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Washington is the first state to open its health care market to all undocumented residents, and those below a certain income will even be eligible for subsidies to help cover the premiums. Eilis O'Neill, with member station KUOW in Seattle, has the story.
EILIS O'NEILL, BYLINE: Almost three decades ago, Javier (ph) was in his mid-40s and had just moved to the U.S. from Mexico when he had a heart attack.
JAVIER: (Speaking Spanish).
O'NEILL: Javier asked NPR not to publish his last name because he's undocumented. He says someone called an ambulance and he woke up in a hospital. They stabilized him and sent him home.
JAVIER: (Speaking Spanish).
O'NEILL: Javier didn't have insurance, so he got bill after bill for that trip to the ER. They were asking for tens of thousands of dollars, which he couldn't afford. He also didn't get any follow-up care, no tests or scans or ongoing medication.
WYNNE MCHALE: When people have access to health insurance, it can often be the difference between life and death.
O'NEILL: Wynne McHale is with the Washington State Health Care Exchange. Nationwide, about half of undocumented immigrants are uninsured. The exchanges explicitly exclude them. And to change that, states have to get a special waiver from the federal government.
MCHALE: When people don't have access to insurance coverage, they often delay getting care. And that can mean showing up in the ER with cancer that has developed to a much later stage.
O'NEILL: In about a dozen states, including Washington, undocumented children can qualify for state Medicaid or other state-funded coverage. And a handful of those states have also extended coverage to some undocumented adults, depending on their health conditions, incomes or ages. But Washington will be the first to open its marketplace to all undocumented residents.
MCHALE: We are really excited that Washington State is joining just a handful of states in trying to figure out, how do we make coverage available for all of our community members regardless of immigration status?
O'NEILL: Despite this change, McHale doesn't expect many new people to sign up for insurance this year. One issue is cost. The premiums, even subsidized premiums, are still too expensive for some. Others don't yet know about the change. Adrienne Sabety is a health care economist at Stanford.
ADRIENNE SABETY: It's a very hard population to get access to, to get information to.
O'NEILL: Sabety suspects most of those who sign up immediately will be people with chronic conditions like hypertension or diabetes. But, she says, access to insurance is only a first step to actually getting regular health care.
SABETY: My guess is that, you expand insurance, you don't suddenly see millions of people making a primary care appointment immediately.
O'NEILL: Sabety says it can be so hard to get a doctor's appointment in the U.S., it remains to be seen how much of a difference health insurance alone can make. Critics of Washington's policy change say it could make the state a magnet for undocumented immigrants with medical needs. But overall, the pushback here has been muted.
JIM WALSH: This particular issue doesn't rank high.
O'NEILL: Jim Walsh is a state lawmaker and chair of the state Republican Party. He says his main problem is with the U.S. health care system as a whole.
WALSH: I'm totally against spending tax subsidies on this rotten system, but whether they're documented or undocumented doesn't matter.
O'NEILL: But in many other states and nationally, giving undocumented immigrants more access to health care remains a tough sell. Leading up to the 2020 presidential election, Democratic candidates were asked whether they'd support opening up Medicaid or subsidized health insurance to undocumented immigrants, all said yes. Then President Trump opposed the idea, and a CNN poll after the debate found most respondents were also opposed.
For NPR News, I'm Eilis O'Neill in Seattle.
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