Will legislators undo LePage’s rollback and restore health coverage to low-income immigrants?

Members of the New Mainer community outside U.S. Rep. Jared Golden’s office in Lewiston in 2021. | Photo courtesy of Mohamed Ibrahim

Maine lawmakers will again consider legislation this year to close a discriminatory loophole and restore healthcare access for all Mainers, regardless of their immigration status. 

Democrats have so far only been able to partially undo the measures passed by former Gov. Paul LePage and a Republican majority in 2011 that barred immigrants from accessing a variety of programs, including MaineCare, the state’s Medicaid program.

In the 2021 budget, Democrats, who hold majorities in both the Maine House and Senate and control the Blaine House, partially closed the healthcare gap created by LePage by restoring MaineCare coverage to those who are pregnant and people under 21 regardless of immigration status.

The following session, a bill to include those remaining people failed to make it out of committee, prompting proponents of the bill to speculate that Democrats were afraid to take a vote on the matter in an election year. 

With the election over and a projected budget surplus for the next fiscal year, supporters say now is the time to restore these services to the New Mainers who are still without healthcare.

In a joint public hearing last week hosted by the Appropriations and Financial Affairs and the Health and Human Services committees, immigrant leaders, economists and health advocates called on lawmakers to fund a bill, LD 199, introduced by House Speaker Rachel Talbot Ross (D-Portland), that would restore health coverage to low-income immigrants. 

Lewiston resident Habone Ibrahim, who lost her husband three years ago in a car accident while he was on duty for a transportation company, is raising her six-year-old daughter by herself. 

She lost access to MaineCare six months after her daughter was born. 

“Since then I cannot afford going to the doctor or doing any annual medical check ups. For years I have lived without health care insurance and if I feel sick I buy my meds from the pharmacy,” Ibrahim said in testimony submitted to the budget committee. “It’s hard to be in the shoes of someone who feels left behind.”

Ibrahim’s account of skipping routine medical care is not uncommon. 

One in ten adults in Maine skipped or delayed medical care because they couldn’t afford it, according to a 2021 survey by the U.S. Centers for Disease Control and Prevention. This was even more common for low-income Mainers whose incomes fell below $15,000 a year. Their share was as high as one in four.

Exclusion creates costs for the healthcare system

Health advocates told lawmakers that many residents like Ibrahim, who lack health insurance, also often rely on emergency rooms to get basic care. A 2019 analysis by UnitedHealth Group found that going to the ER for medical care that could be handled elsewhere is costing the U.S. healthcare system an excess of $32 billion a year.

“Those who are only eligible for emergency Medicaid often delay their care until they need to seek emergency treatment,” explained Alex Carter, a policy advocate for Maine Equal Justice. “This not only leads to worse health outcomes, but it also means more costly care and a greater burden on our hospitals.”

Kate Ende, the policy director at Consumers for Affordable Health Care, explained that many health advocates are busy trying to connect uninsured residents to a patchwork of schemes to pay for their healthcare, including tapping into financial assistance offered by hospitals, community health centers, and other non-insurance programs.

“Unfortunately, these programs are not a substitute for comprehensive coverage and many people who are ineligible for health insurance have medical needs that go unmet,” Ende said. “In such cases, serious and chronic medical conditions can become extremely difficult, and sometimes impossible, to manage without consistent access to prescription drugs and timely and appropriate care.”

Economic costs

Other proponents of restoring health coverage to low-income immigrants made economic appeals to lawmakers. They noted how the lack of coverage exacerbates an existing labor shortage in Maine where an aging workforce is retiring and not being replaced at the same rate. 

“New Mainers are particularly likely to work in grocery stores and care homes, restaurant kitchens and hotels — many of the industries which are currently struggling to find workers,” said James Myall, an economic policy analyst at the Maine Center for Economic Policy. “At the same time, health concerns are the leading reason many Mainers either aren’t working at all, or not working as many hours as they might like. Ensuring that new arrivals have access to healthcare makes it more likely that they will be able to contribute fully to our economy in the future.”

Myall also said that the pandemic has made it more clear than ever how our collective safety and economic recovery are tied to each person’s ability to get to the doctor or fill a prescription. 

“We know that COVID-19 spread particularly quickly among low-income Americans, often people of color, because they were more likely to work in close-contact service jobs, and because they often had underlying health conditions that were untreated,” he said. “And especially in the first year of the pandemic, Black, Latino, and Indigenous people had some of the highest mortality rates from the virus, for similar reasons.”

‘I fought for this for everyone’

Phippsburg resident Brandy Staples urged lawmakers to finish the job for the 59% of Maine voters who passed Medicaid expansion in 2017 by ballot referendum.

Years ago, Staples was diagnosed with stage-four breast cancer when she was 26-years-old. While undergoing treatment, she lost her health coverage when she was required to reapply for MaineCare and then denied. Staples is now in remission but her experience propelled her into action. In 2017, she collected over a thousand signatures and knocked on over 600 doors for the campaign to expand MaineCare eligibility to people within 138% of the federal poverty line.

She said she and other volunteers did that work for every Mainer, regardless of immigration status.

“I lost my healthcare and almost my life because someone got to pick and choose who got to have healthcare in our state,” Staples said. “I didn’t fight so hard for this to have others get to pick and choose who gets to have healthcare or decide who gets to live. I fought for this for everyone.”

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