New York State Health Foundation

Shortcut Navigation:

Keeping the American Dream Alive

By David Sandman, President and CEO, New York State Health Foundation
Published in the HuffPost on October 11, 2017

“When our families landed on Ellis Island, they never imagined the door to opportunity could slam shut.”

A poster with that headline has hung on my office wall for the last 16 years. It was a gift from a colleague and a memento of some work we did together to expand health insurance coverage for immigrants in New York State. It’s a potent reminder of both the rich history of New York’s immigrant population and the persistent challenges that immigrants continue to face today. It’s a reminder too of my own family history of immigration and the chances that were given to my ancestors to succeed in a new country.

While this poster was produced in 2001, its message couldn’t be timelier. The Trump administration’s announcement last month that it would rescind the Deferred Action for Childhood Arrivals (DACA) program moves us away from the American dream of opportunity, inclusion, and fairness. DACA provides a measure of protection for young people known as the “Dreamers.” Since 2012, DACA has provided employment authorization, Social Security numbers, and temporary protection from deportation to immigrants who arrived in the United States before the age of 16 and who have lived here for five or more years. They work legally and pay taxes. Many of them have no memory of living anywhere other than the U.S. Some of them now have American children of their own.

You might know or work with a Dreamer. I did, when a former intern in my office shared with us that he was a DACA recipient. Cesar, originally from Ecuador, embodies the American dream today. He grew up in Washington Heights and is an honors graduate of the City University of New York. Now, he is in medical school and determined to improve the health of the community he grew up in. We’d be better off with more people like him.

Hundreds of thousands of Dreamers like Cesar are facing elimination of the protections and benefits they have been promised. Dreamers’ futures are uncertain and anxiety is mounting. The President has challenged Congress to make the DACA program permanent by March 2018, but I’m not holding my breath. Further complicating the task, the President has tied DACA-related legislation to a host of controversial demands including construction of a border wall. Without Congressional action, Dreamers could begin facing deportation as early as next spring.

Many of the 42,000 or so Dreamers in New York State also face uncertainty when it comes to their health care. Those who are covered through employer-sponsored plans could lose their health insurance when their work authorizations expire. And as many as 10,000 Dreamers in New York State are covered by Medicaid. Federal funds cannot be used for unauthorized immigrants’ health insurance, but New York and a few other jurisdictions (including California, Massachusetts, and D.C.) use state funds to provide Medicaid coverage to income-eligible DACA recipients. A lot of innovative work has gone into educating Dreamers in New York about their Medicaid eligibility and signing them up for coverage.

The best solution to these threats is a federal one; Congress could enact legislation to continue permanent protections for Dreamers. A bipartisan push by Senators Durbin and Graham would give Dreamers the chance to become U.S. citizens if they pursue higher education or seek careers in the military or the workforce. It won’t be easy to pass a bill like that; immigration policy has been among the most vexing areas for Congress.

New York State can’t and won’t rely exclusively on a solution to emerge from Washington. Governor Cuomo recently stated, “This cruel move to rescind DACA feeds the beast of bigotry, and it will upend the lives of hundreds of thousands of young people across the nation. …New York will never stop fighting for the values embodied by the Lady in our Harbor. The federal government’s action is antithetical to everything we believe as New Yorkers.”

With moral leadership like that from our Governor, there are immediate solutions at hand for New York State to continue providing health insurance coverage for its Dreamers. DACA recipients in New York qualify as “permanently residing under color of law,” or PRUCOL, which in turn makes them eligible for Medicaid if they meet the income criteria. As Max Hadler of the New York Immigration Coalition put it, “Many advocates believe there is a legal argument that DACA recipients should still be considered PRUCOL after they lose DACA status.” It is solely within the State’s power to determine PRUCOL status and continue Medicaid coverage for Dreamers. Doing so would have almost no additional cost because these funds are already included in the State’s budget.

Another option for New York State, developed by the Community Service Society, would establish universal coverage for young adults. For those who don’t qualify for other types of coverage, the State could expand the Child Health Plus program to all young adult immigrants through age 29. This policy change could provide an estimated 27,900 New Yorkers—both DACA recipients and other unauthorized immigrants—with affordable health insurance coverage. Such an expansion would cost the State around $78 million, or about $2,800 per enrollee.

Viewed narrowly, this issue is about health insurance and the peace of mind and financial security that come with it. Millions of Americans felt the threat of having their health insurance taken away earlier this year when repeal of the Affordable Care Act seemed imminent. People worried about how they’d pay the bills; how they’d manage with a chronic illness that keeps them from working; whether a loved one would have to forgo cancer treatment if they lost their health insurance. For the Dreamers, this threat—among others—remains very real.

Viewed broadly, this is about our values. It’s about our history as New Yorkers. It’s about our heritage as a place that opens its arms to people from around the world who want to pursue the American dream of freedom and opportunity. As that poster in my office says, immigrants “are working hard for a better life. They deserve a healthier life too.” We should keep that dream alive.

Follow David Sandman on Twitter: www.twitter.com/davidsandman1