Gabina Santamaria, an undocumented single mother who lives in Staten Island with her twelve year old daughter, hasn’t had health insurance since she came to the United States 20 years ago. During the pandemic, most of the income she earned as a home cleaner dried up. Cash from New York’s Excluded Workers Fund has kept her afloat, but she’s still three months behind on rent, she said—leaving her no money for medical treatment when she needs it.
“When I feel sick and my daughter notices, she worries, and sometimes she can’t sleep,” Santamaria told New York Focus through an interpreter. “I say to her that I can’t just go and see a doctor whenever I need to, because I don’t have the money.”
Santamaria contracted Covid-19 early in the pandemic. She waited for two days after her symptoms began before going to the hospital. When she arrived, she was asked for her insurance. “And since I didn’t have any, they said that I needed to pay some money for me to receive medical attention,” she said. She left without receiving treatment.
In the two years since she contracted the virus, she’s been experiencing heart palpitations. She’s worried that without treatment, that might turn into something worse.
New York State offers free or inexpensive health insurance to low-income citizens through its Essential Plan, which covers preventative care, vision and dental benefits, and prescription drugs. About 900,000 New Yorkers are on that plan—but Santamaria isn’t one of them, because she is undocumented.
The state budget, due April 1, could change that: For the first time, both chambers of the legislature included a measure to expand the Essential Plan to cover undocumented immigrants in their budget proposals. But Governor Kathy Hochul has balked at the cost, which she puts at more than five times the figure that lawmakers and outside researchers have estimated. The issue has become a sticking point in budget negotiations.
“We’re still fighting it out,” Senate Health Committee Chair Gustavo Rivera (D-Bronx), the chamber’s lead sponsor of the initiative, told New York Focus. “I’m certainly very thankful to the leader for continuing to hold the line on this,” he added, referring to Senate Majority Leader Andrea Stewart-Cousins (D-Westchester).
The expansion would follow the lead of California and Illinois, which have recently offered health insurance to older low-income undocumented residents, and would make New York the first state to offer such coverage regardless of age. The legislature estimated that the expansion would cost $345 million a year, taking that figure from a report published this year by the fiscally conservative Citizens Budget Commission and the liberal think tank Community Service Society. The Hochul administration put the price tag far higher, at $1.9 billion.
The governor’s team has not disclosed how it arrived at its figure. A Hochul spokesperson referred New York Focus to the state budget office, which did not respond to questions for this article.
Elisabeth Benjamin, a health policy expert at the Community Service Society and a co-author of the report, said she’s been frustrated at the Hochul administration’s lack of transparency. “It’s kind of hard to understand their numbers without a public document that we can really take a look under the hood at,” she said. “It’s a little bit of a black box.”
Rivera and Assemblymember Jessica Gonzalez-Rojas (D-Queens), also a supporter of the expansion, attributed the difference in cost estimates largely to what they see as the governor’s unrealistically high enrollment projections.
Both lawmakers said Hochul’s $1.9 billion cost assumes that all undocumented immigrants currently enrolled in New York’s emergency Medicaid program, which allows immigrants and foreigners without insurance to temporarily access Medicaid benefits, will enroll in the Essential Plan once they become eligible.
Rivera said such high projections are unrealistic.
“There is no program whatsoever that’s ever been run by any governmental agency in the history of time which has a 100% participation rate,” Rivera said. “That’s just not a reasonable suggestion.”
Immigrant advocacy groups like Make the Road and the New York Immigration Coalition have pushed for the expansion since 2017. It has also garnered support from some unexpected quarters, including the Business Council of New York State, which represents 3,500 companies employing 1.2 million New Yorkers. That group says that the program will ultimately save taxpayers money by reducing emergency health costs.
“A healthier state—not to be base, but it’s a cheaper state to run,” Lev Ginsburg, counsel to the Business Council, told New York Focus. “So for those of us that are some of the major taxpayers, that’s really important.”
Rivera expressed optimism that Hochul and the legislature will reach a deal. “I believe that the continued negotiations will lead us to at least a version of this that can make it to the end,” he said, noting that modifications like changing the income eligibility level could “possibly” be part of a final bargain. (The Essential Plan’s current eligibility threshold is 200% of the federal poverty line, or $27,000 in income for individuals this year.)
Benjamin suggested one potential solution to Hochul’s fiscal fears: a cost ceiling. “If it’s a cost objection, well then cap the program,” she said. “If the advocates are so underestimating the costs, call our bluff, cap it at $345 million.”
Santamaria says that if the state allows her to enroll in the Essential Plan, she intends to see a doctor as soon as possible. “I want to be well and healthy for my daughter,” she said. “She tells me, ‘Mom, I’m getting older. I want to go to college, and I want you to be here and healthy.’”