By Janet Varon, NoHLA Executive Director

For many years, Washington has demonstrated its commitment to cover residents on equal terms whether they are citizens or immigrants. In 2008, the state passed landmark legislation to ensure that all children living in Washington have health coverage through age 18. Under the state-funded Children’s Health Program – known as “Cover All Kids,” neither income nor immigration status is a barrier.

Starting in 1987, immigrants had the opportunity to apply for the state’s Basic Health program (BHP) on equal terms as citizens, with income up to 200% of poverty. BHP was a state-subsidized health insurance program. Though enrollment numbers fluctuated with the state budget, many thousands of immigrants purchased insurance through BHP. Unfortunately, during the recession in 2011, the Legislature stopped enrollment and excluded most immigrants from coverage. A class action lawsuit brought by NoHLA and Riddell Williams on behalf of these immigrants preserved coverage for some, but only temporarily.

In 2014, BHP ended when the Affordable Care Act (ACA) established new, federally-funded programs – the Medicaid expansion and the Exchanges. These programs significantly improved access to affordable coverage – but they do not provide such coverage to all. The chief gap: low-income immigrants. They are excluded from the Medicaid expansion with limited exceptions. Many cannot get subsidies on the Exchange or even purchase insurance there.

Two bills in this year’s Legislature, HB 1697 (prime sponsor Rep. Nicole Macri) and SB 5814 (prime sponsor Sen. Joe Nguyen), would take a step toward reviving Washington’s previous commitment to coverage for all residents. They would have the state extend health coverage to thousands of low-income young adults age 19 to 26 who would otherwise be eligible for Medicaid if not for their immigration status. These young adults, many of whom are “Dreamers,” have no affordable option when they lose their Apple Health coverage at age 19.

Disparities in coverage lead to disparities in care. Health care access and insurance coverage are major factors that contributed to racial and ethnic health disparities before implementation of the ACA. But studies show that these disparities have been reduced significantly for most groups during the initial years of the ACA implementation. Coverage is associated with fewer people delaying or forgoing necessary care, and a greater likelihood of physician visits.

Dreamers and other low-income immigrants deserve to have the same access to affordable coverage as their peers. This can be achieved by providing coverage on par with the Medicaid expansion for young adults with income below 138% of the federal poverty level. This would be an important step toward restoring our state’s commitment to health coverage for all Washington residents.

NOTE: For latest news on the 2019 Legislative Session, see NoHLA’s Legislative Update page and click on the most recent update.