ILAP Testimony in Support of LD 199: An Act to Improve the Health of Maine Residents by Removing Exclusions to the MaineCare Program
The Immigrant Legal Advocacy Project (ILAP) is Maine’s only statewide immigration legal services organization, providing critical legal assistance to low-income people who would not otherwise be able to afford an attorney. ILAP serves people in need of humanitarian protection including survivors of crimes and trafficking, asylum seekers, and vulnerable immigrant children. Through our work serving immigrant communities across Maine, ILAP sees firsthand the impact that lack of access to healthcare has on vulnerable individuals and families and in turn, our whole state.
ILAP applauded the expansion of MaineCare to cover children and pregnant people regardless of immigration status. We ask the Health and Human Services Committee to support LD 199, which takes the next step in improving public health in Maine by expanding access to all low-income people, regardless of immigration status.
We know that access to healthcare helps people live longer and healthier lives, keeps families secure and stabilized, and helps our communities and economies thrive.¹ The COVID pandemic has made that even more clear. Across our nation, a study estimated that at least 340,000 lives would have been saved during the pandemic had people had access to healthcare.² Undocumented people – who are majority people of color – suffered and died disproportionately during the pandemic.³ In addition to irreplaceable human lives, studies showed that a lack of access to healthcare led to massive and unnecessary costs to taxpayers and our economy - more than $105 billion in hospitalization costs from COVID could have been saved.⁴
While there are multiple barriers to vulnerable immigrant populations in Maine and across the country in accessing both preventative and life-saving medical care, studies show that lack of access to healthcare is at the top of the list.⁵ This vital legislation would not only expand access to those without a pathway to immigration status in our communities, but would also help those who could become eligible but face obstacles and backlogs in our immigration system that leave them in limbo.
For many years, Congress has failed to pass meaningful immigration reform that would provide green cards and citizenship to people who call Maine home, raise their families, volunteer, contribute to our communities, and play key roles in our workforce and economy. Those categorically excluded from access to MaineCare include people brought to the U.S. by their parents when they were infants and children, those whom the federal government has granted temporary humanitarian protection, farmworkers, and many others. Those currently facing serious medical conditions who are excluded from access to MaineCare include a current ILAP client who escaped the war in Ukraine and is in need of dialysis.
Importantly, LD 199 also addresses the lack of access to healthcare for those who may technically have a pathway to an immigration status under which they would qualify for MaineCare, but face barriers and obstacles in our deeply inaccessible and backlogged U.S. immigration system. For example, MaineCare covers those who have already been granted asylum, but not those navigating the system.
In our outreach events, ILAP frequently encounters asylum seekers who ask us “how am I supposed to pay for healthcare when I’m not allowed to work?” Under current federal law, asylum seekers are not allowed to apply for a work permit until approximately six months after they file an asylum application. Applying for asylum in and of itself is a deeply complex and bureaucratic process and there are not enough qualified immigration attorneys in Maine to assist. If a person is able to successfully apply for asylum, they may face many years of backlogs. The result is that already-vulnerable people are forced to try to cope with untreated medical conditions until they eventually become emergencies. LD 199 addresses the compounding issues that immigrants face, making eligibility for MaineCare based on income and need, not on immigration status.
In our work serving those who need humanitarian protection in the United States, ILAP also encounters people in Maine who face serious medical issues related to the persecution and violence that forced them from their homes. One of our clients, a survivor of torture, suffers from serious mental health issues as a result. As our attorney has worked to serve our client, multiple healthcare professionals have said that someone in this situation would normally be referred for residential care, but lack of health insurance makes that impossible. Lack of healthcare also leaves our client with gaps in access to medications. Because of the inability for our client to receive the health care she needs, she has been unable to put forth her best case in the immigration system and faces risk of deportation to the country she fled from.
LD 199 would help to immediately and meaningfully address the public health crisis of vulnerable and marginalized people not having access to the medical care we all need to be healthy and prevent disease. The overwhelming majority of Mainers agree.⁶ We urge you to support this legislation to help address health disparities, ensure parents are well to care for their children, and save Maine from needless costs related to lack of healthcare coverage, so that we can all individually and collectively thrive.
¹ Uneven access to health services drives life expectancy gaps, World Health Organization (April 2019), https://www.who.int/news/item/04-04-2019-uneven-access-to-health-services-drives-life-expectancy-gaps-who; Jacqueline Howard, US spends most on health care but has worst health outcomes among high-income countries, new report finds, CNN (Jan. 31, 2023), https://www.cnn.com/2023/01/31/health/us-health-care-spending-global-perspective/index.html.
² Rachel Nuwer, Universal Health Care Could Have Saved More Than 330,000 U.S. Lives during COVID, Scientific American, https://www.scientificamerican.com/article/universal-health-care-could-have-saved-more-than-330-000-u-s-lives-during-covid/.
³ Mohammad Tawhidul Hasan Bhuiyan, Irtesam Mahmud Khan, Sheikh Saifur Rahman Jony, Renee Robinson, Uyen-Sa D. T. Nguyen, David Keellings, M. Sohel Rahman, and Ubydul Haque, The Disproportionate Impact of COVID-19 among Undocumented Immigrants and Racial Minorities in the US, International Journal of Environmental Research and Public Health (Dec. 2021), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656825/.
⁴ Rachel Nuwer, Universal Health Care Could Have Saved More Than 330,000 U.S. Lives during COVID, Scientific American, https://www.scientificamerican.com/article/universal-health-care-could-have-saved-more-than-330-000-u-s-lives-during-covid/.
⁵ Paulette Cha, Health Care Access among California’s Farmworkers, Public Policy Institute of California (April 2022), https://www.ppic.org/publication/health-care-access-among-californias-farmworkers/.
⁶ Dan Neumann, Poll: Most Mainers think access to affordable healthcare for everyone should be a priority, Beacon (March 13, 2023), https://mainebeacon.com/poll-most-mainers-think-access-to-affordable-health-care-for-everyone-should-be-a-priority/.