As a 13-year-old undocumented immigrant living in Connecticut, when Jose Palma broke his clavicle playing soccer he didn’t tell his mom because he knew his family couldn’t afford it.
It didn’t take long for his mom to notice something was wrong and she drove him to a clinic in Stamford, where they confirmed his injury. Although Palma needed further examination and X-rays, the attending doctor didn’t order the follow-ups because they couldn’t pay.
“My clavicle healed, but it makes me scared to play and get hurt or to get sick because I know that even though my mom will do everything possible to pay for my medical expenses, I know how difficult it was for her,” he said.
Palma was just one of two hundred people who testified in front of the state Human Services Committee on Feb. 14 supporting House Bill 6616, which would expand Medicaid coverage to income-eligible residents under 26 years old regardless of immigration status. Others at the hearing voiced concerns about the cost of expansion.
Heartbreaking story after heartbreaking story showed the need to invest in preventative care, said state Rep. Jillian Gilchrest, D-West Hartford, Human Services Committee co-chair.
The testimony “really illustrated that this is a matter of life and death,” she said. “Without this coverage, there are people who have experienced family members dying and then there are folks who are fearful that without preventative health care they will die.” What's the issue?
Carmen Lanche, a long-time activist and mother of two, has been living with her untreated lupus diagnosis for over 12 years. She explained to committee members that she hadn't found affordable healthcare since she was undocumented and uninsured.
With a shaky voice, Lanche described the constant pain stemming from her liver, lungs and heart when her condition flared up. She spends around $1,000 monthly to cover her medication and would take a single pill to manage the pain. However, her condition is worsening with frequent and intense flare-ups.
Lanche is only 45 years old and knows that if she doesn't find the proper care, she will be gone soon.
"I'm dying slowly. I really want to see my kids grow up," she said between sobs.
According to the Migration Policy Institute, almost 60% of the 113,000 undocumented immigrants living in Connecticut were uninsured in 2019.
The high rate of uninsured people in the undocumented community is due to systemic hurdles that make it difficult to access public and private health insurance, explained Carolina Bortolleto, a leading member of HUSKY for Immigrants.
The Kaiser Family Foundation found noncitizens face eligibility restrictions with public insurance and work low-income jobs that don't offer or cannot pay for employer-based insurance. Many also face enrollment concerns such as fear, confusion, language and literacy barriers.
In addition, noncitizens were more likely to report not having a usual source of care and avoid medical assistance because of cost. As a result, uninsured individuals rely heavily on emergency services and emergency Medicaid, which are typically more expensive.
"[The current] access to healthcare the [undocumented] folks have is free community clinics or waiting until it's an emergency," Bortolleto said. "Then they go to the emergency room, which means that the treatment that they need is more expensive and more invasive."
Data from the Connecticut Office of Health Strategy shows that the reliance on emergency services presents a heavy financial burden to the state. From 2020 to 2021, statewide uncompensated care charges totaled $834 million, marking a 7.5% increase in costs since 2019.
At the public hearing, numerous people recounted how family members would prioritize everything over their health, even when the injuries were extremely painful or almost fatal.
Yale medical student and public health researcher Hyeong Choi said when she was younger, she would see her parents severely injured while working at factories and restaurants but they never sought medical help. Her parents would instead rely on massages, medication and bedrest to help with the pain because they didn't have health insurance.
"I cannot describe to you how helpless I felt when my dad's car flipped across a rainy, freeway on his commute and he refused to go to the emergency room," she said.
All of Choi’s family members have chronic medical conditions that have worsened since, without insurance, they can't access the necessary care. For example, her mom self-medicated her daily headaches, which were symptoms of severe hypertension. Meanwhile, her father developed lesions throughout his liver because he had untreated hepatitis.
"Current policies are making people sicker," she said. "Having access to insurance will help us live happier and healthier lives." What is the bill?
The HB 6616 bill would expand HUSKY coverage to all income-eligible residents age 26 and younger, regardless of immigration status. The population that the bill provides coverage for includes lawfully present immigrants who have yet to be stateside long enough to qualify for HUSKY and noncitizens, such as asylum seekers and undocumented individuals.
If passed, the bill would increase health insurance enrollment rates among immigrants by 43%, according to the RAND Corporation.
