Inside the State Senate (photo: NYS Senate Media Services)

In the final days of the legislative session in Albany last week, the State Senate passed a bill that would expand healthcare access to hundreds of thousands of low-income New Yorkers regardless of their immigration status. But the State Assembly ran out of time and adjourned without taking up the bill and now faces pressure to approve it when it returns to address unfinished business on June 20 and 21. 

On Thursday, the Senate approved the “Coverage for All” legislation, sponsored by State Senator Gustavo Rivera, a Bronx Democrat and chair of the Senate’s health committee. The bill, which immigrant advocates have been pursuing for years, would expand health care access to more than 240,000 undocumented immigrants in the state, allowing them to enroll in New York State’s Essential Plan that gives low-income New Yorkers access to health insurance. 

“The Assembly is expected to return to Albany so we're counting on the broad support we've received from our legislative colleagues to pass this bill on the floor as we did in the Senate,” Rivera said in a statement to Gotham Gazette.

“We are actively working to both educate our Assembly members and count votes to ensure that if it hits the floor, it'll be supported,” said Assemblymember Jessica González-Rojas, a Queens Democrat and lead sponsor of the bill, in a phone interview. The bill has already been approved by the Assembly’s health committee and is now in front of the ways and means committee, and needs to make it to the full Assembly floor, where it has 63 co-sponsors in the 150-seat chamber. “It's gonna take some work certainly, but I'm feeling really optimistic,” González-Rojas said. 

Since last year, the bill has gained momentum after Governor Kathy Hochul said she would ask the federal government for permission to use federal funds to expand healthcare to undocumented immigrants. At the time, the governor advanced a proposal in the state budget to extend Medicaid coverage to undocumented seniors above the age of 65, while promising to seek federal approval for the broader healthcare expansion. Regardless of immigration status, the state also covers health care for children under 18 and for pregnant people, including for a year after they give birth. 

But the governor reneged on that pledge when she released her budget proposal this year, and waited till May to request a waiver from federal officials to expand income eligibility for the Essential Plan to New Yorkers making up to 250% of the federal poverty level, up from 200%. Undocumented immigrants were not included in that request. State legislators, however, made their own separate request seeking a waiver under Section 1332 of the Affordable Care Act to expand access to all undocumented immigrants as well. 

In a June 6 letter, Chiquita Brooks-LaSure, administrator for the federal Centers for Medicare and Medicaid Services, informed Senator Rivera that New York could request a Section 1332 waiver to use federal funds to expand healthcare access to the undocumented, similar to what Washington and Colorado have already done in the last year. The Senate passed its bill two days later. 

“With clear guidance from the federal government that we can utilize 1332 waiver funding to expand health coverage to eligible undocumented New Yorkers at no cost to the state, passing Coverage for All through the Legislature is essential,” Rivera said in his statement. “We will continue to fight to make sure New Yorkers living in the shadows can access healthcare beyond the emergency room when they need it because every New Yorker deserves guaranteed care.”

Proponents of the bill have repeatedly emphasized that it will not cost the state any additional dollars and in fact save the state money. The state’s Essential Plan, which covers New Yorkers between the ages of 19 and 65, already has a $9 billion surplus and, in fact, the bill is projected to save between $400 to $500 million each year that is spent through the emergency Medicaid program in providing healthcare to undocumented immigrants for services like emergency room visits. 

It’s “not just fiscally smart, but also obviously the right thing to do,” González-Rojas said, “to make sure that everyone can enroll in health insurance and get some preventative care before having to wait till their symptoms are so escalated, we’re spending so much more in emergency medical costs.” The bill does require the state health commissioner to request a 1332 waiver from the federal government, so its implementation would hinge on the delivery and response of that request.

A spokesperson for Assembly Speaker Carl Heastie, a Bronx Democrat, did not respond to a request for comment. 

The governor has, however, raised concerns about the fiscal impact of the proposal and expressed concern that it could exceed projections if enrollment is higher than expected. The governor’s office did not respond to a request for comment. 

At a June 13 news conference, Hochul reiterated those concerns, saying the Essential Plan's surplus funds amount to about $2.2 billion "which will be gone in a very short time." "The costs accrued to the state for the implementation [of Coverage for All] would be in the first few years $6 billion, upwards of $13 billion. So that is the context in which a proposal like that will have to be reviewed," she said. "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."

“Whatever her concerns were should now be appeased by the federal government’s response,” said Murad Awawdeh, executive director of New York Immigration Coalition, which is part of the Coverage for All advocacy coalition.

“As we just saw coming out of a global pandemic, we're only as healthy as our neighbors are. So making sure that everyone has access to health insurance and the ability to purchase health insurance is critical,” Awawdeh said. “It was critical before COVID and it’s even more critical now as we continue to try to recover from the pandemic.”

Republicans in the Legislature have opposed expanding health care access to undocumented immigrants. “The people coming in don't live here, they aren't citizens and the people who are here are going in the other direction,” State Senator Rob Ortt, the Republican minority leader, told NY1 last month.

While advocates wait for Assembly members to return to Albany in the coming weeks, they are keeping up the pressure. Arline Cruz, director of health programs at Make the Road New York, another coalition member, said the group sent a letter to the Assembly over the weekend and plans to hold a rally at the State Capitol this week. 

“We are hopeful. We are positive,” she said. “We're hoping that Carl Heastie will see how the Senate has taken the lead and try and follow the same footsteps.”

Note - this article has been updated to note that the Coverage for All bill has not passed the Assembly ways and means committee. 

Note - this article has been updated with comments from Governor Hochul.