In the best of times, undocumented immigrants in New York City have faced significant barriers to accessing health care.
And these are not the best of times.
Low-income undocumented adults have never had many options for health coverage. They have thus frequently relied on emergency rooms—which serve everyone regardless of documentation status—as their provider of last resort. Thank goodness our society at least offers this protection (for now). But that still leaves hundreds of thousands of immigrants in the five boroughs without basic, primary medical care, with dire results for their own health and for our city as a whole.
And President Trump is making this situation even worse: the nearly unprecedented climate of fear created by his administration is making it more likely than ever that undocumented New Yorkers will avoid medical care altogether, at least until a crisis lands them in the ER.
Now Trump’s Department of Homeland Security has proposed an even more draconian action: a change to the “public charge” rules that would threaten the immigration status of even green card holders when they receive federal- or state-subsidized health insurance like Medicaid.
Our city can and must act locally to remedy this dangerous situation, to ensure that every New Yorker regardless of immigration status receives essential, primary care.
Fortunately, models put in place in San Francisco and Los Angeles in the pre-Trump era point to a sensible, cost-effective solution.
The idea is simple: create a program for uninsured New Yorkers that would give them a community-based, primary care home to receive regular preventive screenings and, if needed, chronic care management.
How do we know that such a plan would work in New York City? Because it already has.
In 2015 the NYC Department of Health and Mental Hygiene ran a pilot, funded by private philanthropy, to offer exactly this type of program to 1,200 participants.
The program, known as ActionHealthNYC, was open to low-income adults who were not eligible for publicly subsidized health insurance through Medicaid or New York State’s Affordable Care Act exchange. (In practice, that mostly means the undocumented).
Participants were able to pick a primary care location from among a group of participating community health clinics or public hospitals—the kinds of places where immigrants can get culturally attuned services in their own language, often in their own neighborhood.
Participants’ municipal ID was integrated with their health records and served as the program membership card. Members paid for services on a subsidized sliding fee scale, with referrals to specialty care as needed at our city’s public hospitals.
Most ActionHealth participants reported rarely—if ever—visiting doctors prior to enrollment. But once in the program, members benefited from high rates of screening, vaccinations, preventative care, and early diagnosis across a variety of diseases. A rigorous outside evaluation pronounced the program a demonstrable success.
And then in 2016, just months before the fateful election of Donald Trump, the ActionHealth program ended. It was never intended to be more than a limited, one-year pilot and didn’t have long-term funding.
Now, in 2018, the need for expanding health care access for the undocumented is greater than ever. And we need bold action.
It’s time for New York City to establish a full-scale immigrant health program, modeled on the success of ActionHealth and similar initiatives elsewhere.
This won’t just be good for the health of New Yorkers, it will also save our city money over the long term. That’s because treating medical problems early through primary care is much less expensive than waiting until patients land in the ER amidst a crisis.
Immigrants are under assault these days by the Trump administration. In the face of such hostility – especially with the proposed “public charge” rule change to further scare immigrants from seeking public benefits – it’s more important than ever that our city step up. Protecting the health of the most vulnerable immigrants is smart policy and fiscally prudent. And most importantly—it’s the right thing to do.
City Council Member Mark Levine represents the 7th district in Manhattan and is Chair of the Health Committee. Council Member Carlos Menchaca, Chair of the Immigration Committee, represents the 38th district in Brooklyn.
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