Connecticut immigrants deserve health insurance

An update from the authors March 4: This bill will not proceed, but some of the clauses are included under SB 956. We ask community members to support the new bill.

As physicians, we have seen how lack of health insurance negatively impacts the lives of immigrant patients in Connecticut.

One of our patients, Mr. Gonzalez arrived at our free clinic for the uninsured with one of the most common chief complaints: “I can’t work anymore.” This was Mr. Gonzalez’s first encounter with medical care in the United States. He had immigrated from Ecuador to Connecticut, where he married, had one child, and took on steady work in construction. When he could, he sent money to his mother and siblings back home.

“So, what is keeping you from work?”

“Weakness,” Mr. Gonzalez replied emphatically. At 23, his broad shoulders and muscular hands were failing him. And there was a “strange tingling” — he gestured to us — moving up and down his extremities. Now he had trouble completing the most basic tasks, much less the strenuous labor required for his job.

Lab tests revealed the devastating cause of Mr. Gonzalez’ weakness: his kidneys were failing. As a result, the electrolytes and toxins in his blood, which are normally regulated by the kidneys, were dangerously out of balance and threatening his life.

To save his life, Mr. Gonzalez needed dialysis, a treatment that works like an artificial kidney to remove waste and to regulate electrolyte levels in our blood. With this treatment, Mr. Gonzalez would be able to return to work to provide for his family.

But the problem for Mr. Gonzalez was not only medical — it was also social. As an undocumented immigrant, he did not have access to state insurance. To access dialysis in Connecticut, Mr. Gonzalez would actually have to wait to become sicker so that he could receive emergency dialysis in a hospital. Not only would this put his life at risk, it is also incredibly expensive. One study estimated that emergency dialysis costs our state $200,000 more per patient each year than regularly scheduled dialysis because it leads to more emergency room visits, blood transfusions, and hospital admissions. Moreover, because of his poor health and the irregular emergency dialysis schedule, Mr. Gonzalez’s community loses his labor and his family misses his pay.

While access to basic medical care allows U.S. citizens the opportunity to live healthy, productive lives, lack of access to care risks leaving undocumented immigrants sick, unable to join the workforce, or care for their families.

The case of Mr. Gonzalez is not unique.  There are more than 130,000 estimated undocumented immigrants residing in Connecticut, and 52% of them are uninsured, compared to 5% of other Connecticut residents. This is a massive public health concern, as being uninsured is associated with an increased risk of being sick or dying. There are also significant financial repercussions. Without healthcare coverage, families risk going into debt for visiting a doctor and receiving costly treatment at full price.

Access to healthcare is especially vital now, as undocumented immigrants have been disproportionately impacted by the COVID-19 pandemic. Approximately 75% of U.S. undocumented immigrants are Latino, a group which dies or falls ill from COVID-19 at much higher rates than the general population. This is due to medical barriers, such as shortages of testing in communities of color, as well as increased exposure to COVID-19 at work. Latino people are overrepresented in frontline industries that place them at higher risk for infection with COVID-19.

We recognize that expanding state-funded health insurance poses a fiscal challenge in light of our state’s budget deficit. However, the upfront cost of this legislation can be mitigated by future savings on unreimbursed care and improved workforce productivity. In 2017 alone, Connecticut hospitals provided $1.66 billion in unreimbursed and uncompensated care, similar to the expensive and life-saving care given to Mr. Gonzalez every time he had to undergo emergency dialysis. Ensuring that all Connecticut residents have access to basic and preventive medical care will help keep patients out of the emergency room, reduce uncompensated care, and prevent costly medical complications.

Access to affordable medical care also leads to a healthier and more productive workforce. While undocumented immigrants invest financially in our state healthcare programs through the roughly $145 million in state and local taxes they pay every year in Connecticut, they do not reap the benefits of their contribution. Expanding Husky to all community members, regardless of immigration status, is not only equitable policy, it recognizes the vital contribution that undocumented immigrants make to their families and  our communities every day.

Connecticut should pass House Bill 6334 to expand health insurance to all immigrants regardless of status. Our state wisely chose to protect the immigrant community by using Emergency Medicaid funds to cover expenses associated with COVID-19 testing and treatment for residents who were excluded from Medicaid based on their immigration status. This is smart and compassionate legislation because it saves lives through early treatment and reduces costs by preventing expensive hospitalizations. It is time to extend this thinking to all conditions, from diabetes and depression to the kidney disease suffered by Mr. Gonzalez. Write to your legislator to support House Bill 6334.

Brooke Lifland, MD, Tanner Bommersbach, MD, Marco Ramos, MD PhD, and Eden Almasude, MD, are resident physicians at Yale University.