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How Health Care Reform May Affect The Undocumented

Bret Jaspers

While many are trying to wade through the glitches in Maryland’s online health insurance exchange, there’s one specific group that won’t be able to get insurance, no matter what: undocumented immigrants.

And their options may dwindle.

More than a third of Baltimore’s 30,000 Hispanic residents are uninsured, according to a city Health Report released last week that used census data. And some of them--it’s hard to know exactly how many—are ineligible for insurance plans on the exchanges and for the newly-expanded Medicaid program because they are undocumented.

The undocumented can still get care through hospital emergency rooms as a last resort or at free clinics like Esperanza Center in Fell’s Point, which is run by Catholic Charities. Yet Victoria Lyford-Pike, Esperanza Center’s community health coordinator, fears that government funds for clinics like hers may dry up as the ranks of the insured increase and the numbers of people seeking services decline. If those programs are cut due to lower enrollment, she says, “then they cut the access to that for our clients.”

Under the Affordable Care Act, money to federally-funded health centers, where many low income people seek treatment, is increasing. But as Harvard health economist Benjamin Sommers wrote recently, there are not enough of these centers to serve everyone. Pam Bohrer Brown, who works at one of the centers, Baltimore Medical System, says that people in government and philanthropic circles are discussing the issue.

She says that any action taken to plug the holes in services depends on what these groups “are willing to do and [how much] politics tie into it.” In other words, any increased support from local governments and/or private donors depends on whether they are willing to fund health programs that benefit the undocumented.  “I think there’re going to be some real efforts to reach out to places where we feel there are gaps in funding or people are not getting what they need,” she said.

Another wrinkle that makes things even more complicated is the fact that many immigrants are in “mixed status” families. The parents may be undocumented, but their children were born in the U.S., citizens, and eligible for health insurance through the exchanges.

At a recent health fair in Patterson Park, one of Health Care Access Maryland’s new navigators, Angelo Solera, spoke to families and passed out information about the state's new online insurance marketplace, Maryland Health Connection. He said that mixed status families should still apply for coverage in order to get their children into an insurance plan.

“Many times, the parents work, even though they may not have legal documentation,” he said. But they do often pay taxes. Their income is taken into account when calculating the amount of subsidy that they receive when enrolling their citizen children.

In order to get people informed, the Baltimore City Hispanic Commission is publicizing a monthly program called “Ventanillas de Salud,” or health windows, run by the Hispanic Institute for Blindness Prevention and the Consular Section of the Embassy of Mexico. The program stops by Sacred Heart of Jesus Church in Highlandtown on the first Monday of every month.