The legislation would be implemented slowly, testified William Gui Woolston, director of Medicaid and division of health services for the state Department of Social Services (DSS). He explained that coverage would open for individuals under 21 years old in January 2024 and remaining individuals would gain access in June of the same year.
Woolston said DSS estimated the expansion would cost the state $15 million annually.
To expand HUSKY to all income-eligible residents regardless of age or immigration status would cost the state $83 million, accounting for 3% of the annual Medicaid budget, according to RAND.
Human Services Committee co-chair state Sen. Matt Lesser, D-Middletown, said the bill is in the early stages of the lawmaking process and he considers HB 6616 the "first draft." However, he hopes it will pass with few amendments since the act is building on a stable foundation that the public has welcomed with open arms.
"We know from other states that have tried this that it leads to a healthier population… it'll save taxpayer money and lower health care costs," he said.
In 2021, the Connecticut state legislature expanded HUSKY coverage to all income-eligible pregnant people and children up to 8 years of age, regardless of their immigration status. On Jan. 1, it was later expanded to cover kids up to 12 years old. Lesser said the last expansion passed through the state Senate with bipartisan support.
According to the DSS, more than 2,000 children have enrolled in HUSKY since the most recent expansion.
Incrementally increasing the coverage age limit allows for further studies on the demand and long-term fiscal impact of expanding coverage without overwhelming the market, Lessor said. Although the most recent expansion information is still coming in, Lesser said the overall outcome will be positive and fiscally responsible.
"We've been able to start small to show that the program works to avoid overloading the system," he said. "We tried it with young children first. Now, we're moving to slightly older kids and we're using that to work out any kinks in the system and figure out what we can do better."Long-term benefits
Bortolleto is undocumented and doesn't have health insurance even though she has been living, working and paying taxes in Connecticut since 1988, she told the Human Services Committee. When she was 25, Bortolleto was hospitalized for eight months due to a ruptured stomach.
One night she woke up in "excruciating" pain but pushed off going to the hospital because she didn't have health insurance. Finally, the pain became too much for her and she went to the emergency room just before her stomach ruptured. The doctors told Bortolleto that she had a large obstruction in her stomach that had gone unnoticed for several months.
Bortolleto was left with a hefty $1.3 million hospital bill for her care. However, she said the state absorbed and covered the medical bill through emergency Medicaid and uncompensated care costs.
"If I had health insurance as a 22-year-old…would my hidden stomach obstruction have been diagnosed earlier?" she asked the committee. "If I had insurance that night when I woke up…would I have gone to [the hospital] sooner? Would it have made a difference?"
A sponsor for HB 6616 state Rep. Robyn Porter, D-New Haven, said that expanding HUSKY is a fiscally and morally responsible course of action since increasing access to preventive care services would create a healthier community and lower the need for emergency services.
According to RAND, expanding HUSKY to all income-eligible residents would save hospitals up to $72 million in uncompensated care. In addition, decreasing the rates of uninsured among undocumented and legally-present immigrants would substantially reduce the state's cost of emergency Medicaid.
"When we talk dollars and cents, it doesn't make sense that we don't cover everyone," Porter said. "That's a lot of money and I don't see why we don't understand the benefit of making sure that we're taking care of people healthwise because there's a loss of productivity."
In addition, Porter said that passing HB 6616 is a matter of morals, stating that everyone deserves access to affordable healthcare. She added that many undocumented immigrants pay state taxes for government-funded public programs but never receive the benefits.
One in six Connecticut workers was an immigrant in 2018, reported the American Immigration Council. That same year, immigrant-led households in the state paid $2.6 billion in state and local taxes. Undocumented immigrants paid an estimated $197.4 million in state and local taxes.
"These folks have invested and continue to invest in this state and in this country even though they may be undocumented. They're improving the quality of life for many of us," Porter said.
Lastly, Gilchrest said the bill received overwhelming support from Connecticut residents and passing the law would fall in line with what constituents want.
A research poll conducted in February by the Universal Healthcare Foundation of Connecticut found that 57% of voters support expanding access to HUSKY.
Gilchrest also estimated that 80% of the 232 testimonies presented at the public hearing were in support of HB 6616.
