“The truth is that if my family had free health insurance, it would change a lot,” a patient on the phone told me in Spanish. The patient delved deeper into explaining how she had received a bill for $150 for a dental cleaning she only scheduled for her certification to attend school. She later called to explain this was an expense she could not pay off, only to receive explanations from the medical billing office that because she didn’t have immigration status, she was ineligible for help with paying for this integral service. “They constantly tell us when you have immigration status, then you can return and communicate with us.”
Call after call, I heard patients recount receiving thousand dollar bills from acute emergency room visits after delaying care and realizing they had an expensive noncommunicable disease like cancer or glaucoma. These were the testimonies I heard and gathered for a bill to expand state Medicaid — also known as HUSKY in Connecticut — to those who are income-eligible regardless of immigration status this past year. And these stories are similar to the ones I heard at the HUSKY4Immigrants Coalition launch on Valentine’s Day at the Legislative Office Building this year. Since undocumented immigrants often lack eligibility for coverage, they are uninsured. As a result, they often delay important primary care visits to prevent non-communicable disease. And when they do show up, they leave the hospital with hefty medical debt.
Although the Coalition has been making steady gains to get undocumented children covered, it is difficult to convince legislators that their parents need to be healthy, too. Earlier this year, Gov. Lamont proposed a new budget, which includes a decrease in the eligibility threshold for HUSKY Part A, one of Medicaid’s programs for low-income individuals. This would mean that many parents and caretakers who are between 160 percent and 138 percent of the federal poverty level would have to rely on Covered CT, a no-cost share program that is funded through public and private funding. Undocumented parents currently cannot access HUSKY Part A. This proposed budget would cement their exclusion from future coverage.
America has prioritized creating a system based on profit, which relies on people only accessing services when they have acute, emergency conditions. We are in the midst of deep political change and are reckoning with our healthcare system’s evident hybridization and subsequent lack of navigability. With stories like the Providence health system barraging people eligible for free care with phone calls and sending debt collectors to their homes; the amendment of the bill to expand HUSKY to all regardless of immigration status up to the age of 15 instead of 26; and of the immense financial burden that comes with delaying care, it is evident that the U.S. healthcare system is one centered around “sick care.”
When emergency patients cannot pay, this burden of uncompensated care costs falls on hospitals, which is evident in how most previously profitable hospitals were in the negative during the pandemic. This is not a surprise given the many institutional inequities in our healthcare system. For years, healthcare providers and entrepreneurs have constantly created patchwork solutions to address a fractionated system.
A robust, accessible primary care system can only thrive if we transition to a non-hybridized system of universal healthcare, often referred to as “Medicare for All.” Research shows that the onset of Medicare eligibility in 65-year-old Americans leads to increases in healthcare service and medical care utilization, as many previously disadvantaged and uninsured groups now gain access to healthcare. Among these services, routine doctor visits and primary healthcare access increased for groups that previously lacked coverage, and these populations experienced the largest gains in coverage at 65. Under a single-payer system, Yale researchers calculated that we would have saved 212,000 lives in 2020, alongside $105.6 billion for hospitalization and medical care costs. In a normal, non-pandemic year, they estimated that universal health care would save $438 billion. The most cost-effective argument for pandemic preparedness is universal healthcare coverage.
Alongside the expansion of healthcare to all of our country’s residents, it is important that we mitigate the systematic racism that adds another barrier to equitable health care. For example, undocumented immigrants with other intersectional identities face numerous barriers such as language, cultural responsiveness and racism that hinder their access to free health services.
We must do better. We can start by advocating for Medicaid expansion through small age limit increases, but this is just a first step. We can recruit more diverse healthcare providers who understand their patient’s backgrounds and try to holistically take into account patients’ social conditions when making a diagnosis. We can save more lives and money if we shift from a system that relies on treating health as a privilege to have instead of a right. It is up to us to chart a path towards the future, and make true transformative change for better global health.
ANJALI MANGLA is a senior in Ezra Stiles College, and a former Science and Technology Editor and Director of External Affairs at the Yale Daily News. She is also the Chair of the Communications Committee of HUSKY4Immigrants Coalition. Contact her at anjali.mangla@yale.edu.