While the Affordable Care Act cut the number of uninsured by about 32%, millions of immigrants don't qualify for the law's coverage expansions. They still have few options for primary care.
People living in the U.S. without authorization can't buy health insurance from the ACA's exchanges and aren't eligible for Medicare, Medicaid or the Children's Health Insurance Program. Even lawful residents who have lived in the U.S. for less than five years can't get Medicaid or CHIP. Local governments in areas with large numbers of new immigrants have stepped up to become their health safety net.
Local health officials see expanding preventive, coordinated primary-care services to undocumented immigrants as an effective means of achieving effective population health management by ensuring equitable health outcomes for the entire populace.
“The future is not about keeping individuals healthy, it's about keeping the population healthy,” said Dr. Ram Raju, president and CEO of NYC Health & Hospitals, the country's largest public healthcare system, which serves roughly half a million uninsured patients. “You cannot keep one part of the population healthy because they have access to healthcare because of their insurance, and then the other part of the population cannot get healthcare because they don't have insurance.”
In 2014 New York Mayor Bill De Blasio launched ActionHealthNYC, a program aimed at providing access to preventive care for the city's roughly 345,000 residents who are uninsured due to their immigration status.
And earlier this year NYC Health & Hospitals launched its own five-year initiative to develop a coordinated model to provide discounted or free care to uninsured patients that focuses on outpatient, preventive services in an effort to avoid hospitalizations and expensive treatments for otherwise manageable conditions.
“It's easier and cheaper for us to treat them as outpatients and keep them healthy rather than treat them in the emergency department or as an inpatient, which would cost us a lot more and for which we are not getting reimbursed,” Raju said.
Raju said it's too soon to put a number on the savings the program may reap, but its structure resembles the system's Medicare accountable care organization, which has generated savings for the past three years.
Other municipal public health systems are likewise betting that providing basic preventive health services now will help achieve long-term savings.