I met my patient, Armando, four months after he was injured at work. He was a construction worker and had broken a bone and torn the cartilage in his right, dominant hand. The Emergency Department immobilized his hand in a splint. But Armando was undocumented, and he did not have health insurance, so he couldn’t follow up for the treatment he needed.
By the time I met him four months later, when I was working in a primary care clinic as a medical student, he had severe pain in his palm that radiated up his forearm, and he had lost most of the function of his hand. Armando could not work. He lost his apartment. He worried about how he was going to support his son, and he fell into a state of depression.
Unfortunately, Armando’s story is typical. An estimated 52 percent of undocumented immigrants in Connecticut are uninsured. This is a direct consequence of our state and federal laws. The Affordable Care Act made huge strides in increasing access to health insurance, but it excluded undocumented immigrants from its programs. Undocumented individuals in our state are effectively cut off from access to reliable health care. As a result, we have stories like Armando’s — stories of treatable medical conditions leading to devastating, avoidable consequences.
This legislative session, we have an opportunity to change that. HUSKY, Connecticut’s Medicaid program, provides a safety net by offering health insurance to most low-income residents, but it currently excludes undocumented immigrants and green card holders who have been in the country for less than five years. Senate Bill 956 would expand HUSKY eligibility to these groups, allowing our most vulnerable immigrant community members to finally access quality health care. As almost 300 Connecticut health care providers communicated in a letter to legislators, we have a moral responsibility to care for all community members and expect our state laws to reflect that commitment.
Notably, our health care system already incurs the costs of this care. Hospitals are required to treat emergency medical conditions, regardless of an individual’s immigration status. The state pays for this through Emergency Medicaid and for other uncompensated care through government subsidies. The way that this care is delivered, however, makes little sense — for the payor or the patient. Restricting patients from accessing health care until their medical conditions are advanced leads to more expensive treatments that are less likely to succeed. In Armando’s case, by the time he could access the health care that he needed, he already had complications that required additional costly procedures and that kept him from returning to work. Most importantly, it came too late to prevent his life from unraveling.
In thinking about how we might improve this system, the state’s response to COVID-19 offers a window into what is possible. Recognizing that immigrant communities have been particularly devastated by the pandemic, Connecticut expanded Emergency Medicaid to cover COVID-19 testing and treatment for all low-income residents, regardless of their immigration status. This decision has saved lives, both by preventing illness and treating it early. The wisdom of this approach is obvious, but it is not unique to COVID-19. Improving access to care is always the right approach to community health.
In the end, what is our state achieving by blocking undocumented immigrants from obtaining health insurance? Preventing people from accessing health care does not prevent them from developing the diseases or sustaining the injuries that will require emergency care and hospitalization. It merely prevents us from treating those illnesses early and effectively. This is not sound policy. And in the long run, it is unlikely to save money. The reality is that blocking access to health insurance is simply punitive — rooted in the misguided belief that undocumented immigrants do not deserve access to adequate medical care.
This session, it is time for Connecticut legislators to begin to repair this damage. The Human Services Committee has announced a public hearing for Senate Bill 956 on March 11. As written, the bill appears to leave out certain groups, including parents and children under HUSKY A and elderly and disabled individuals under HUSKY C. Its language should be modified to clearly expand HUSKY eligibility to all low-income residents, regardless of immigration status, and the legislature should act swiftly to pass it. It is time, finally, to make quality health care accessible for undocumented members of our community.
Matthew Meizlish is an MD/PhD student at Yale School of Medicine.
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