Is Massachusetts Still a Leader in Health Reform?
By Alison Stevens
In Massachusetts, we pride ourselves on being national leaders in healthcare. At 2.8%, we have the lowest uninsured rate in the US. However, a look at our immigrant population tells a very different story: 19% of our undocumented residents are uninsured. This staggering gap is unfortunately not surprising. While the majority of Americans receive some help from an employer or the government when paying for health insurance, undocumented and recent immigrants are often locked out of these opportunities. Adults are largely excluded from government subsidies, Medicare, and Medicaid (aka MassHealth), they cannot purchase plans through the HealthConnector marketplace, and they have significantly lower rates of employer-provided insurance - not because they work less, but because they frequently work jobs that do not offer insurance. This is a national problem. However, while Massachusetts does nothing to address it, other states are taking action.
Illinois and California have led the charge, expanding comprehensive healthcare to low income seniors and/or young adults regardless of immigration status over the last two years. Many individuals inspired this change, including Genoveva Angeles. A San Diego resident in her late 60s, Angeles dismissed her chronic stomach problems because, being undocumented and uninsured, she could not afford to see a specialist. Yet in September 2019, she had no choice but to go to the hospital. She was diagnosed with gallbladder cancer - and died two weeks later.
Undocumented and recent immigrants in Massachusetts can get emergency care through MassHealth Limited. However, this pushes people to refrain from seeking help until their condition is severe. California and Illinois used to have a similar system and, as Angeles's death proves, it is woefully insufficient. Limitations are also evident when it comes to COVID-19. While pandemic-related services are covered, it’s not clear that MassHealth Limited will protect the “long-haulers” who, months after getting the virus, are still suffering from other conditions caused by the COVID-19 virus. Immigrants are especially vulnerable; a recent study of COVID-19 in Massachusetts found that the strongest predictor of high case-rates in a community was its number of noncitizen residents.
Do we want to live up to our state’s reputation as policy innovators? Do we want to do right by all of our residents? Then Massachusetts must join Illinois and California on the front lines. Some opponents will argue that undocumented residents are freeloaders and we do not owe them anything. Yet, countless studies show that undocumented immigrants are established, beloved members of our communities, as well as a vital part of our economy. In 2019, undocumented residents of Massachusetts paid $734.6 million in taxes, ironically helping to fund the very programs from which they are excluded.
Others will object that expanding coverage would be too expensive. However, there is evidence it could actually save taxpayers money in the long-term. Similar expansions have historically been accompanied by reduced debt, reduced third-party collections, increased workforce productivity, and stronger health care delivery systems. When undocumented immigrants receive scheduled rather than emergency-only services, it results not only in reduced mortality, but also reduced health care utilization and costs. Illinois legislators anticipate that providing access to less-expensive preventative care will help undocumented and recent immigrants avoid trips to the emergency room - trips that cost the state three times as much as regular Medicaid coverage.
That said, even if expanding coverage to undocumented and recent immigrants costs more money than it saves, Massachusetts must still act. Since Angeles died in 2019, her family has been pushing for change. Summarizing interactions with lawmakers, activists and the media, Angeles’ daughter-in-law noted, "the conversation I have is about the cost. The conversation we want to have is about our families".
Illinois and California have already begun closing the immigrant insurance gap and other states are following. Now it is time for Massachusetts to step up. Lawmakers and policy experts must begin a formal inquiry process into expanding coverage in our state. Advocates must make sure that the Genoveva Angeleses of Massachusetts are getting their stories told. It is a grim truth that the longer we delay, the more Angeleses there will be. Immigrants across Massachusetts and the many people who love them should not have to wait any longer.
