For Patricia Rosas and other undocumented residents without health insurance, going to a doctor is an expensive last resort.
So, in the fall of 2019, after Rosas had been feeling an unfamiliar pain in her side for over a year, friends helped to raise $5,000 simply to get a diagnosis.
“My concern is, what if I didn’t know all those people?” Rosas said. “My story is thousands of people’s stories.”
A new study from the RAND corporation, though, suggests that extending HUSKY health coverage to all undocumented residents in Connecticut would cost 3% of the state’s annual Medicaid budget, putting quality health care within reach for more than 21,000 additional people.
A state feasibility study of Medicaid expansion to undocumented residents is also anticipated in coming days.
When Rosas first began feeling the pain in her side, she ignored it. She hoped it would go away, but it grew worse and more frequent.
In 2018, she visited a community health center, where providers couldn’t find the cause. The pain didn’t go away, so she took aspirin when it became unbearable but avoided going to the doctor.
“Every time when you need a doctor, the first thing [you need is] health insurance,” Rosas said. “That’s the first thing they ask.”
When Rosas finally made it to a specialist through the generosity of her friends, the doctor diagnosed her with kidney cancer. Once she received her diagnosis, she was able to get life-saving kidney removal surgery at St. Francis Hospital. She said she applied for financial assistance through the hospital to help cover the costs.
The RAND study estimates that expanding HUSKY coverage to undocumented immigrants of all ages who qualify based on income would cost Connecticut between $83 and $121 million, which represents about 3% of the state’s $3 billion Medicaid budget for 2023.
In Connecticut, 94% of residents have health insurance, but among the state’s undocumented population, the share of insured residents is only 42%. Under the expansion, that rate could jump to 57% based on estimates of how many would enroll, representing 21,400 people who currently do not qualify for Medicaid because of their immigration status.
The legislature has debated the issue of Medicaid coverage for undocumented residents repeatedly over the last several years.
In June 2021, the legislature passed a bill qualifying children 8 and under who come from families earning up to 201% of the federal poverty level for HUSKY, regardless of immigration status. Children from families earning between 201% and 325% of the federal poverty level also qualify, subject to an asset test.
Earlier this year, a proposal to expand that coverage to all children under the age of 19 failed, not even garnering enough support to pass a legislative committee vote. Legislators ultimately passed a reduced expansion as part of the state budget that granted coverage to children 12 and younger and allowed any child enrolled in the program to keep the insurance through age 19.
The 2021 bill granting coverage to qualifying children 8 and under also called for the state to conduct a feasibility study regarding the extension of HUSKY coverage to children, regardless of immigration status, from ages 9 to 18, and to adults whose households earn up to 200% of the FPL.
A spokesperson with the Office of Health Strategy, the agency tasked with the feasibility study, said it will release its report to the legislature by July 1.
The RAND study examines the cost of implementation for different scenarios, including allowing undocumented residents to enroll in marketplace coverage and receive subsidies.
“What we hope to have really done with this work is to give policymakers a tool with which they can say, ‘OK, I want to implement this policy. How’s this going to affect enrollment? How much is this going to cost the state?’,” said Preethi Rao, a policy researcher with the RAND Corporation and the lead author on the study.
Rao and her co-authors also note that the cost estimates do not account for potential savings the state could realize from expanding eligibility. Hospitals could save anywhere from $63 to $72 million on uncompensated care, which is the loss incurred by providing services to people without insurance who will likely never be able to pay for them.
In 2021, the state also spent approximately $15 million through its emergency Medicaid program, which covers emergency care to people with qualifying incomes, regardless of immigration status. Presumably, the study explains, this cost would decrease “substantially” if more people had coverage.
According to the study, six states — California, Illinois, Massachusetts, New York, Oregon, Washington — and the District of Columbia have expanded Medicaid, or a similar program, to children up to 18 and pregnant people, regardless of immigration status. In California and Illinois, certain portions of the undocumented population over the age of 18 can also enroll.
Rosas feels lucky to have had the kidney removal surgery, but not having insurance still weighs on her. She’s supposed to have annual follow-up visits with a doctor but has already skipped one because she didn’t know how to pay for it.
Every time she feels pain, she can’t stop asking herself, “If something like that happened to me again, what am I going to do?”