er­age rates for undoc­u­ment­ed New York­ers hov­ers at around 40 per­cent, a fig­ure rep­re­sent­ing most­ly chil­dren and those insured as depen­dents of legal residents. 

Giv­en the undoc­u­ment­ed community’s stag­ger­ing unin­sur­ance rates, incre­men­tal mea­sures to expand cov­er­age have long been cham­pi­oned by immi­grant advo­cates. Beyond the obvi­ous good of secur­ing health­care for peo­ple who need it, this serves a prac­ti­cal polit­i­cal pur­pose. It makes it eas­i­er to deliv­er on the promise of sin­gle-pay­er if we make incre­men­tal steps in the mean-time,” says Clau­dia Cal­hoon of the New York Immi­gra­tion Coali­tion, which is part of the coali­tion sup­port­ing the New York Health Act — a statewide sin­gle-pay­er bill. We’re always try­ing to talk to peo­ple about why it’s good for every­one to have insur­ance, it’s not a zero-sum game.”

Bring­ing more undoc­u­ment­ed peo­ple into the sys­tem in the short-term will both enlarge the con­stituen­cy like­ly to fight to defend those gains while also refut­ing the right-wing talk­ing point that cov­er­ing undoc­u­ment­ed com­mu­ni­ties will some­how hob­ble the Amer­i­can health­care system. 

If the so-called safe­ty net” hos­pi­tals have long been a crit­i­cal source of care for mar­gin­al­ized peo­ple, that role hasn’t nec­es­sar­i­ly been empha­sized by pub­lic offi­cials. That the de Bla­sio admin­is­tra­tion is out­ward­ly cham­pi­oning health­care ser­vices for undoc­u­ment­ed res­i­dents is a sig­nif­i­cant con­trast from the rhetoric and poli­cies of Pres­i­dent Trump who has made anti-immi­gra­tion fer­vor a sig­na­ture of his polit­i­cal brand.

In this polit­i­cal cli­mate it’s real­ly impor­tant to have pro-immi­grant rhetoric from New York State,” Rob­bins says. It’s one of the issues that will be used to divide the move­ment.” This is par­tic­u­lar­ly true giv­en the degree to which an imag­ined drain on the wel­fare state is used to stoke xeno­pho­bic sen­ti­ments, and the demon­strat­ed his­to­ry of exclud­ing undoc­u­ment­ed pop­u­la­tions from pub­lic insur­ance pro­grams. Plans like de Blasio’s (and the Healthy San Fran­cis­co” pro­gram on which it was mod­eled) can help set a prece­dent for immi­grant inclu­sion before these polit­i­cal bat­tles advance at the state or nation­al level.

For now, the impact of the reform on indi­vid­ual lives will depend on the slid­ing scale pric­ing mech­a­nism and out­reach ini­tia­tives, which have yet to be announced. How patients’ ongo­ing com­mu­ni­ca­tion with the health­care sys­tem is man­aged — includ­ing cul­tur­al com­pe­ten­cy and clar­i­ty — will be key.

Get­ting the word out and under­stand­ing how it works will be real­ly impor­tant,” Cal­hoon says. In gen­er­al, peo­ple are real­ly excited.” 

Natal­ie Shure is a Los Ange­les-based writer and researcher whose work focus­es on his­to­ry, health, and politics.
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