Trump wants Harris to pay a political price for generous health care policies for immigrants

Maria Sanchez immigrated to Chicago from Mexico about 30 years ago. Now 87, she still lives in the US without permission. Like many longtime immigrants, she worked — and paid taxes, including Medicare taxes — all the while.

But Sanchez never had health insurance, and when she turned 65, she couldn’t sign up for Medicare. She never underwent prevention and examinations. No medical examinations. No cholesterol checks. Without mammography.

“Nada, nada, nada,” she said in an interview in Spanish. Nothing, nothing, nothing.

When she got sick, she put off getting help until she got sick enough to be hospitalized twice with pneumonia. Last year, she was finally covered by Illinois’ historic undocumented seniors program, which went into effect in December 2020.

Democratic-led states like Illinois are increasingly opening public insurance programs to immigrants without permanent legal status. A dozen have already covered the children; even more so with prenatal insurance. But more states now cover adults who are in the country without permission, and some are phasing in coverage for seniors, who are more expensive and carry more political costs than children.

The extensions take into account the costs that patients living here illegally might otherwise impose on hospitals. But the policy has come under fire from former President Donald Trump and other Republicans, who are eager to make his opponent, Vice President Kamala Harris, the face of reckless immigration policy.

Republicans point out that in Harris’ home state of California, the Medi-Cal expansion covers immigrants of all ages, regardless of legal status, saying it comes at the expense of American citizens.

For Trump, this is a common complaint. “She’s going to go around saying, ‘Oh, Trump is going to do bad things to Social Security,'” he said of Harris at a Sept. 13 news conference. “No, she’s going to do it because she’s going to put these illegal immigrants on welfare, on Medicare, and she’s going to destroy those programs, and people are going to have to pay.”

Harris’ choice of Minnesota Gov. Tim Walz as his running mate added fuel to Republican attacks on the intersection of immigration and health care policy.

Under the legislation signed by Walz, immigrants living without permission in Minnesota will be able to get health insurance starting next year through the state’s MinnesotaCare program for low-income people who don’t qualify for Medicaid.

This question worries some Americans. At a town hall in Las Vegas on Oct. 10, a Univision host identified as Yvette Castillo asked Harris what her administration would do about health care for people like her mother, who immigrated from Mexico without permission years ago, worked with her . her whole life, and died this year without ever receiving “the type of care and services she needed or deserved.”

“What are your plans, or do you have plans, to support this subset of immigrants who have lived here all or most of their lives and are forced to live and die in the shadows?” Castillo asked.

Harris noted that she has in the past supported a path to citizenship for unauthorized residents — and a bipartisan border security bill that Senate Republicans rejected earlier this year at Trump’s behest.

“This is one example that there are real people who are suffering because of the failure to put solutions before politics,” Harris said.

Even without such a policy, immigrants can get free or low-cost primary care at community clinics across the country — assuming they know it’s an option and feel safe in the facilities. But primary care cannot meet all medical needs, especially as people age and develop more complex health problems and chronic diseases. So immigrants often rely on charity, go into debt or, like Sanchez, save. Some even return to their homeland for care.

Illinois, where Sanchez obtained insurance, was a pioneer in expanding insurance coverage to unauthorized immigrants. Six states and the District of Columbia — all led by Democrats — now cover at least some elderly, low-income immigrants under Medicaid or the Affordable Care Act. Minnesota will be the seventh next year. The expansion must use state funds because federal dollars typically cannot cover people who do not have legal status.

It remains to be seen whether new states will follow or how quickly, and if Trump wins the White House, his administration will likely try to buck the trend, given that he has promised mass deportations. Insurance coverage for all immigrants is still a difficult economic and political issue — and non-citizens can’t vote their thanks at the ballot box. Immigrant health initiatives in several other states have failed or been scaled back.

For example, the state of Maryland decided to open its Obamacare exchange to people living in the state without a permit starting in 2026, but without taxpayer subsidies for their premiums.

Still, there’s enough activity in the states to make immigrant health advocates believe something has changed. The severity of the pandemic and its uneven toll have helped build support for older immigrant coverage, said Lee Che Leong, senior policy attorney at Northwest Health Law Advocates in Washington state.

“People are looking around and realizing that our health is interconnected both globally and locally,” Leong said. “The pandemic has really highlighted that when you look at the disparity in who has contracted covid, who has been exposed to covid and who has died from covid.”

Access to health care in the US has long been a barrier for immigrants, even those who are in the country legally. People with green cards must wait five years for coverage under Medicaid or other government health care programs. Some older green card holders must pay extra Medicare Part A premiums — the part that covers hospital care — if they haven’t worked in the U.S. for at least 10 years

The state’s new health care programs are closing those gaps, said Shelby Gonzalez, vice president for immigration policy at the Center on Budget and Policy Priorities.

In July, Washington state began covering low-income immigrants in a Medicaid-like program called Apple Health Expansion, using a federal waiver. Enrollment is limited and the program filled up quickly, but some spots were reserved for people 65 and older, Leong said. Earlier this year, the state opened its Obamacare exchange to immigrants living in the U.S. without authorization.

Oregon and Colorado now also offer some coverage to people in their states who don’t have legal status, though Colorado’s program hasn’t attracted many elderly immigrants, according to data recently provided to the state’s Affordable Care Act exchange oversight committee.

New York has for years covered immigrant children who were ineligible for residency, and in January the state’s Medicaid program was opened to all immigrant adults regardless of status. About 25,000 people signed up in the first four months, according to New York Medicaid director Amir Bassiri.

Back in Illinois, Maria Sanchez said her new coverage has been life-changing — and possibly life-saving. Her bouts of pneumonia were severe, partly because she was late in getting help. After the second hospitalization, she required further cardiac treatment. The hospital did not charge her for the stay.

But now, with her”Tarjeta Medica” — her medical card — she can see a doctor. The condition of the heart is under control. I was at the dentist. Removes cataracts.

“With my medical card, I’m calm,” Sanchez said.

Illinois gradually added coverage for other age groups; in the summer of 2022, he lowered his age to 42 years. That means immigrants like 45-year-old Gabi Piceno can age more healthily.

“I don’t have to worry anymore,” she said, referring not only to herself, but also to her family.

But expanding coverage has cost more than Illinois anticipated. People like Sanchez and Piceno who are already on the lists remain covered, but registration for new members has been suspended this year. More people signed up than expected, and many continued to go to more expensive hospital emergency rooms rather than doctors’ offices, said Acting State Insurance Commissioner Ann Gillespie, who was an Illinois senator when it was established. program.

The state is now moving covered immigrants into Medicaid health care plans, hoping to lower costs over time.

This article was reprinted from hn. orga national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF, an independent source of health policy research, polling and journalism.