New York City Initiative to Cover the Uninsured Reflects Hastings Research, Recommendations

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On January 8, New York City Mayor Bill de Blasio announced that the nation’s largest public health system would guarantee comprehensive health care for all New Yorkers, regardless of immigration status. The new program, NYC Care, will serve 600,000 uninsured city residents, including an estimated 300,000 undocumented immigrants who are excluded from federally funded benefits and may lack other insurance options. The initiative builds on recommendations made by The Hastings Center’s Undocumented Patients project in partnership with the New York Immigration Coalition.

NYC Care aims to provide eligible patients with direct access to a primary care doctor and tools to connect with specialty care, prescription medications, behavioral health care, and other services in the city’s public system, known as NYC Health + Hospitals. The initiative also expands an existing insurance program covering services in public hospitals and clinics. This initiative reflects lessons from a 2016-2017 pilot, ActionHealthNYC, informed by a 2014 Hastings Center convening. In collaboration with the New York Immigration Coalition, Hastings Center research scholars Nancy Berlinger and Michael K. Gusmano made actionable recommendations for a direct-access approach to Mayor de Blasio. Berlinger and Gusmano have also served on two public advisory groups, the Mayor’s Task Force on Immigrant Health Access and the ActionHealthNYC Community Advisory Panel.

The Undocumented Patients project, launched in 2011 by Berlinger and Gusmano with seed funding from the Overbrook Foundation, provides analysis, recommendations, and tools supporting health care access for unauthorized immigrants in the United States. Commenting on the NYC Care announcement, Berlinger said, “Most immigrants in the United States and globally live in cities. Municipal solutions are a key mechanism for providing and coordinating care where people live and work, although they cannot fully compensate for a population’s lack of access to federally funded insurance such as Medicaid or Medicare. They also demonstrate how a city can recognize immigrants as local citizens by investing public funds in the health of this urban population.”

Research shows that investments in primary care for immigrants pay off by avoiding preventable, high-cost emergency treatment.” Berlinger continued. “At a time when national policymaking concerning immigrants is often harmful to health, positive action by local and state government, including California, is ever more important.”

Listen to this new AMA podcast on immigrant health, featuring Berlinger.

The focus of The Hastings Center’s ongoing work on immigrant health has expanded in response to federal policy changes affecting legally present immigrants and asylum seekers. In October 2018 the Center held a national meeting on creating systems of safety for immigrant health to explore how health systems in collaboration with other sectors should respond to policy changes with negative health consequences for immigrants and their families. Participants included immigrant health practitioners working in health care, health law, community-based organizations, and municipal government from New York City, Boston, Baltimore, and the US/Mexico border region. Experts in health care ethics, health policy, and public health communications contributed further perspectives. The convening was made possible by a rapid-response grant from the Public Health Program of the Open Society Foundations.

Learn more:

Nancy Berlinger, Claudia Calhoon, Michael K. Gusmano, and Jackie Vimo, “Undocumented Patients and Access to Health Care in New York City: Identifying Fair, Effective, and Sustainable Local Policy Solutions: Report and Recommendations to the Office of the Mayor of New York City, The Hastings Center and the New York Immigration Coalition, April 2015.

Nancy Berlinger and Rachel Zacharias, “Resources for Teaching and Learning About Immigrant Health,” AMA Journal of Ethics, January 2019.

Nancy Berlinger, “Is It Ethical to Bend the Rules for Undocumented and Other Immigrant Patients?” AMA Journal of Ethics, January 2019.

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