Three hours 22 minutes and 32 seconds have passed, and I have not moved from this hard seat in the basement of Jersey City’s Medical Center, but who’s keeping track other than me. Certainly, not the three tired-looking members of staff who sit at the front desk shouting out people’s names from a list. By the time September has arrived, I have used all my paid time off, vacation and sick days to accompany my diabetic father to his countless doctor appointments — appointments that could have been avoided had his treatment begun 11 years ago when he was first diagnosed with type 2 diabetes.
Unfortunately, a decade ago, access to anything but absolute emergency health care in New Jersey for an undocumented person was not feasible. Since then, and with the passing of the Affordable Care Act in 2010 by the Obama administration, hospitals have had an incentive to provide more care for uninsured patients. If hospitals did not meet the requirements, they were subject to a new $50,000 annual excise tax.
On average, a person in a private practice waits 30-35 minutes to be seen and 16 days to schedule a first-time visit with a new physician. Uninsured patients spend almost double that time to be seen and one to two months to schedule a new patient-physician appointment. The waiting time varies depending on location, staff numbers, among other reasons. Regardless of the new requirements, hospitals that care for a large population of charity care patients — which includes those without insurance, or those without adequate coverage — are only able to recover a small portion of the cost. The financial impact will depend, among other factors, on whether hospitals are located in states that expanded Medicaid coverage through the ACA.
As the debate for universal health care continues and Gov. Phil Murphy works to implement a state-based exchange, New Jersey needs to implement health care reform that includes undocumented residents. According to Migration Policy Institute analysis from 2012-2016, there were 526,000 undocumented folks living in New Jersey and 56% of those were uninsured. In addition, a 2018 report from New Jersey Policy Perspective showed that the state has the second-highest uninsured rate for children in the Northeast — and many of these are from immigrant families. Research shows that if undocumented people have health insurance, usage of emergency rooms will decrease, there will be a healthier population, thus a stronger workforce. And simply stated, it is the right thing to do.
Using the emergency room
Most undocumented people do not receive health care until their medical condition has advanced — requiring more costly and complex solutions — or they frequently go for care to emergency rooms, which are more expensive and designed to respond to problem issues, not prevent or reduce their severity. In 2013, the New Jersey Department of Health implemented the federal Delivery System Reform Incentive Program (DSRIP). It was designed to result in better health care for individuals and the population, and to lower the cost of emergency-room use by incentivizing hospitals to achieve performance goals related to quality of care and health outcomes. Implementing health care literacy and having community health workers aid patients in the process, the program helped to cut expenses in the states where it was implemented. A study by the United Hospital Fund on DSRIP’s Promising Practices found that using community health workers in a care triage program decreased emergency-department visits from 184 in the 12 months preceding program enrollment to 56 visits in the six months post-enrollment. Using this model and providing undocumented people with health insurance that allows them to see a primary care physician once a year would surely reduce the use of emergency rooms and lead to a healthier population.
California recently became the first state to pass legislation to allow undocumented people to buy coverage on state-run exchanges with their own money and without using any public subsidy — a change some have recommended for New Jersey. California officials believe this to be a cost-saving measure since 70% of undocumented people living there are in mixed-status families, whose members include people with different citizenship or immigration status. This change allows for everyone in the family to buy into coverage, not just some members. It is also the first state to offer government-subsidized health benefits to young undocumented adults. If New Jersey cannot agree on providing insurance to all undocumented New Jerseyans, we should at least consider providing health insurance for those below the age of 25. California’s legislation has proved that providing those under 25 with health insurance has been beneficial to the state.
In expanding care to those without legal residency status, New Jersey would thrive with a healthier community, the most vulnerable population would not have to spend their limited days off work every month to go to a doctor appointment, and hospitals would not be at capacity with charity care patients making it seemingly impossible to see everyone — hence the hours-long waiting times and the five months it can take to schedule a visit to a specialist.
Reluctant to enroll
A recent report by New Jersey Policy Perspective agrees that coverage reduces adverse health outcomes for children, provides major social benefits, and lessens medical debt for residents. The 2019 study argues that over half of all uninsured children in New Jersey are eligible for New Jersey Family Care, the state’s Medicaid program. One reason for this high uninsured rate is because New Jersey has the sixth highest number of children in immigrant families in the nation and immigrant parents are reluctant to enroll their children in any public program for fear of federal anti-immigrant policies. Studies show that immigrant families are specifically concerned about the proposed “public charge” rule that could result in the denial of citizenship to legal-immigrant parents if their child received Medicaid. Since almost all of these children are eligible for coverage that is matched by the federal government under the status quo, New Jersey is losing up to $60 million annually in federal funds for uninsured children. It is estimated that between 22,500 to 52,500 citizen children in New Jersey Family Care with noncitizen parents could lose coverage because of the “public charge” rule.
Those who oppose these measures may argue that providing health insurance for undocumented people would incentivize migration and that New Jersey taxpayers should not subsidize their care. To those, I ask, “What if you suddenly fell ill and lost your job and could not afford health insurance? Wouldn’t you want help? How can you decide if a person deserves to live or not just because they do not have a Social Security number?”
Extending access to care for undocumented immigrants would be a meaningful step to a more prosperous New Jersey. With the current Democratic presidential candidates unanimously agreeing to support policies that provide health care for undocumented people, New Jersey politicians or health care administrators should hold public forums or do assessments to understand what the population needs. And New Jersey should follow the lead of California in order to decrease the number of uninsured patients and thus help the hospitals financially and the state overall. New Jersey is heading in the right direction by issuing driver licenses to undocumented residents. Politicians must not forget about health care for all.