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 ShureFebruary 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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