Protecting all children: Promoting health equity by insuring undocumented children
The General Assembly’s Appropriations Committee has favorably voted out S.B. 956, An Act Providing Medical Assistance to Certain Individuals Regardless of Immigration Status. The state, not surprisingly, has countered with a fiscal note that presents a two-year cost-estimate of $267 million to $374 million. But what if the cost of gradually insuring everyone who is eligible for health insurance in the state but for their immigration status works out to less than ten percent of that amount? Wouldn’t that be an investment that Connecticut’s policymakers should consider?
The real question we should be asking is “What is the real cost of healthcare for vulnerable and uninsured?” Healthcare analysts, policy makers and legislators constantly refer to the “price” of health insurance coverage. We are paternalistically reminded that insuring “undocumented” or “illegal” individuals will drain hundreds of millions of dollars from the state’s budget. But what really is the cost of not providing health insurance to the most vulnerable individuals in our state – those individuals who have made Connecticut their home seeking refuge, hope and a new life?
Perhaps the cost of not having access to healthcare can best be measured in what is lost rather than what is gained. It might be measured through the agonizing story of a child who was not eligible for outpatient dialysis treatment after contracting COVID-19 and ended up spending over 100 days as an inpatient in the hospital – creating a vicious cycle that will inevitably reoccur a few months down the line. Perhaps the cost is best measured by the heart-wrenching stories of immigrants who relayed anecdote after anecdote of inaccessible healthcare at a public hearing in Hartford on March 11 of this year. Perhaps the cost is borne by the thousands of children who are seen by emergency departments across the state each year – and have no meaningful access to medically necessary preventative care and treatment, intensive behavioral health interventions, and therapeutic medications to address acute and chronic medical needs.
As the Connecticut General Assembly moves toward declaring racism a public health crisis, what better way to begin addressing the systemic inequities in our healthcare system that have been so brutally exposed over the past year than to take the first step in creating a pathway for health insurance coverage for undocumented children and youth, the vast majority of whom are children of color. The best starting point would be to enroll the approximately 13,000 individuals under the age of 19 without legal status into the state’s HUSKY insurance programs by amending Senate Bill 956 as a first step toward a graduated approach to covering all ineligible residents. This first step would provide direly needed coverage to the same children who are enrolled in our schools, share spaces in our houses of worship, and who have been disconnected from their peers and community supports for over a year.
Connecticut has already made great strides in welcoming and integrating immigrant children into our state– regardless of their immigration status. The state provides in-state tuition for undocumented students who attend our public colleges and universities (2015); allows undocumented higher-education students to apply for financial aid (2018); and pursuant to a federal Constitutional mandate provides free, publicly funded primary and secondary education to all residents, regardless of immigration status (1981).
And what is the price of such an endeavor? Thanks to the Connecticut Health Foundation and health policy experts at the Georgetown University’s Health Policy Institute’s Center for Children and Families policy brief entitle” “Expanding HUSKY Coverage for Children in Connecticut,” we know exactly what providing full HUSKY healthcare coverage will cost for children and youth, starting in July of this year. The price tag: $25 million, or less than one-quarter of one percent of the Department of Social Services’ proposed $9.3 billion budget for the next two fiscal years, and well under the cost posited by the state’s Office of Fiscal Analysis. With over $6 billion in federal pandemic relief headed to Connecticut, and with a budget surplus of over $130 million, how can the state not afford to invest in expanding health insurance to all of the state’s children and youth?
If our goal is to truly address the health disparities that plague our state and nation – what better way to start than to give all of Connecticut’s children a pathway to healthcare, and to work toward the ultimate goal espoused in the World Health Organization’s constitution – that “[g]overnments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.”
Jay E. Sicklick is Deputy Director of the Center for Children’s Advocacy.
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