Avoiding the emergency room (photo: Michael Appleton/Mayoral Photography Office)

Mateo first came to the United States to be a caregiver for his terminally ill brother, who had cancer. Shortly after his brother passed away, Mateo went to a regular doctor’s check-up. He had not been feeling well lately. After further tests, doctors determined that his kidneys were failing. Since then, Mateo has been reliant on hemodialysis, a treatment intended to help a patient with kidney failure survive while they wait for a transplant.

But Mateo is not able to get on a waitlist for the kidney transplant that would save his life. Why? He is one of the estimated 400,000 undocumented and uninsured immigrants in New York state. Despite the contributions immigrants like Mateo make every day to our community as well as to the economy, New York leaves them without support when they need it most.

At the onset of the pandemic, Mateo contracted COVID-19. He had to be hooked up to a ventilator and nearly died. Unfortunately, Mateo’s experience is not uncommon for immigrants in New York.

Our state has spent the last two years fighting against the spread of COVID-19, and immigrants have played a huge role. They pay billions in taxes every year and serve as essential workers on the front lines of the fight against COVID-19. And yet they are systemically left without access to health care. The pandemic has shown how essential that care can be: it is estimated that over 2,000 undocumented New Yorkers died from COVID-19 due to a lack of health coverage.

This is the daily reality for Mateo, who uses Emergency Medicaid, the only form of insurance he is eligible to receive. Emergency Medicaid only covers the treatment of severe “acute symptoms” that threaten an individual’s health. This means that Mateo’s dialysis is covered, but the treatment of other conditions that intersect with kidney failure (such as heart problems and loss of vision) are not – and neither is a kidney transplant. While undocumented immigrants can be organ donors, they are excluded from receiving organs themselves. New York benefits greatly from the contributions of immigrants like Mateo but does not give back to them to anywhere near the same degree.

Preventive care has the potential to save both money and lives; the Centers for Disease Control and Prevention estimate that about 90% of annual health expenses go to treatment of chronic physical and mental health conditions, many of which are preventable and treatable when addressed early. However, preventive care is not included in Emergency Medicaid coverage, which many immigrants rely on. Had Mateo been able to visit the ophthalmologist when his doctor recommended it, his eyes may not have suddenly started bleeding, requiring surgery. Due to the cost, he has also had to put off visiting a cardiologist despite the urging of his doctor.

Providing only emergency care is simply not enough. Mateo’s trips to dialysis three times per week are only intended to help him survive while he waits for a transplant. Once one’s kidneys have failed, they cannot be recovered; a transplant is the only permanent solution.

Mateo’s experiences demonstrate how a lack of insurance prevents immigrants from accessing the care they need. Many uninsured individuals may delay going to the doctor until it is too late due to an inability to pay. Health problems like heart disease, diabetes, or other chronic illnesses are known to make one more likely to get severely ill with COVID-19. While these conditions may be treatable or preventable, uninsured immigrants are left as though those treatments don’t exist, instead forced to face the serious and often fatal consequences of a condition that has been treatable for decades.

Luckily for Mateo and other immigrants like him, there is a solution. A proposed state law, (A880A/S1572A), would create a state-funded Essential Plan for all New Yorkers earning up to 200% of the federal poverty level, regardless of immigration status. If this law were passed, Mateo and thousands of others would be able to access the life-saving medical coverage they need and deserve. Other states are expanding access to health care in similar ways, including California, Minnesota, and Illinois. New York cannot be left behind on this. All New Yorkers deserve access to healthcare, no matter what their immigration status.

Immigrants are at the heart of New York’s communities: they are friends, parents, children, colleagues and partners. They pay taxes, work as essential workers and donate their organs. Still, many are left out of necessary health coverage. They contribute just as much as their neighbors who have citizenship, yet they receive far fewer benefits. This blatant discrimination is unacceptable. New York must pass coverage for all to ensure that every New Yorker, no matter their immigration status, has access to quality health care.

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Emily Hodgkins is a Post-Graduate Legal Fellow in New York Lawyers for the Public Interest’s Health Justice Program.