Anna lives in the Lawrence area, where she is a tax-paying member of the workforce. While she does not receive health insurance through her employer, she is covered under the Commonwealth Care program and pays a monthly premium of $39. Her health insurance not only helps cover the three medications she takes daily for high blood pressure but also gave her the security to have a lump in her throat checked out recently. Test results brought positive results, but doctors notified her that surgery may be required down the road and she should have it checked out annually. Unfortunately, Anna will lose her coverage under Commonwealth Care on August 1st. Why? Despite paying taxes and working, she happens to be a recent legal immigrant.
In 2006, Massachusetts became the first state to affirm that access to health care was a right for all lawfully-present residents and not a luxury. Now, in 2009, Massachusetts is one step away from taking a significant step backward in its commitment.
The FY10 Conference Committee Report eliminates full CommCare coverage for approximately 30,000 lawfully-residing, tax-paying immigrants, who represent 15% of the total CommCare population. Without CommCare, this population would be eligible only for emergency medicaid and/or the Health Safety Net (previously the uncompensated care pool).
Who are these 30,000 immigrants? They are legal permanent residents (commonly known as green card holders) with less than 5 years in status, persons fleeing persecution, and more than 20 other legal immigration statuses known collectively as persons residing under color of law. They are working, tax-paying residents of the Commonwealth who do not qualify for federal medicaid reimbursement.
Fortunately, Governor Patrick affirmed his commitment to continuing the eligibility gains made by health reform and offered a compromise amendment that would eliminate full CommCare coverage for the population, while including $70 million in a supplemental budget that would go to creating a new, less expansive plan that would maintain access to preventative and primary care for this group of 30,000. The $70 million is slightly more than the cost for providing coverage to 30,000 CommCare members who did receive federal medicaid reimbursement. So, in a sense, the Governor has agreed to cover the state’s share of the cost for this population.
Why should we care that this population is losing access to care?
Aside from the obvious moral and health-care-as-a-right arguments, immigrants in MA contribute a significant amount as taxpayers to the Commonwealth. A recent study commissioned by The Immigrant Learning Center, with researchers Paul Watanabe and Alan Clayton-Mathews of UMASS-Boston, found that while immigrants make up 14.1% of the MA population they are 16.4% of tax filers. They are also overrepresented among those paying sales and excise taxes. With this group working and paying taxes like any other resident, why should they not have the same access to quality and affordable health coverage?
All stakeholders involved in health reform, from outreach workers to providers and insurers, have invested a significant amount of time and energy to preach the importance of preventative and primary care, particularly to populations who may not have as much history with the insurance model in MA and the U.S. Now, after considerable effort, the proposed cuts will bring us back to square one and the progress that has been made will be stilted.
While ending coverage for this group will cause tremendous personal hardship to the affected individuals, it will also increase the burden on the increasingly fragile health safety net system. Ending coverage won’t suddenly end the need for care for these 30,000 people. When they get sick, they will be more likely to skip primary care, since without insurance they can’t cover the cost. Rather, many will wait until little problems become acute, and show up in the emergency rooms and community health centers in much worse shape.
The cost of covering the more severe problems will put a great strain on our struggling safety net hospitals. The latest report from state officials on hospital finances found that while all hospitals suffered from declining margins, for the first time in seven years the 18 designated safety net hospitals were losing money as a group. The health safety net program, which reimburses hospitals for care to uninsured low-income patients, has been financially stable the past 3 years, as health reform dramatically reduced the numbers of uninsured. However, the funding for next year did not anticipate adding some 30,000 new people to the pool, and the fund will certainly experience a shortfall. When that happens, hospitals and community health centers are left holding the bag, eating losses that they have no choice but to pass on as increased costs to everyone else.
Finally, while national health reform is debated in Washington and all eyes focus on Massachusetts as a model, it is critical to show all Americans the benefits of health reform and increased access to care. Increasing the ranks of the uninsured does the opposite and is a disservice to the progress we’ve made as a state.
We hope the legislature chooses to adopt the Governor’s compromise amendment to outside section 121 and passes outside section 37 of his supplemental budget to ensure continued access to preventative and primary care for this population. It was the legislature that led in bringing us health reform; it is only fitting that they now have a chance to sustain its success.
If after reading this you feel compelled to contact your legislator, please do so by calling 617-722-2000 or visiting here. For a district-by-district look at the impact of the cuts, click here. (Please note that numbers are based on zip code and only include towns with at least 100 total Commonwealth Care members.)
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