NY Assembly does not vote on healthcare for 245,000 undocumented immigrants

The bill, called "Coverage for All," had passed the State Senate on June 8. But inaction by leadership in the Assembly, which like the Senate is controlled by Democrats, means the bill is unlikely to pass the State Legislature in 2023.

With Gov. Kathy Hochul expressing concerns about the long-term cost — and any bill passed by the Legislature requiring Hochul's signature — Assembly Speaker Carl Heastie was ultimately unwilling to bring the bill to the Assembly floor for a vote.

The bill would extend New York's "Essential Plan" — a basic state health insurance plan available to lower-income state residents — to undocumented immigrants wishing to enroll. The Essential Plan is currently available for people who don't qualify for Medicaid, and is affordable: There are no premium payments. The nonprofit Community Service Society, which supports the legislation, estimates up to 245,000 undocumented immigrants would qualify.

In a June 6 letter, President Biden's administration indicated that New York could gain a waiver to use federal dollars to fund the program, and New York has a major surplus of federal dollars to fund Essential Plan coverage.

The Community Service Society estimates that covering a maximum of 240,000 people would cost a net of $1.2 billion annually — which, in turn, could be covered by a $2 billion annual surplus in federal funding for the state's Essential Plan.

A trust fund for the state health insurance program, which cannot be used for any other purpose, has an overall surplus of about $10 billion, according to the nonprofit Empire Center for Public Policy.

Still, Gov. Kathy Hochul, a Democrat, has expressed concern about the program's long-term cost and whether the federal funding will remain sufficient.

"It's not just saying that $2 billion will be there forever, because it won't be," Hochul told reporters earlier this month. "If the federal government wishes to give us more to complement that, supplement that, give us $13 billion, that makes it a lot easier on the state. But I have to look at everything holistically, and the impact on our state finances, before I make a decision."

Her office has cited estimated potential annual costs of the bill of $2 billion or $3 billion. The Assembly sponsor of the bill, Democrat Jessica González-Rojas, told Politico that the debate was "complicated when your governor's throwing out numbers that came out of the thin air."

"Passing Coverage for All is a moral imperative," González-Rojas wrote in a joint op-ed published Tuesday in El Diario. "Every day in our state, our undocumented neighbors facing illness and injury are put in an impossible position. Without health insurance, they cannot afford to seek necessary and preventative care, prolonging their illness, suffering, or even putting their lives at risk. Our uninsured neighbors fear exorbitant medical bills that would drive them into endless debt."

Advocates for the bill believe it will save the $500 million annually: Undocumented immigrants currently using state-funded emergency care, through Medicaid, could now be covered by the federally-funded Essential Plan.

Bill Hammond, the Empire Center's senior fellow for health policy, wrote last week that factors appearing to make "Coverage for All" financially viable could shift over time: Congress could scale back funding for New York's Essential Plan, or a future administration could reverse the Biden policy allowing federal funds to cover undocumented immigrants.

"Given the rising cost of health care generally, the expenses for operating the Essential Plan could escalate faster than its funding," Hammond wrote. "The population of undocumented immigrants is inherently hard to measure — and might well be rising, given the recent surge in border crossings — which could lead to higher-than-expected enrollment."

The Assembly's two-day return to Albany was necessitated because two weeks ago, the chamber was unable to finish voting on bills before the session's scheduled end.

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