New York Assembly Approves Immigrant Health Care Coverage Despite Governor’s Effort to ‘Tighten’ Budget

The New York state Assembly on June 11 passed a bill (A 7774) that would require the state to cover health care costs for low-income legal immigrants, less than a week after the New York State Court of Appeals ruled that a 1996 federal welfare reform law denying Medicaid benefits to legal immigrants violated the state and federal constitutions, Newsday reports. While Democrats praised the measure, it received a "cool reception" from Gov. George Pataki (R) and Senate Republicans. The "Republican-dominated" state Senate has a similar bill (S 5223) pending, but lawmakers said that measure's "fate is tied" to broader negotiations over the state budget. State Sen. Kemp Hannon (R), chair of the Senate Health Committee, said that he agreed with the "intent" of the bill, but added that "there were still too many unanswered questions about cost and scope." The Commonwealth Fund estimated that covering legal immigrants would cost the state $5 million in the first year and at least $34 million annually in three years, but Pataki has said that the cost could "go up to nine figures." Supporters of the legislation said that the "state is already paying millions for health care" to immigrants "unable to afford treatment" in emergency rooms (Metz, Newsday, 6/12). While last week's ruling found that cutting off benefits to legal immigrants violated the federal Constitution, the state court cannot compel federal lawmakers to fund new coverage, meaning the state must completely cover such an expansion (Kaiser Daily Health Policy Report, 6/6).

Medicaid Budget Issues
The New York Times reports that the court decision "comes at a time when the governor is holding steady on his position that the overall state budget -- now two months overdue -- should be tightened." Pataki said that he would "comply" with the ruling, but "demurred on whether he believed the state would have to foot the bill" for legal immigrants participating in a new program, Family Health Plus, that provides health coverage for those who earn too much to qualify for Medicaid. Meanwhile, a federal appellate court ruled last month that pregnant women in the United States illegally have "no right to prenatal care" under Medicaid. Before the ruling, the federal Medicaid funded 50% of the cost of a state program that covered roughly 13,000 pregnant women, and the ruling leaves the state to decide whether to "dip into its Medicaid till" to "pick up the tab" for the program.

Asking for Help
The Times asks, "Could the Medicaid budget be cut in other places?" answering, "Not likely." This year, Pataki had proposed a $300 million reduction in the state's contribution to nursing homes, but both the state Senate and Assembly "pronounced it dead on arrival." The governor now plans to "do what many states do in the face of rising costs" -- ask the federal government for additional funding. John Signor, a spokesperson for the state Health Department, said, "We will be looking for some help from the federal government and our congressional delegation to ensure that New York state gets its fair share of its federal dollars to cover the costs of these programs" (Steinhauer, New York Times, 6/9).

Editorial Reactions
In an editorial, the New York Post maintains that the "last thing New York needs is an expansion" of Medicaid, pointing out that Family Health Plus "is itself a likely budget buster." The Post concedes that New York "has responsibilities to the indigent," but adds that "these must be redeemed responsibly." While lawmakers have said that the state's share of the national tobacco settlement and increased cigarette taxes will cover the cost of Family Health Plus, the editorial asks, "But what happens during the next economic downturn, when job losses could increase basic Medicaid expenditures?" (New York Post, 6/11). Meanwhile, a Syracuse Post-Standard editorial agrees with the New York State Court of Appeals ruling, but adds, "Now it's time for the federal policy to reflect the mandate nationwide ... and share in the cost." The Post-Standard concludes, "Extending New York's decision to the federal policy so that all immigrants are covered -- along with the federal government help -- should be the next step" (Syracuse Post-Standard, 6/11).