Nada Hassanein, Tribune News Service

Gabriel Henao fled Colombia to escape a guerrilla group who, he said, twice threatened to kill him. After some time in Mexico, he arrived in Colorado in July 2022, settling in Fort Collins. His severe stomach pain started when he was in Mexico, he said. It was debilitating and left him bedridden for days at a time. The pain continued to plague Henao in the United States, but he said he didn’t make enough money cleaning houses to pay for health insurance. Colorado did not offer Medicaid coverage to residents living in the country without legal status such as Henao, or to immigrants in the mandatory five-year waiting period after receiving their green cards. Without coverage, Henao couldn’t get a proper checkup, he said, let alone a diagnosis or treatment for his stomach pain.

That changed at the beginning of January, when Henao received care through Colorado’s OmniSalud programme, which provides health care coverage to low-income immigrants in the country without documentation. When the programme started accepting enrollments in 2022 it covered 10,000 people without requiring them to pay premiums, and this year Colorado expanded the number of zero-premium slots to 11,000. Alianza NORCO, a nonprofit organization that supports immigrants in northern Colorado with legal and other resources, is helping Henao acclimate to the US and assisted with his application to the OmniSalud programme. “I started to get really scared, nervous, anxious because I didn’t have money to care for my health,” said Henao, 44, a father of three who owned a clothing warehouse in Colombia. He has applied for asylum, saying his life was in danger in his native country.

Now, after undergoing an appendectomy a few weeks ago, “I feel excellent,” he said in Spanish through a translator provided by the Colorado Immigrant Rights Coalition. Colorado is one of a growing number of Democratic-dominated states that are extending health care coverage to a limited number of immigrants who otherwise wouldn’t be eligible for public insurance because of their legal status. Supporters say such programmes save money in the long run, because insured people are more likely to receive treatment for chronic conditions and get preventive care, thereby avoiding expensive medical crises that end up costing taxpayers and raising premiums for the insured. But as more states face budget crunches, critics object to spending millions to insure people who are living here without authorisation. Meanwhile, the flood of migrants at the US-Mexico border figures to be a major issue in the presidential campaign. And recently, nine Democratic governors sent a letter to the Biden administration and congressional leaders urging them to solve the “humanitarian crisis” of “the sustained arrival of individuals seeking asylum and requiring shelter and assistance.”

The Colorado programme serves immigrants, regardless of their legal status, who have an income of less than $22,000 a year for an individual or less than $45,000 for a family of four. The state filled its 11,000 available slots in two days. The programme costs the state an estimated$73 million annually, according to the Colorado Division of Insurance. “For some people, it’s the first time that anyone in their family has been able to have health care, which is a huge, life-changing advancement,” said Raquel Lane-Arellano, communications manager for the Colorado Immigrant Rights Coalition. “They’re not just seeking emergency care. They’re able to go get preventative care.”

Advocates say the pandemic, and the health disparities it revealed, prompted state efforts to provide coverage to more people, regardless of their immigration status. “It’s a very exciting trend that we are monitoring very closely. Some of the work on this has been decades long,” said Tanya Broder, senior staff attorney at the National Immigration Law Center. “But the recognition of the value of investing in health care for all really increased during the height of the pandemic, when states recognised that our health is interconnected, and it makes sense to protect the health of everyone in the community in order to protect public health.” California, Oregon and Washington state also offer health care coverage to people of all ages who have incomes below a certain level, regardless of their immigration status. Minnesota will do so starting in 2025.

In addition, at least 24 states and Washington, DC, now offer coverage to pregnant immigrant women who are in the five-year waiting period to qualify for Medicaid, according to an analysis by KFF, a health care policy research organisation. Meanwhile, seven states — California, Illinois, Maryland, Massachusetts, Minnesota, Rhode Island and Washington — use state dollars or money from the state-federal Children’s Health Insurance Programme, known as CHIP, to offer coverage for a year postpartum regardless of immigration status, according to KFF. Starting in March, Michigan will eliminate the five-year waiting period for Medicaid for children and pregnant women. The change will result in coverage for up to 4,000 children and about 5,500 women, most of them Hispanic, said Simon Marshall-Shah, senior policy analyst for the Michigan League for Public Policy. Michigan will spend about $6.4 million on the programme, but federal matching funds will bring the total to$26.4 million.

And in January, a new law went into effect in California offering Medicaid coverage to adults ages 26 to 49 regardless of immigration status. California rolled out its health care coverage for immigrants in phases. In 2020, the state expanded its Medicaid programme, which it calls Medi-Cal, to young adult immigrants ages 19 to 25, modeling the Young Adult Expansion programme after a previous one for children under 19. “This expansion comes out of our state general fund, meaning there isn’t like a new tax or a new funding source that we have to raise for this expansion,” said Sarah Dar, California Immigrant Policy Center’s policy director. Since emergency room visits are costly to both individuals and hospital systems, creating programmes that expand access to primary health care coverage “makes good fiscal sense,” she said.

But critics say California can’t afford the expansion amid the state’s mounting budget deficit. Republican state Sen. Brian Jones, who is the minority leader, released a statement in January urging Democratic Gov. Gavin Newsom to enact an 18-month freeze on the programme. “In the midst of a significant budget deficit, hospitals shutting down, and a massive influx of migrants illegally crossing our open border, now is not the time to be expanding this costly government programme,” Jones wrote. “Our priority should be safeguarding critical services and core functionalities.” In Nevada, Republicans blocked efforts to expand Medicaid to immigrants without documentation last year, saying the proposal would be too costly. During a March floor debate, Republican state Sen. Robin Titus, who is also a physician, said she worried about adding thousands more to the Medicaid rolls when the state already struggles with a lack of enough health practitioners.