Voters “recognize that everyone should have access to healthcare and that this is a human right first and foremost,” she said. “Second, it just makes sense both healthwise and financially because we should be investing in preventative care.”Creating access
Passing HB 6616 would make it easier for teenagers to access vital mental health services in an environment where mental health is severely stigmatized, said Juan Fonseca Tapia at the public hearing.
"I am sure that this bill will open the doors for more young people who are struggling today and seek help even if their parents or community tell them that depression is not real," Tapia said. "The passage of this bill will move us closer to a society where more people can access the care they need, especially when life gets hard and one might feel like that there is no other way out.”
Tapia told the committee about his 15-year-old niece, Jenny, who died by suicide in 2015. Jenny was five when her family moved from Mexico to Connecticut. As soon as she learned English, Jenny became the family translator and was put under a lot of pressure, Tapia said.
Jenny made the first attempt on her life in Feb. 2015, but Tapia said her father (his brother) dismissed it as an overreaction and attention-seeking tactic.
"Unfortunately, Jenny's dad was wrong because, on September 15, I found myself in a funeral home talking about my niece's funeral arrangements," Tapia said as he held back tears.
Tapia ended his testimony by begging the committee to pass HB 6616 so teenagers who feel like Jenny can access the care they need. Concerns
Many people at the public hearing expressed concerns and opposition to the bill.
Woolston announced that the DSS didn't support the bill since the annual expansion cost wasn't included in Gov. Ned Lamont's proposed budget. He added that more research must be done on the economic impact and believes further expansion would be "premature."
"The Department does not yet know whether funds appropriated for the program in its existing format will be sufficient to cover all eligible individuals through the end of the fiscal year," he said.
Gilchrest noted that DSS often opposes bills with high costs not written into the governor's proposed budget. However, she said they would negotiate with DSS once the appropriations committee draws up their budget.
Director of Program Oversight and Grant Administration for DSS, Peter Hadler, said expanding HUSKY to kids up to 12 years old has had a "good pace of enrollment" with more than 2,000 signing up within two months.
Similarly, Rep. Hilda Santiago said she fully supports the measures of HB 6616 but worries about the fiscal sustainability of expanding HUSKY. She plans to closely monitor the bill as more research on the cost comes out.
"You can't give [HUSKY] for three years and cut it off because there was no money in the budget. This is a program that has to be sustainable," Santiago said.
A handful of people submitted written testimony against HB6616.
Registered nurse Linda Dalessio wrote that providing healthcare to undocumented residents is a "slap in the face to every working American," arguing that the bill's passage would only benefit people not legally present. Meanwhile, Kathleen Misset questioned the fiscal impact of expansion, the cost to taxpayers and the impact on citizens who barely miss the income requirements for Medicaid. She also wrote that providing health insurance would make the state much more attractive to newly arrived non-citizens.
State Rep. Gale Mastrofrancesco, R-Wolcott, posted her opposition to the bill on Facebook the day after the public hearing. Mastrofrancesco, whose district includes part of Southington, wrote that expanding HUSKY to everyone is just one of many bills on the "wild wild left's" agenda.
"These aren't just ideas; they are bills that have actually been introduced by members of the Democrat majority and are being pushed as part of an extreme progressive agenda," Mastrofrancesco wrote. "These proposals benefit special interest groups at the detriment of average taxpayers, parents, and property owners and infringe on our constitutionally protected rights and liberties."
Mastrofrancesco did not respond to Record-Journal's requests for comment. Impact
Mirka Dominguez-Salinas is the program manager for Services for Undocumented Neighbors as part of the Integrated Refugee and Immigrant Services based in New Haven. She said the HUSKY expansion to pregnant people and children 12 and younger has already had many ripple effects.
The most significant change is among pregnant clients, many of whom had gone months without proper natal care. With HUSKY, Dominguez-Salinas said her clients now have access to many pre and post-natal programs.
"You can go get an ultrasound, you can get medication if you need and then suddenly, you're also connected to these other programs. They can maybe provide you with diapers or could help you apply for WIC," she said. "It's like a chain. Once you're in, you can get connected to these other services."
Reporter Cris Villalonga-Vivoni is a corps member with Report for America, a national service program that places journalists in local newsrooms. Support RFA reporters at the Record-Journal through a donation at https://bit.ly/3Pdb0re. To learn more about RFA, visit www.reportforamerica.org.