liberty-300x225-5942351Should New Yorkers — and Americans generally — provide government-financed health coverage for undocumented immigrants?

Making a case for yes is the president and CEO of the New York State Health Foundation, David Sandman, in an op-ed today for the Huffington Post. (Launched in 2002 with $50 million in proceeds from the conversion of Empire Blue Cross Blue Shield to for-profit ownership, the foundation is run by a board appointed by Gov. Cuomo and legislative leaders.)

“Immigration is clearly a charged issue in the national political discussion right now,” Sandman writes. “But we need to rise above politics. When more people have health insurance coverage, we all win in terms of our physical, financial, and societal health.”

Sandman gives New York credit for being among the most generous of all states in covering immigrants: “Emma Lazarus, whose words adorn the Statue of Liberty, would be proud.” But he adds that the state “could do more still” for the segment of undocumented immigrants who remain ineligible for its government-sponsored insurance programs.

The fraught politics of immigration aside, Sandman’s suggestion raises the question of how much a universal coverage policy for immigrants would cost the state’s taxpayers. One answer: As much as $462 million, according to a study by Elisabeth Benjamin of the Community Service Society.

Benjamin estimates that 457,000 undocumented immigrants living in New York remain ineligible for health coverage, and offers three options for insuring more of them.

  • Buying very low-income immigrants “bronze”-level plans through the ACA, at a cost of $307 million.
  • Expanding Child Health Plus — which is already open to children under 19 of all immigrant statuses — to cover young adults up to 29, at a cost of $78 million.
  • Opening the “Essential Plan,” the state’s low-cost health plan for people making up to 200 percent of the poverty level, to undocumented immigrants, at a cost of $462 million.

These estimates do not include amounts that the federal government would contribute. They also assume that only part of the eligible population would opt for coverage. If the Essential Plan option achieved 100 percent enrollment, the state’s cost would exceed $1 billion.

“This paper demonstrates that affordable, high quality and viable options exist that both improve the lives of our newest State residents and close the coverage gap left by the Affordable Care Act,” Benjamin wrote in the study, which was partly funded by the Health Foundation.

As Benjamin notes, $462 million is less than 1 percent of New York’s total Medicaid spending. On the other hand, it’s enough to pay the minimum starting salaries of more than 9,000 New York City school teachers.

These numbers bring to mind a warning from former state Senate Majority Leader Dean Skelos in December 2014, when President Obama issued an executive order (later blocked by the courts) shielding some 5 million undocumented immigrants from deportation. In a letter to the president — five months before his arrest on corruption charges — Skelos said the move could cost New York’s Medicaid program $1.1 billion to $2 billion and called it “a massive unfunded mandate on New York State.”

Of course, New Yorkers already foot the bill for uninsured, undocumented immigrants when they seek care in emergency rooms and safety-net hospitals, which are subsidized by tax dollars, donations, and cost-shifting to private insurance plans. Enrolling more undocumented residents in health plans would ease the pressure on those resources.

But if New York adds to its already expansive health-care options for immigrants, it runs the risk of becoming a magnet for those in need of costly treatment — and shouldering a burden on behalf of other states. Consider this Kaiser Family Foundation study of HIV, which found that patients across the country were aware that California and New York had the best benefits.

In fact, one participant in the New York group had recently moved to the state from Georgia, specifically to gain access to better health coverage despite knowing nobody in New York. … He says “if you are HIV positive, New York is the state for you.”

About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

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