When Maricela became pregnant with her fourth child in late 2019, she dreaded going to the doctor.
The bills, she knew, would follow. The 28-year-old farm worker is undocumented, and though she and her husband have lived in Vermont for seven years, they have no way to obtain health insurance.
Then Maricela, who asked to be identified only by her first name, had complications with her pregnancy. Sure enough, by the time she gave birth to a healthy baby last summer at North Country Hospital, she had racked up $12,000 in medical bills.
“If I could pay, I would,” she told VTDigger in Spanish. “But I can’t.” Meanwhile the bills just keep coming. “We’d like to have health insurance,” she said. “It’s hard knowing that we don’t have access to anything.”
Lawmakers are considering changing that. On Friday, the House Committee on Health Care will weigh a proposal to expand insurance coverage to help noncitizen pregnant women and kids obtain medical care.
Advocates contend the bill would improve health fairness and provide much-needed relief for a small number of vulnerable, undocumented Vermonters — roughly 100 kids age 18 and under and about 22 pregnant women a year. It’s also cheap — about $1.4 million a year, according to estimates from the Department of Vermont Health Access.
“It’s low-cost for the state, but a moral imperative,” said Erin Jacobsen, an immigration lawyer and professor at Vermont Law School. It would also provide “an enormously important benefit for the individuals, of which there are just a handful,” she said.
Low-income families in Vermont typically get their health insurance through Medicaid, which is paid for by the state and federal governments. Kids age 18 and under whose households earn below than 317% of the federal poverty line — or about $83,000 a year for a family of four — are eligible for Dr. Dynasaur, Vermont’s expanded version of the federal insurance.
Expectant mothers can also receive coverage for prenatal care as well as labor and delivery.
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But under federal rules, the program excludes people who aren’t U.S. citizens. That leaves roughly 5,000 undocumented Vermont residents without any insurance at all.
For Maricela, that means rationing care for her kids. Her two youngest, a 6-year-old and a 9-month-old baby, were born in Vermont and, as U.S. citizens, qualify for insurance. Her two oldest, ages 13 and 9, were born in her native Guatemala, and can’t get coverage.
That means tough decisions about when to bring them to the doctor.
“I’m scared to take them to the hospital because of the bills,” she said. She dreads a more serious illness.
Not long after she gave birth last year, a collection agency started calling her house. She tells the callers she doesn’t speak English, but the calls stress her out. “I can’t pay,” she said.
In testimony before the committee last month, Yadira, another migrant worker, described the fear of showing up at the hospital and disclosing her immigration status and inability to pay. “If you can’t pay, you get these looks, like why are you even here?”
The proposed program would cost the state an estimated $1.4 million — $300,000 for the kids, $1 million to cover the pregnant women, and about $100,000 in IT and administrative costs for the state, said Addie Strumolo, deputy commissioner of the Department of Vermont Health Access. By comparison, the state pays $431 million annually to cover its residents on Medicaid, according to department spokesperson Nissa James.
During testimony Thursday, lawmakers pointed out that the coverage could actually save money. Some undocumented residents get care at free clinics or through free care programs at hospitals or simply never pay their bills. Those costs trickle down to the state and private insurance ratepayers in other ways, said Rep. Bill Lippert, D-Hinesburg, health care committee chair
It also may lower expenses in the long run because women and children would have access to preventive care. “If we can prevent one premature birth in a five-year period, we’ve done a tremendous good — financially, let alone the human cost,” health care advocate Mike Fisher told the committee.
If it’s passed by the Legislature, the change would take effect on July 1, 2022. Some urged a shorter timeline. “I can’t help but get the feeling as though you’re supportive of this, but we’re asking people of color that they just need to wait their turn,” Rep. Alyssa Black, D-Essex, told leaders at the Department of Vermont Health Access. “And that’s a little disturbing to me.”
Advocates and nonprofit workers estimate that half of those who would benefit from the change are migrant farmworkers. The other half, roughly 50 kids and 10 pregnant women, are in the process of applying for citizenship, but don’t yet qualify for benefits. The latter group would need the extra assistance only temporarily, said Jacobsen, the immigration attorney.
They would still have to qualify under the income requirements for Medicaid, said Heidi Sulis, executive director of the Open Door Clinic in Middlebury, which provides free care to about 400 undocumented Vermonters. The clinic doesn’t offer obstetrics or prenatal care. While some patients manage to get free services from local hospitals, others end up with thousands in medical bills, Sulis said. The uncertainty prevents many people from seeking medical attention at all.
“There are very basic needs that go unmet when services are not accessible,” Sulis said.
Sulis and others described the proposal as a moral policy choice.
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“They’re in legal limbo, they’re living in the margins, they’re fearful of immigration enforcement. and they have no access to any benefits,” said Jacobsen, the immigration attorney, of those who would benefit from the bill. “We’re talking about children here. It’s unconscionable for us not to take this step.”
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