NYC and NYS Are Paving The Way For Health Care For All, Bring Hope to Undocumented Immigrants

With about 600,000 uninsured people and about half of them are undocumented, New York City is trying to fill the gap in current safety-net health care systems and connect undocumented New Yorkers to coverage.

NYC’s Push of Health Care For All

Mayor Bill de Blasio announced in January that he plans to bring “universal health care” to NYC. His administration will launch the largest, most comprehensive plan in the nation to guarantee health care for every New Yorker including the undocumented.

The initiative includes two ways to better connect people to health care: a new program called NYC Care will make sure insurance-ineligible New Yorkers has direct access to NYC Health + Hospitals’ physicians, pharmacies and mental health and substance abuse services on a sliding scale;  Boost enrollment in MetroPlus, the City’s public option, which provides free or affordable health insurance that connects insurance-eligible New Yorkers to a network of providers that includes NYC Health + Hospitals’ 11 hospitals and 70 clinics. The plan also includes creating a customer-friendly hotline to help New Yorkers to make appointments with different kinds of health care services, regardless of their insurance.

The idea is to better connect uninsured New Yorkers with primary and preventive care rather than go to an emergency room. According to the plan, NYC Care will start in the Bronx in summer 2019 and then roll out geographically across the five boroughs in 2021.The estimate annual cost of NYC Care is at least $100 million at full scale. Additionally, MetroPlus will announce a series of enhancements throughout the year.

The Inspiration of Healthy  San Francisco

San Francisco inspired NYC to launch such an innovative plan. “It is the New York City version of Healthy San Francisco,” said Dr. Mitchell Katz, the President and Chief Executive Officer of NYC Health + Hospitals, “NYC Care will be larger and more comprehensive. 

From 1997 to 2010, Dr. Katz served as the Director of Health and Health Officer for the San Francisco Department of Public Health, and he implemented the Healthy San Francisco (HSF) program, which is the United States' first municipal universal health care system.

San Francisco Department of Public Health implemented HSF in 2007 to ensure access to appropriate and timely medical care for low-income uninsured adults ages 18 to 64 in San Francisco. HSF enrollees can get access to primary care (including preventive and routine care),  specialty, hospital, behavioral health care and prescription drugs through a network of established clinics in San Francisco.

According to HSF’s 2011 report Healthy San Francisco: Changes in Access to and Utilization of Health Care Services, HSF has gains some success within the first year of enrollment: three out of four HSF enrollees had at least one physician visit; about half of HSF participants received at least one recommended preventive service; HSF participants show steadily declining ED use over time; a decrease in the number of non-emergent ED visits to San Francisco General Hospital (SFGH) made by uninsured adults.

The Possibilities Brought by New York Health Act 

Some local elected officials applauded the launch of NYC Care and view it as a start to improve the current healthcare system, but they said it is not enough.

“What the mayor talked about is not all that new, New York City public hospital system has provided either free or very low cost care for whoever walks in the door for generations.” Said Richard Gottfried, the chair of the New York State Assembly's Health Committee and the chief architect of the New York Health Act (NYHA), which will create a publicly financed, privately delivered, single-payer system, and will provide universal complete health coverage for every New York resident without premiums, deductibles, copays, or restricted provider networks, regardless of age, income, wealth, citizenship or employment.

Gottfried said NYC Care is very helpful to immigrant community in NYC, but it only applies in NYC and has its limits. “It only enables uninsured people to go to doctors who work for HHC. So what’s important about NYHA is that everyone will be covered, regardless of wealth and anything else including immigration status, and there will be no restricted provider network. You can go to any doctor or hospital. Nobody would be paying out-of-pocket costs whether you are rich or poor.”

“Mayor strongly support NYHA, what he is proposing doesn’t mean we don’t need NYHA. NYC Care will help fill gaps for now, but it doesn’t fully solve the healthcare needs of undocumented immigrants.” Gottfried also mentioned that NYC Care doesn’t affect the vast majority of New Yorkers who already have health coverage but have enormous problems with the coverage.

NYHA co-sponsor New York State Senator Gustavo Rivera also agreed that NYC Care is a step forward, but not necessarily fundamentally changing the system. “NYHA is not only covering the people who are not covered, but also it goes further than that and it fixes the problems that currently people who are insured have to deal with. They still have to deal with the facts that they have to pay premiums, out-of-pocket costs, they go out of network, and let insurance company decide what medical services are covered or not covered. For undocumented people, they are human beings, they will get sick. They don’t have to go to an emergency room to just get primary care.The change we need is to make a system. Wealth should not determine your health, that’s the reason why we are pushing the NYHA.”

According to Gottfried, the funding for NYHA will come from Medicare, Medicaid, ACA and graduated assessments on payroll and non-payroll income. With full Democratic control in Albany, NYHA now is supported by a strong majority members of NY Assembly and Senate, and sponsors are hopeful in 2019.

RAND Corporation, a nonprofit, nonpartisan research organization, has conducted an assessment of the NYHA in 2018. The authors estimated that the NYHA could expand coverage without greatly increasing overall health care spending: in the short term, health care spending would be relatively similar with the status quo if administrative costs are reduced; in the long term, health care spending would grow more slowly if provider payment rates are restrained. New taxes and shift financing among households and businesses are required to implement NYHA.

Multiple Parties Are Looking For Other Solutions

However, there is still uncertainty of NYHA’s fate, Gottfried said some members in State Legislature “are not totally committed as they said.” Gottfried also mentioned that some doctors are concerned that they may not receive payments under NYHA. Rivera suggested that what the State can do before NYHA get passed is to extend the current health insurance programs to people who are not insured. For example, the current NY Essential Plan, a New York health insurance program for lower-income state residents that don't qualify for Medicaid or the Child Health Plus Program, could be extended within the state to cover undocumented people. Rivera also suggested extending the age limits of Children Health’s Insurance Program (CHIP) from 18 years old to older.

At the same time, New York Immigration Coalition and Make the Road New York are undertaking Coverage 4 All, a campaign of Health Care for All New Yorkers. According to Hadler, under anti-immigrant attacks from Washington, the immigration organizations also call for expansion of Child Health Plus program by increasing the upper age limit from 18 to 29, protection of coverage of New Yorkers with Temporary Protected Status and giving more funding to safety-net health care services.

Local safety net hospitals and community health centers are also making efforts to better connect undocumented immigrants to health care services. “Ongoing communication regarding important health benefits for undocumented immigrants, particularly in our community, is very important.” said Morris Gagliardi, Chief Medical Officer of NYC Health + Hospitals/ Gotham. According to Gagliardi, HealthNYC Health + Hospitals/Gotham Health, Gouverneur alone conducts over 200 educational and informational events annually. “We provide print information and communication about health resources in multiple languages.  We do this because we know that being able to access care is a critical step for overall health and leads to better outcomes.” Gagliardi said.