State Leaders Continue to Neglect Immigrant Marylanders’ Need for Health Coverage

The Maryland General Assembly missed a great opportunity to affirm healthcare as a basic human right by failing to pass the Access to Care Act (House Bill 588). No person should be denied access to healthcare due to their immigration status or their ability to pay. Yet, in Maryland, undocumented immigrants will continue to face barriers excluding them from various types of health services and programs. Despite a clear passage in the House, the Access to Care Act—a bill that would open up the state’s marketplace for purchasing health coverage to everyone regardless of immigration status—stalled in the Senate Finance Committee and thus failed to pass in the Senate chamber. The bill would have helped reduce Maryland’s uninsured rate and address long-standing racial and ethnic health disparities, particularly among the state’s immigrant communities.

Work to Expand Access to Health Coverage Must Continue

Through the Access to Care Act, Maryland was en route to replicate similar efforts in other states. Similar to current policy in the state of Washington, HB 588 would require Maryland to apply for a 1332 federal waiver that would ensure access to health insurance for undocumented residents through the Maryland Health Benefit Exchange. The legislation would also create a subsidy program that would help address affordability concerns. Eligibility for the subsidies would be determined after the federal waiver was approved, as would implementation processes. This was not the first time immigrant rights advocates pushed for the Access to Care Act; Senate Bill 728 was introduced during the 2022 legislative session, establishing the same access to the exchange through a waiver application and guaranteeing funding for the subsidy program to implement state premium assistance and cost-sharing reductions to residents regardless of status. The bill did not pass then either.

Our livelihoods and economy depend on our ability to be healthy and present, and on the preservation of our overall well-being. In many cases, however, low-wage workers cannot afford to be sick and miss work, especially as the cut in earnings ultimately and directly impacts their families’ ability to stay afloat. This is particularly true for undocumented immigrants who often hold low-wage jobs and are overrepresented among the uninsured. The inability to access a doctor for preventative care, afford prescriptions, or be treated for a chronic illness is a harsh reality for thousands of residents in the state. We do not have to live like this. Maryland needs to enact legislation that will interrupt the cycle of health inequity so commonly experienced across the country and within its own communities.

While the Access to Care Act did not pass, the legislature did commit to studying the issue and identifying the best path forward for providing health coverage to immigrant Marylanders. Senate Bill 806 requires the Maryland Health Benefit Exchange and the Maryland Department of Health to develop a report comparing options for offering affordable health care and dental care coverage to state residents who are ineligible for current programs due to immigration status. The report is due to be completed by the end of October.

Healthcare Coverage is a Lifeline That Policymakers Should Prioritize

While resources such as federally qualified health centers help fill in the gaps to basic healthcare access for undocumented immigrants, they are not nearly enough nor do they substitute an adequate health insurance plan. More than 100 organizations across the state supported HB 588 with the understanding that we need and can do more for one of our most vulnerable and excluded communities.

The importance of expanding healthcare access to everyone was made clear this month when the Biden Administration announced its plan to expand health coverage to “Dreamers” – individuals who were brought to the U.S. as children without proper documentation and who are covered under the Deferred Action for Childhood Arrivals program. Around 600,000 DACA recipients, of which roughly one-third are uninsured, are currently ineligible for health insurance through their state Medicaid programs or through the Affordable Care Act marketplaces. A new rule proposed by the U.S. Department of Health and Human Services would expand the definition of “lawful presence” to include Dreamers for the purposes of health coverage.

While this executive action is significant for expanding coverage to people with different immigration statuses, the proposal still leaves out millions of people without access to care, including thousands in Maryland. The current presidential administration has shown that it is possible and necessary to protect the health of those living in this country, just as some state leaders tried to convey by supporting the Access to Care Act this session. HB 588 would have helped DACA recipients and with this new rule, the cost to implement the bill would likely be reduced.

It is time that we prioritize the health of all Marylanders and leave no one behind. We can do this by:

• Enacting healthcare reform and providing comprehensive healthcare access to excluded communities
• Allocating necessary funding resources for affordable health coverage
• Providing resources that will educate and ensure beneficiaries that their participation in any program will not compromise their immigration case or result in a public charge
• Investing in outreach and implementation efforts that are culturally and linguistically appropriate