Aim Higher: Cover Immigrants

David Sandman
3 min readMar 9, 2023

A few years ago, I wrote a blog post inspired by a poster that’s now hung in my office for more than 20 years:

Black-and-white family photo of immigrants who arrived in New York via Ellis Island under the headline, “When families landed on Ellis Island, they never imagined the door to opportunity could slam shut.”

What was true then is true now: immigrants are working hard for a better life. They deserve a healthier life, too. And New York has a unique opportunity to put it in reach.

The State is requesting a federal waiver to expand health insurance coverage through the Essential Plan, a no-cost or low-cost coverage option for low-income New Yorkers who earn too much to qualify for Medicaid. The proposed waiver would increase the income eligibility for Essential Plan coverage to 250% of the Federal Poverty Level, from the current cap of 200%. The waiver proposal is a step to improve access to and affordability of health insurance; it is estimated that 20,000 people could gain coverage and another 70,000 would pay less for their coverage.

But we could go further and there’s a missed opportunity in the proposed request: it continues to exclude immigrants from coverage. New York State has been a leader in expanding health insurance coverage, including extending coverage to children regardless of their immigration status. At the same time, the State has left behind many adult immigrants; an estimated 40% of New York’s 835,000 unauthorized immigrants are uninsured. Without coverage, many turn to the emergency room or delay needed care, which can lead to poor health outcomes and higher health care costs. An analysis from the Community Service Society found that offering comprehensive coverage through the Essential Plan to undocumented immigrants with incomes up to 200% of the Federal Poverty Level could reduce New York’s uninsured rate by 10% or more.

The waiver offers the perfect opportunity for New York to expand health insurance coverage to a group that’s been left out for too long. In the past year, both Colorado and Washington were granted federal waivers that allow them to cover undocumented immigrants. California and Illinois also have developed creative solutions to use State Medicaid dollars to cover immigrants regardless of documentation status.

Expanding coverage to currently ineligible immigrants would yield numerous benefits, beyond the moral victory of doing the right thing. It would contribute to substantial coverage gains, which is good for everyone, regardless of immigration status. Having a larger share of the population covered promotes a high-functioning health care system; it creates access to primary and preventive care and reduces reliance on emergency departments. An enhanced waiver would also save New York money by securing federal financial support for coverage of immigrants.

Our State has the chance to deliver on the promise to ensure that as many people as possible have health insurance coverage, and on the promise of an America where everyone has the opportunity for a healthy, fulfilling life. We can and should aim higher than another modest incremental step when the possibility exists for much more. New York should preserve its reputation as a pioneering state and use the proposed waiver to extend coverage to currently ineligible immigrants. Doing so would be a major step to expand access to health care for all New Yorkers in need.