Immigration advocates are regrouping after a recent ruling prevented the expansion of health care access for over 4,000 people in Kansas brought to the country illegally as children.
A 19-state coalition led by Republican Kansas Attorney General Kris Kobach successfully challenged a rule that would have extended coverage options to people in the Deferred Action for Childhood Arrivals program, known as DACA. The rule would have given the recipients access to health care plans in the marketplace created by the Affordable Care Act.
The decision leaves those people dependent on outreach organizations and emergency rooms for health care.
Before the ruling, the nonprofit El Centro was helping clients in Kansas City, Kansas, enroll in insurance plans through the Affordable Care Act in anticipation of the rule change.
Justin Gust, vice president of community engagement at El Centro, said they’ve had to tell people their coverage is “on pause” after a North Dakota judge temporarily denied that access.
“We're in the process right now of changing those communications and messages that we’re sending out because we don't want to send out false hope,” he said.
Gust said his organization has advocated for years to put new options on the table for DACA recipients. Also known as “Dreamers,” they came to the United States as children and have lived here continuously since then.
Over half a million people have temporary work permits and deportation protections because of DACA. They contribute an estimated $6.2 billion in federal taxes and $3.3 billion in state taxes per year. Despite widespread misperceptions, however, DACA recipients lack access to services like Medicaid and food stamps.
“They're buying into the system but they're not able to receive anything back,” Gust said.
The plaintiffs in the case argued — and the judge agreed — that expanding access to DACA recipients would cause “irreparable harm” to states forced to provide public benefits.
“This decision is a big win for the rule of law,” Attorney General Kobach said in a press release following the ruling.
Immigrant rights groups argue inefficiencies in the existing patchwork of health care options for DACA recipients ultimately costing taxpayers money — which is what critics said they wanted to avoid by excluding DACA recipients from the federal marketplace.
Some have health insurance through their employer, or their spouse’s. The few who can afford it pay for private health insurance.
But the many who remain uninsured rely on community health clinics to fill the gap. Federally Qualified Health Centers offer primary care on a sliding income scale.
These clinics are vital for providing services for low-grade illness and chronic conditions. Nevertheless, these health centers are sometimes overwhelmed with patients, and most can’t offer surgeries or specialists.
“They aren't able to afford that surgery or that procedure that they need and oftentimes just put it off until their health care gets worse or to the point where it's an emergency,” Gust said. “And when they show up at the hospital it's a matter of life and death.”
When uninsured patients seek emergency care they can’t afford, hospitals shoulder part of the cost, drawing reimbursements from a cocktail of local, state and federal taxes.
The Kansas Hospital Association estimated hospitals in the state spent $441.2 million on uncompensated care in 2018 for all individuals, not just immigrants without permanent legal status.
“You're just adding on to what the state's burden is by not offering (federally subsidized health care) as a coverage option for folks,” Gust said.
Micah Kubic, executive director of the Kansas American Civil Liberties Union, said the ruling is “just one waystation” in what he expects to be a lengthy court battle on the issue.
Meanwhile, immigrant rights groups are responding to the setback by doubling down on efforts to help immigrants navigate the health care options they do have.
For Itzel Vargas-Valenzuela, program director at Advocates for Immigrant Rights and Reconciliation in Kansas City, Kansas, that means even more education.
“Not just telling people what to do but then being able to walk them through and show them,” she said.
Her group gives referrals to immigrants seeking care and helps mixed-status families understand the choices available to different household members. Part of that work is also convincing a population that might distrust social services to seek preventative care even if they don’t have insurance.
Those efforts would be easier, she said, if immigrants who live and work legally in the U.S. could benefit from health insurance subsidies they help pay into.
“People are going to try to continue blaming the immigrant seeking care,” she said, “instead of the people profiting off of our system.”
Zane Irwin reports on politics, campaigns and elections for the Kansas News Service. You can email him at zaneirwin@kcur.org.
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