dr. Nish Pandya, a pediatric resident at Yale New Haven Health, remembers the 10-year-old boy who came to the emergency room five times with breathing difficulties.
“His breathing improved when he received the necessary medication and treatment,” Pandya said on Thursday. “He started to feel better. The look of fear started to slide off his face.”
Pandya asked the boy’s mother what medicines he was taking at home.
She bowed her head and said, ‘We don’t have any medicine. We have no insurance. We have no papers,” Pandya recalls. “This patient has been to the emergency room five times in the past year. His asthma was not well managed because his family could not afford the medicines he needed to breathe comfortably. His family had no access to healthcare or health insurance.”
Pandya is one of hundreds of doctors and other health care providers in the state urging Legislature and Governor Ned Lamont to expand Medicaid, known as HUSKY in Connecticut, to the undocumented community.
Lawmakers passed a law last year opening the Medicaid program to children ages 8 and under, regardless of immigration status, beginning January 1, 2023. The children must come from households earning up to 201% of the federal poverty level (for a family of four this year, that’s $55,778). Children ages 8 and under from households earning between 201% and 325% of the federal poverty level are also eligible, but are subject to an ability test.
Earlier this year, lawmakers unsuccessfully tried to pass a bill that would have expanded access to children 18 and under regardless of immigration status. The measure died in the Human Services Committee.
But this month, a version of the plan was revived and linked to a new proposal for the state budget. The credit committee has recommended opening the program to children aged 12 and under. Once enrolled, those children would continue to be eligible for Medicaid coverage up to age 19.
Children over 12 years old who wish to enroll are not covered.
Protesters are calling for the HUSKY Health Program to be expanded to all immigrants in Connecticut, starting with undocumented minors under 18 this year. Health care advocates, members of the immigrant community and health care providers protested in the state capitol for four consecutive days. Yehyun Kim / ctmirror.org
As the General Assembly weighs in on the latest proposal, more than 400 physicians, physician assistants, nurses and other health care providers signed a letter urging legislative leaders and Lamont to extend Medicaid to all low-income residents, regardless of immigration status.
“We recognize that expanding access to the undocumented immigrants who have been excluded will be a lengthy process,” they wrote in the letter. “This session, we are urging the Connecticut state legislature to extend Medicaid to children ages 8 to 18.
“As healthcare providers, we recognize our responsibility to care for all patients, regardless of race, income or immigration status. Unfortunately, our state laws do not reflect that same commitment. While the uninsured rate in Connecticut is roughly 5.9%, an estimated 52% of undocumented immigrants in our state are uninsured.”
The letter was passed before the State Capitol on Thursday morning by Senator Saud Anwar, D-South Windsor, who is a physician himself. Several doctors gathered there to share stories about the treatment of undocumented migrants and the need to expand health coverage.
dr. Heidi Zapata knows firsthand the challenges of seeking healthcare as an undocumented resident of the United States. She didn’t get citizenship until she was 12 years old.
“I remember my family paying out of pocket for medicines, pediatrician visits and hospital stays,” she said. “I remember my mother saving up for my youngest sister’s birth and praying that she wouldn’t have any complications because we couldn’t afford it. That kind of stress shouldn’t happen.”
In her role as an infectious disease physician at the Yale School of Medicine, Zapata still sees the toll that not having health insurance takes on many people. Some delays to get to the hospital because they can’t cover the medical bills. By the time they decide to go, “they have uncontrolled infections,” she said.
Some uninsured patients have “taken it to the extreme,” she added, while others were “overdue” in seeking care.
dr. Molly Markowitz, a pediatrician at the Yale School of Medicine and pediatrician at the Fair Haven Community Health Center in New Haven, said children who don’t have health insurance are less likely to see a doctor and take a usual course of health care. They are more likely to postpone or go without care.
“I know that the way children live today will affect their lives for years to come,” she said. “We are currently in the midst of a mental health crisis for children. But for many undocumented children in Connecticut with no insurance – who have already suffered significant trauma – these serious health problems may not come to medical attention until it is too late.”
dr. Jemma Benson worked in an intensive care unit during the pandemic, treating several sick uninsured patients “who were more concerned about how they would pay a hospital bill than the illness itself.”
“These delays in care are not limited to COVID. I’ve cared for undocumented patients who came to the hospital with advanced illnesses because they couldn’t get preventive care or prior treatment because of a lack of health insurance,” said Benson, an internist at Yale New Haven Health.
Shesia Mejia, 8, headed to the state capitol during a protest to expand HUSKY Health to all immigrants in Connecticut, starting with minors under 18 this year. Yehyun Kim / ctmirror.org
Legislative leaders hope to send a budget package to the full House and Senate for consideration before the regular 2022 session closes on May 4.
Expanding access to health care, especially for children, has been a priority for majority Democrats in the legislature, and COVID-19 has exacerbated the need, said Senator Cathy Osten, co-chair of the credit committee.
Legislators have recommended spending $400,000 in the coming fiscal year to expand HUSKY to children ages 12 and under (outside of the current plan for children ages 8 and under). That’s about 1/500th of 1% of all general fund spending proposed for 2022-23.
Analysts predict that opening enrollment to children ages 12 and under would add 1,020 children to the program next fiscal year and 2,750 in 2024.
Some proponents say that, while a step in the right direction, enlargement should go further.
“It’s a humble beginning,” said Jay Sicklick, deputy director of the Center for Children’s Advocacy. “But it’s not nearly as comprehensive and effective as it could be. I think the opportunity is now, given the state’s position, given the pandemic, to insure all children up to the age of 19.”
Anwar, a pulmonologist at Manchester Memorial Hospital, called on his colleagues to do more.
“If the moral argument doesn’t make you waver, the financial argument is also very strong,” he said. “Healthcare costs go up if children don’t receive health care for prevention and early identification and management.”
Osten said lawmakers hope to continue expanding eligibility in the coming years.
“The goal is for all the kids to be covered,” she said. “To me, a child’s legal status shouldn’t matter whether we’re treating them for a broken leg or cancer, and that’s what matters.”
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