Submitted March 3, 2023. Learn more here
The Health Foundation for Western & Central New York is an independent private foundation serving 16 counties in western and central New York State. The Health Foundation’s vision is a healthy central and western New York where racial and socioeconomic equity are prioritized so all people can reach their full potential and achieve equitable health outcomes. In support of that vision, we advocate for access to quality, affordable health care for all in New York State.
It is a well-known fact that increasing the number of people with health insurance coverage will improve not only their individual health outcomes but also their economic security, as the increasing incidence of medical debt is one of the leading causes of bankruptcy for families. Healthier, more equitable, and more financially stable communities make for a stronger New York.
In fact, Governor Hochul previously campaigned on the idea—rightly—that health care is a human right. Human rights, by definition, are not contingent on immigration status.
Therefore, we write today to express our significant concern that the proposed 1332 Innovation Waiver proposal would inexplicably exclude undocumented people as being eligible for health insurance coverage through New York’s Essential Plan, and we urge the Governor to amend the waiver amendment request to reflect that our undocumented neighbors deserve quality, affordable health care access.
Based on a 2019 report by United Hospital Fund and commissioned by the Health Foundation titled Reaching the Five Percent, we know that of the approximately one million people uninsured in New York State, roughly 25 percent do not have health insurance coverage because their immigration status makes them ineligible under federal law to receive benefits through public programs such as Medicaid and the Affordable Care Act.
This lack of coverage means undocumented people are often forced to forgo preventative care and resort to emergency care only, a situation that has been proven to lead to poorer health outcomes and greater health disparities, inefficient care delivery, and greater financial burden for both the individual and the care provider.
We applaud Governor Hochul for many aspects of New York State’s 1332 Innovation Waiver proposal, including seeking approval to raise the income eligibility from 200 percent to 250 percent of the federal poverty level. It is anticipated that people enrolled in this coverage will save an average of $7,400 per year in premium savings and out of pocket costs.
However, we are extremely disappointed that Governor Hochul has not fulfilled her commitment to request a waiver to expand coverage under the Essential Plan for undocumented immigrants. Therefore, we regretfully oppose the 1332 waiver as it is presently written as it excludes undocumented people from health care coverage.
In 2021, New York spent approximately $500 million using the state’s emergency Medicaid fund because undocumented people did not have access to health coverage. At the same time, there is a surplus of approximately $9.3 billion—growing by approximately $2 billion annually—in the state’s Essential Plan trust that must be used for health care. These federal funds could be used to pay for the health care cost of including undocumented residents who meet the income eligibility requirements for the Essential Plan.
This would also enable New York to benefit from a massive savings. The $500+ million in state Medicaid emergency funds currently used to pay for the health care for undocumented people with incomes of 0-138 percent of the federal poverty level could then be used for other purposes that improve the health care of New Yorkers. This information was supported in a report by Community Service Society and Citizens Budget Commission in 2022, Narrowing New York’s Health Insurance Gap.
Not only will this be a savings for New York State but also a savings for providers of health care. It is estimated that providers spend $1,174 per person annually on uncompensated care. Since reimbursement rates to providers from insurance companies covering people under the Essential Plan are higher than those provided under Medicaid, this would also address their concerns about insufficient reimbursements that have adversely impacted providers’ ability to address the community’s health care needs.
Including undocumented people for health coverage eligibility under the Essential Plan is the correct moral and economic decision. This will move New York closer to realizing the goal of affordable, quality health care for all people and help build a healthier, stronger New York overall.
In closing, we strongly urge New York to amend its 1332 waiver application to include coverage for undocumented residents who otherwise meet the eligibility requirements for health insurance coverage under the Essential Plan.
